Friday, January 20, 2006

Polo

Indeed the silent are not absent, just apathetic over the littany of personal tid bits and lack of controversy. I had this one on the back burner for a couple of days, and since you prompted I will answer.

Fish out of water!

As you are probably aware, the supreme court just announced its 6-3 vote to uphold the state of Oregon's physician assisted suicide law. This is of acute interest to myself and my colleagues because it has been suggested that other states may follow suit. I am sure you legal types can find a more authoritative source to post than MSNBC on the matter, the article does link to full and abridged versions of the majority opinion, however. Some firestarters:
1. The law in Oregon allows a Physician to write a prescription for a lethal oral dose of barbiturates for patients with a documented terminal illness for which life expectancy is less than six months. It is up to the patient to request, fill, and administer the prescription. Thus, theoretically, some degree of initiative and mental capacity is required to follow through. The nature of the law also prohibits chronically immobile patients and patients who cannot take medication by mouth from receiving the drugs. Self-administration is key.
2. About 30 people a year in Oregon have used the prescription to take their own lives since its enactment in 1997, representing 1 in every 1000 deaths in Oregon. Many more have requested the prescription though.
3. It has been suggested, although not proven, that the law has had dramatic effects on palliative care in Oregon. Namely that physicians, when faced with the spectre of a patient who could successfully take his/her own life, are more likely to take care to assess patient pain and overall comfort than otherwise. For many this represents the major victory of the legislation.

So, what do we think about PAS? What do we think about Justice Roberts in the dissenter's corner with Scalia and Thomas? Is taking ones own life inherently immoral? Why? Is the Department of Justice's argument that prescription of barbiturates for PAS is not "a legitimate medical purpose" valid? Is there a better argument for federal jurisdiction over this kind of legislation? Enjoy, but please, stay in the pool....and no diving.

9 comments:

Becca said...

All I have to offer at the moment: Cross reference to Garnett's post on the topic on Mirror of Justice.

Maybe more later, once I develop an independent opinion.

BTW, thanks for the post. I was fresh out of controversy. If that's your taste, feel free to serve it up.

Becca said...

I'm just curious... Does anyone know of precedent for this? Are there other cultures, presently or historically, that recognize the "right to die"? I suppose Japan's "honor suicide" might count. What about cultures that consider the "right to die" a human dignity issue to be considered in the treatment of disease? Does it square with the Hippocratic and/or other medical oaths?

Monkey Lung said...

As far as I know Hippocrates does not address the issue of death with diginity and many physicians believe that euthenasia is in direct conflict with the Hippocratic edict to "do no harm." I don't think death with dignity is an uncommon cultural value though. It is only modern medicine's heroic attempts at prolongation of life that have given rise to death without dignity. On the other hand, it has been said that there is no such thing as a "dignified" death. That death itself is inherently an undignified process. The only dignified part of it is one's struggle against it. Certainly death can be more or less comfortable or anticipated. But maybe not dignified.

Monkey Lung said...

The excerpt from justice Scalia's dissent is very telling. In discussing the matter with my dad he brough up that the Supreme Court ruled earlier this year on the same Department of Justice action against the medicinal use of marijuana in California and upheld the Department of Justice's authority over state laws in this case. This would seem to suggest the court has conflicting opinions about the jurisdiction of the federal government in the matter and is more or less making a moral call about the rectitude of suicide. A troubling stance to say the least.

Becca said...

First, this seems to be a bit of a split discussion. See Monica's post and comments on the same topic.

Second. Hmm. Yeah, this one's tough. I really can understand the court's reluctance to touch such a distinctly medical issue (really, do we want the federal courts to make a habit of making discretionary calls about how to practice medicine?), but on the other hand, Scalia does have a point. Call it an administrative call all you want, but I think how you answer the procedural question is going to be determined, or at least colored by, what you believe about assisted suicide.

Sorry to link so much, but I found this article about what many regard as the genesis (at least as far as the mainstream media goes) of physician-assisted suicide. Nasty.

Becca said...

Oh, yeah. And another link to Mirror of Justice. This is the original report on the case, including a link to the text of the decision.

Monkey Lung said...

Let me post a quick terminology alert. The term, "physician assisted sucicide" refers specifically to physician prescription of lethal doses of barbituates to patients who must then actively fill and take the prescription themselves. It is generally limited to the terminally ill and the disabled cannot partake in physician assisted suicide per se because they cannot administer the meds to themselves. What the article on Kevorkian refers to is euthanasia, physician administration of lethal medication (stereotypically potassium chloride injection) to a patient at his/her request.

Becca said...

Valid point, Monkey Lung. A technicality, but one courts will probably take note of. Still, if producing death is not a "legitimate medical purpose," why should it matter if the patient participates in it? It seems that if the doctor is not allowed to do it because it isn't a legitimate function of medicine, he shouldn't be allowed to prescribe otherwise illegal substances for the purpose. It's not like they would be making suicide illegal (what's the point?); they would be precluding a certain means--means that are forbidden for any end except healing.

Monkey Lung said...

The PAS vs euthenasia distinction is valid because it speaks to the active vs passive role of the physician in the process. Courts have long upheld the ability of physicians to assist their patients in hastening their own demise through means deemed "passive" (withdrawing treatment at patient request, withdrawing life support, terminal sedation) but physicians taking actions that directly end life apart from all other variables is a different and far more contentious matter.
One must also be wary of the use of the word "healing." Legitimate medical purposes may not always be bent on eliminating disease. In fact most uses of controlled substances in medicine are not curative at all but damaging to the patient. However, because they alleviate suffering they are legitimate interventions. In many cases these medications are responsible for bringing about a state of sedation that ultimately leads to the patient's demise yet this is still regarded as a "legitimate medical purpose" because it alleviates suffering at the patient's request. The Oregon law still seems to be using the medications for this purpose, albeit in a rather extreme manner.