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Rachel DLima
Mr. Davis
Government 4
10/9/16
The Right To Die
Imagine deciding whether your loved one should live the remainder of their life brain dead
with a very low quality of life, or if you should let them go in peace. Many patients that are
diagnosed with terminal illnesses, do not take the time to specify their wishes for when they
choose to die. This unbearable decision causes immense pain and heartache. As much as we
claim to know one another, we cannot possibly know what kind of quality of life our loved one
would want. When they become incapacitated, meaning no longer able to advocate for
themselves, we are forced to make these decisions and sometimes we end up keeping someone
alive when they cannot function on their own and are hooked up to machines for the rest of their
life. By creating an advanced directive we can help avoid this terrible decision and allow the
patient to explicitly state their desires. Requiring a terminally ill patient to issue an advance
directive can help them avoid hospitalization, can reduce costs, and can eliminate any confusion.
An advance directive states the patients wishes and allows them to determine the course of
their treatment before they become incapacitated. The degree to which physical pain and
psychological distress can be tolerated is different in all humans. Quality of life judgments are
private and personal, thus only the sufferer can make relevant decisions(Humphry). The truth is
that we cannot begin to imagine the pain that a terminal ill patient experiences. We cannot
estimate the pain they go through and we cannot make judgements whether they should live or
not because we have no idea what they are feeling. That is why patients should have the right to
assisted suicide. They should determine their course of treatment and decide when they want to
give up, instead of being kept alive in constant pain or in a barely conscious condition. The
issue arises today in part because the advent of life-sustaining treatment and other aggressive
treatments to prolong life has generated the need to make choices about the timing and manner of
death. Legalization of assisted suicide and/or euthanasia would be a profound shift in public
policy and professional standards (Chapter 6). Due to the many advancements in medical
technology, we now have the ability to keep someone alive for longer than necessary. If a
patient is on a ventilator and has no brain activity then in medical terms they are dead because
the only thing that keeps them alive is the machine. If the machine is unplugged then the patient
will die. This shows that machines have the ability to keep someone alive for an extended
amount of time but that may not be the patients desires. The ultimate decision in treating
hopelessly ill people should ideally rest with both the patients or their families (if they are unable
to speak for themselves) and the physician handling the case. However, traditionally, most
patients tended to passively accept their doctors dictates in such matters(Landau,13). While
many say that doctors forcing patients to stay alive cannot be a bad thing, this is not true because
they are forcing the patient to make a very personal decision. They cannot and should not be able
to force a decision upon a patient regardless of what the situation is. Physicians are to present
options for treatment and they must accept the decision of the patient. When a patient is
incapacitated they cannot express their decision concerning their end of life care. The solution to
this problem is to issue an advanced directive to loved ones and physicians explicitly stating the
patients desires for end of life care.
Most of the time, patients who are diagnosed with a terminal illness spend the end of their life
in a hospital or hospice care. Patients with advanced cancer who reported having EOL(end of

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life discussions) conversations with physicians had significantly lower health care costs in their
final week of life. Higher costs were associated with worse quality of death(Zhang). Patients
who have end of life discussions and issue an advanced directive are more likely to save money
because they will be unplugged at a time that they choose and will not be kept alive past a point
that they desire. The money that is saved can be kept for the loved ones of the patient or it can
even be donated to search for a cure for this disease."This is the way so many Americans die.
Something like 18 to 20 percent of Americans spend their last days in an ICU," Byock told
Kroft. "And, you know, it's extremely expensive. It's uncomfortable. Many times they have to be
sedated so that they don't reflexively pull out a tube, or sometimes their hands are restrained.
This is not the way most people would want to spend their last days of life. And yet this has
become almost the medical last rites for people as they die"(The Cost Of Dying). On average it
costs ten thousand dollars per day to be maintained on life support(The Cost of Dying). This
does not account for the many other expenses within the terminal illness that the patient would
have. The patients would be subject to scans, blood work and many other tests that increase the
cost of a terminal illness. These tests, which provide no cure, just avoid the fact that the patient is
dying. Keeping a patient alive with a machine does not do anything for the patient or the loved
one. Once the machine is finally unplugged the loved ones now have to deal with their loss and a
massive hospital bill does not help. The establishment of the advanced directive will avoid this
problem because it will show the patients desires and when they want to end their life. This will
save money for the loved ones and they will not have to watch the patient suffer and wither
away.
