Is it legally or morally wrong to "pull the plug" on a terminally ill patient? What really constitutes "physician-assisted suicide?" These and other controversial questions were addressed Friday morning at the final workshop of the 7th annual Bio-Ethics workshop series at Roy L. Schneider Hospital.
In a videotaped presentation, Thomas Beauchamp discussed the "vague, the gray areas" surrounding physician-assisted suicide. Beauchamp served on the President's Commission for the Study of Medicine and BioMedical and Behavior Research and is senior author of the book, "The Principles of BioMedical Ethics." He is Senior Research Scholar at the Kennedy Institute, Georgetown University in Washington, D.C.
Oregon, Beauchamp said, is the only state which allows doctors to write a "lethal prescription" for a terminally ill patient. A state referendum passed the measure in 1993, but it was held up in court battles until 1996.
In 1997, the Supreme Court said there is no constitutional right to physician-assisted suicide, contrary to a decision handed down by the 2nd and 9th Courts of Appeals a year earlier. However, the court said states can make their own rules.
So far, Oregon is the only state, and the Netherlands and Japan are the only countries allowing the procedure. Japan has had a law allowing it for 30 years, but has never had one case.
Beauchamp said "homicide" is a very tricky term to use, and one that doctors would obviously shy away from when allowing a patient to be taken off a life-support system.
Dr. Leighmin Lu, a St. Thomas psychiatrist, said such a decision is often influenced by economics. He cited a case last year where a comatose young man was brought into the hospital with an extremely slim chance of recovery.
The family wanted to know how long he could remain comatose, and the doctors had to say they had no means of knowing, Lu said. The family was concerned about hospital bills, and felt they would have to let him go.
The hospital Ethics Committee met and went along with the family's decision. "The family's decision was economic and fear-based," Lu said.
Beauchamp cited the American Medical Association's tenets: "Killing is wrong; letting die is right." The doctor said this leads to many areas of gray.
"Intention" is a factor. The doctor's intention is to remove pain; the side effect is dying. Contemporary law and ethics do not adequately cover the many aspects of the problem, he said.
Another videotape showed the well-publicized case of burn patient Dax Coward, who had suffered third-degree burns all over his body and was kept alive through painful debrading, pulling the skin back and putting him in water baths, seven days a week.
Coward pleaded with doctors to let him die; they refused. He recovered, took them to court, and won, but he is permanently scarred.
Dolores Marshall, Schneider vice-president of patient care services, said Coward now is a public speaker and a very powerful one. She also cited the pain factor in patients with terminal illnesses, which often is overlooked in the battle over whether to keep them alive. She said, "Dr. (Jack) Kevorkian was open, but I think subtlely, all over the nation, doctors are assisting patient's wishes."
Retired Moravian Church Pastor Ray Joseph said he thought guilt was a factor in many families' decisions, when the patient has made no advance plans about his desires. "Do all possible" is frequently heard in such cases, even when a family knows it's futile. Joseph said more thought should be given to the spiritual side of these decisions.
Adeline Connor, Schneider clinical care coordinator, said more workshops are planned specifically for the clergy on these issues.
