The matter of end-of-life decisions is a highly controversial topic as it is always challenging to determine whether those decisions are justifiable in particular cases. People with severe illnesses often have two paths: to keep fighting for life or decide to end it. In many cases, such patients are close to death and do not have a chance for recovery, which is why it may seem unreasonable to continue their treatment.
However, many circumstances do not allow to clearly define a patient’s will, such as an unclear state of the patient’s mind or being in a coma. The discussion is open on who should make end-of-life decisions in the situations mentioned above and, if they do, under what conditions it is approvable. This paper aims to discuss end-of-life decisions along with related subjects, such as assisted suicide. Also, a comparative study of differences in policies of end-of-life decisions in the United States and other developed countries has been conducted. In brief, the end-of-life policy is acceptable in the United States and many other developed countries when a patient is incurably ill; however, the decision should be made after a collegial discussion.
The End-of-Life Practices: Assisted Suicide
The problem of the right to die was brought to public attention at the beginning of the twenty-first century. Since then, these issues have been actively addressed from medical, social, and legal perspectives. That dispute began with the case of Terri Schiavo, whose parents and husband could not come to an agreement on whether they should decide to stop Terri’s life after her heart stopped (Berk, 2018).
According to Berk (2018), nowadays, all the U. S. states “have laws that honor patients’ wishes concerning the withdrawal of life-sustaining treatment in cases of terminal illness” (p. 531). However, there are many completely different situations concerning the end-of-life policy, meaning that people in the community continue to argue about how to act under diverse circumstances (Berk, 2018). That said, many issues are to be solved before society can appropriately address the problem of decisions related to the end of life.
However, several practices currently exist that are focused on the right-to-die ethical dispute. First of them is ending life-sustaining treatment, which is performed with the permission of a terminally ill patient or, if the patient cannot do that, with the consent of their substitute decision-maker (Berk, 2018). For instance, doctors do not perform surgery or administer life-prolonging medications, and thereby the patient can die naturally (Berk, 2018).
In this case, any attempts to save the patient’s life are stopped, meaning that this practice is primarily applicable if there is no hope for the patient’s recovery. Otherwise, if there is a chance to save the patient even without any guaranteed positive outcome, ending life-sustaining treatment should be put into deep consideration before applying it to the patient’s treatment.
Some practices are not so passive as the one described in the previous section, meaning that a patient is “forcefully pushed” to death by various means. Such practice is called medical aid-in-dying, and it is performed at the request of an incurably ill patient or at the request of that patient’s substitute decision-maker in case the patient cannot decide (Berk, 2018). In that case, a doctor prescribes a lethal dose of a specific medication so the patient could self-administer it and end their life (Berk, 2018). That practice is similar to ending life-sustaining treatment to a certain extent, yet it is even more debatable from a moral viewpoint. Deciding to apply the medical aid-in-dying practice means killing, though painlessly, a patient to end their suffering, which is not a decision that is easy to make for the patient or their caregiver.
Medical aid-in-dying is a form of assisted suicide, which is ethically justifiable in cases when the patient’s life does not imply anything except fighting for life. There is little reason to continue living if the patient’s life has no other meaning than lying in the hospital and gaining life-sustaining treatment. However, decisions related to assisted suicide “should be made through the collegial procedure, including consultation with the healthcare team, external counselor, patient’s trustee, and family” (Gerdfaramarzi & Bazmi, 2020, p. 6).
The decision of assisted suicide should only be made under the conditions when the patient’s life brings them more suffering than pleasure (Gerdfaramarzi & Bazmi, 2020). For instance, if a patient lies in bed unable to move or speak, cannot comprehend the meaning of their life, and has no hope of recovery, assisted suicide is allowed (Gerdfaramazri & Bazmi, 2020). However, that decision should be made when the patient’s healthcare team and family are confident that it is for the best of the patient.
Another practice described in the current research and actively used in medical care involves euthanasia, which is similar to medical aid-in-dying. Although euthanasia also implies using a lethal dose of medication, the main difference between medical aid-in-dying and euthanasia is administering that medication (Berk, 2018). When it comes to euthanasia, the doctor administers the preparation, whereas medical aid-in-dying implies that the patient self-administers it (Berk, 2018). Euthanasia has two types: voluntary and involuntary, which differ by the patient’s involvement in deciding to administer the medication (Berk, 2018).
In the case of voluntary euthanasia, the drug is administered at the request of a suffering patient, whereas involuntary euthanasia is performed without the patient’s consent (Berk, 2018). That practice is the subject of an open ethical discussion, especially when it comes to involuntary euthanasia because it implies killing the patient, as in the case of medical aid-in-dying.
End-of-Life Decisions: A Cross-National Comparative Study
All the practices mentioned above are controversial because, in each case, the question arises whether applying those practices to a dying patient is ethically correct and justifiable. In different countries, including the United States, there are differences between the physicians’ attitudes to the ethical justification of end-of-life decisions and the conditions under which end-of-life care is applicable. According to Berk (2018), various surveys reveal that 70% of adults and 95% of physicians “support the right of patients or family members to end treatment when there is no hope of recovery” (p. 531).
As mentioned above, all states in the U. S. honor patients’ desires to end their lives in cases of incurable illnesses (Berk, 2018). On the contrary, according to the research conducted by Gerdfaramarzi & Bazmi (2020) on the end-of-life policy, French physicians are “against its legalization assuming that this illegality status would limit abuses” (pp. 4-5). Therefore, there are external factors that can impact the attitude of physicians toward end-of-life decision-making.
In other European countries, many physicians do not accept any elements of end-of-life policy considering various ethical issues regarding the matter. For instance, the research of Gerdfaramarzi & Bazmi (2020) shows that almost half of physicians in Italy did not accept treatment prohibition. Moreover, they did not accept administering pain-control preparations compared to other countries when “the hastening risk of death is possibly involved” (p. 3). The data from which these conclusions are made was gathered in 1996-1997, and after 20 years, in 2016, the end-of-life policy became more acceptable in most European countries (Gerdfaramarzi & Bazmi, 2020, p. 8). However, the subject under discussion is still more debatable in the mentioned European countries compared to the United States.
Summing up, many developed countries, including the United States, find end-of-life policy ethically justifiable when patients are terminally ill, but the corresponding decision should be an outcome of the collegial procedure. Various practices are applicable in end-of-life care, including ending life-sustaining treatment, medical aid-in-dying, and voluntary or involuntary euthanasia. However, those practices are considered assisted suicide, meaning that the final decision should be thoroughly considered and made only if the patient has no hope of recovery. Several parties should be involved in making end-of-life decisions, including the patient’s healthcare team, an external counselor, the patient’s trustees, and their family.
Physicians in different countries have different opinions regarding the end-of-life policy and its acceptance, yet it has recently become more admissible in the developed world. The subject under discussion is still controversial from ethical and moral viewpoints because it is challenging to consciously end a human’s life. It is even more complicated when the patient’s will is unclear, meaning that third parties, such as doctors or family members, have to take responsibility for the end-of-life decision in that case.
Berk, L. E. (2018). Exploring Lifespan Development. Pearson.
Gerdfaramarzi, M. S., & Bazmi, S. (2020). Neonatal end-of-life decisions and ethical perspectives. Journal of Medical Ethics and History of Medicine, 13(19), 1-10. Web.