Patients with a terminal illness do not always state how they want their life to end. This can
cause a large amount of confusion and burden placed on the loved ones because they essentially
hold that patients life in their hands and may not choose the patients desires. In each case,
persons seek what for them in their bleak circumstances is the best means to the end of quitting
life. Their judgment is that lingering in life is worse than death. The person in search of assisted
suicide, the person who seeks active euthanasia, and the person who forgoes life-sustaining
technology to end life may be identically situated. They simply select different means to the end
of their lives(Beauchamp). The choices a person makes to end their life is very personal and
should not be swayed by the physician or loved one. A person with a terminal illness should be
able to choose when they want to die and how they want to die. Most patients do not want to die
in a hospital surrounded by machines and doctors who cannot save them anyway. A patient who
seeks assisted suicide and a patient who wants to end life sustaining care can be placed in the
same boat. They are both in search to end their life because they do not want to experience the
pain. Some patients make this decision early and decide to end their lives before symptoms of
their illness begin to show. They cannot be denied this right. These patients do not want to
experience pain and be bed ridden until the end of their overextended life. Advance care
planning involves learning about the types of decisions that might need to be made, considering
those decisions ahead of time, and then letting others know about your preferences, often by
putting them into an advance directive. An advance directive is a legal document that goes into
effect only if you are incapacitated and unable to speak for yourself. This could be the result of
disease or severe injuryno matter how old you are. It helps others know what type of medical
care you want. It also allows you to express your values and desires related to end-of-life
care(Advanced Care Planning). The advanced directive will clearly lay out the patients
desires for their end of life care. This eliminates all confusion with physicians and loved ones
because they will know what to do when the patient is incapable of making their own decision.

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An advanced directive is conditional and unique to the individual and their illness. This means
that patients can decide to fight until the end of their life or they can choose to end their pain and
suffering. The doctors sacred rights and privileges seem paramount in the hospital, to the point
where one could sometimes almost wonder whether the good of the doctor or the good of the
patient is the primary meaning of the institution.All of this can be said without detracting from
the heroic service that many doctors have traditionally given their patients. Indeed, this history of
service only serves to enhance and consolidate the sacerdotal status of the physician(
Maguire,178). Physicians cannot change the wishes of the patient just in an attempt to better
their status. This decision is very personal and physicians should not be allowed to express their
opinion or push the patient in a certain direction to maintain their status as a physician. A
physician should not be pursuing heroic measures just to maintain their status, they should be
pursuing these measures because it is what the patient wants. The advanced directive will not
allow anyone but the patient to make decisions regarding the end of their life.This document can
be changed by the patient if they choose to do so but it can only be changed by the patient. These
changes help to ensure that everyone knows their desires and there is no wiggle room or
confusion.
For terminally ill patients, the majority of the advanced directives state that they would
not like life sustaining measures. Many people across the United States would interpret this as
assisted suicide which they believe would be sanctioning murder. Most states have not approved
of assisted suicide because they believe it contradicts a physicians hippocratic oath. Physicians
take an oath to only help their patients, and many believe that allowing assisted suicide is going
against that oath and should be considered illegal. Since 1990, Dr. Kevorkian has aided in the
deaths of more than 100 people suffering from terminal diseases. Three times the state of
Michigan has charged him with assisted suicide, and three times the state has failed to win a
conviction because of loopholes surrounding physician-assisted suicide. He was recently
convicted on two misdemeanor charges relating to a confrontation with police. But this time Dr.
Kevorkian described what has happened as his first euthanasia, distinguishing it from the assisted
suicides in which the individual, rather than the doctor, pulled a string or pushed a button to start
the flow of deadly drugs. Michigan state prosecutors are charging him with homicide,
premeditated murder, and assisting a suicide(LL.M). Advanced directives contractually obligate
a doctor to respect a patients wishes. This is analogous a doctor respecting a patients right to
privacy. Therefore, by fulfilling the advanced directive the doctor cannot be accused of
committing murder. Another major concern about assisted suicide is that it will open the door to
abuse and patients that are not diagnosed with a terminal illness will seek it as a means to end
their life. Any loosening of the assisted-suicide laws could eventually lead to abuses of the
privilege. For example, patients who want to die for psychological or emotional reasons could
convince doctors to help them end their lives. Attitudes would loosen to the point that certain
states may decide that any person can commit suicide at any time. We can't let our values shatter
this way(Messerli ). This bill would require a diagnosis of a terminal illness prior to establishing
an advanced directive ending life sustaining measures. With this requirement there will be no
room for any patient who does not qualify, to receive means to end their life. According to the
New York Times, Doctors are allowed to help terminally ill patients die in Oregon,
Washington, Vermont, California and Montana under strict guidelines. Two physicians must
concur that the patient is likely to die within six months. Doctors must ensure that patients
making the request are of sound mind and that they are not being coerced. In four of the states
that allow it, a request for a lethal dose of painkillers must be reiterated 15 days after it was

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originally made in order for the drugs to be prescribed(Aid In Dying). This shows the process
of how a terminal ill patient may seek means to end their life. Two physicians must confirm that
the patient is terminally ill, making it impossible for any non-terminal patient to receive this
medication. Medical practitioners would face civil and criminal legal action if they were to
prescribe a lethal dose to someone who is not terminally ill.
Advanced directives are very important to the terminally ill because they can help avoid
hospitalization, can reduce costs, and can eliminate confusion. Most terminally ill patients do not
want to spend their last days in a hospital hooked up to machines and surrounded by doctors who
will not ease their pain, but only make it worse. The cost of being hooked up to life sustaining
machines is substantial and could bankrupt the patients family. The advanced directive helps
eliminate any confusion concerning the patients end of life care. This way physicians and family
know exactly what the patient wants and can fulfill these desires. Families will not have to suffer
in deciding whether they should unplug their family member because the patient will have stated
their decision. Medical costs in the United States have been dramatically increasing over the past
decade. The elderly account for more than 33 percent of the health care cost(Advanced Care
Planning). Their medical expenses in the last year of their life ranges around 30 percent largely
due to life sustaining measures. If they had an advanced directive that ended life sustaining
measures, they would not continue their own pain and suffering nor increase the medical cost of
the United States. Ladies and gentlemen of Congress I urge you to approve this bill to reduce the
cost of medical care across the United States.

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Work Cited
Websites
Advance Care Planning/National Institute of Aging. U.S National Library of Medicine. U.S
National Library of Medicine, Mar. 2014. Web. 18 Sept. 2016.
<https://www.nia.nih.gov/health/publication/advance-care-planning>.
Beauchamp, T.L. The Medical Ethics of Physician-assisted Suicide. Journal of Medical Ethics.
U.S National Library of Medicine, Dec. 1999. Web. 18 Sept. 2016.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC479288/?page=1>.
Chapter 6: Crafting Public Policy on Assisted Suicide and Euthanasia. New York State.
Department of Health, Apr. 2011. Web. 07 Sept. 2016.
<https://www.health.ny.gov/regulations/task_force/reports_publications/when_death_is_s
ought/chap6.htm>.
Humphry, Derek. Liberty and Death: A Manifesto Concerning an Individuals Right to Choose
to Die. Assisted Suicide. Euthanasia Research & Guidance Organization, 24 Mar. 2009.
Web. 07 Sept. 2016.
<http://assistedsuicide.org/liberty_and_death_manifesto_right_to_die.html>.
LL.M., By Raed Gonzalez J.D. "Physician-Assisted Suicide." Physician-Assisted Suicide. N.p.,
30 Dec. 1998. Web. 18 Oct. 2016.
<https://www.law.uh.edu/healthlaw/perspectives/Death/981230Physician.htm>.
Messerli, Joe. "Physician Assisted Suicide (Pros & Cons)." Physician Assisted Suicide (Pros &
Cons). Balancedpolitics.org, 7 Jan. 2012. Web. 18 Oct. 2016.
<http://www.balancedpolitics.org/assisted_suicide.htm>.
"The Cost of Dying." CBSNews. CBS Interactive, 19 Nov. 2009. Web. 18 Oct. 2016.
<http://www.cbsnews.com/news/the-cost-of-dying/>.
Zhang, MS Baohui. "Health Care Costs in the Last Week of Life." The JAMA Network.
American Medical Association, 09 Mar. 2009. Web. 18 Oct. 2016.
<http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/414825>.
Print Sources
"Aid In Dying Movement Advances." The New York Times, 10 Oct. 2016: n. pag. Print.
Landau, Elaine. The Right to Die. New York: F. Watts, 1993. Print.
Maguire, Daniel C. Death by Choice. Garden City: Doubleday, 1973. Print.