The Social Issue of Assisted Suicide

The Social Issue of Assisted Suicide The thoughts of the final days of one’s life are not something anyone would like to consider. The loss of a loved one is a loss of connection to the past and the emotional attachment to historical events from war and conflict to family history. The coming years present a situation where the elderly population will exceed levels never seen before in the U.S. (Danigelis, Hardy, and Cutler, 2007). There is also the consideration that many will be leaving long held employment positions and the paying of premiums for health care insurance purchased via their employment location. The resulting pressure on the health insurance industry may be staggering in the coming years especially in the areas of Medicaid and Medicare (Kaufman and Fjord, 2011). The increased elderly populations suggest a trove of difficulties and possibly the most looming specter of physician-assisted suicide. Hospice and extended family care at home can be overwhelming for families both financially and psychologically.

Those facing end of life under the conditions of a debilitating terminal disease may want to retain dignity and choose the time and the place of their demise. Social opinion may vary on the subject of socially acceptable behaviors along with long-held religious ideologies (Setta and Shemie, 2015). Religious doctrines play a large part in influencing social expectations as many religions view the taking of one’s life as pure heresy (Setta and Shemie, 2015). Religious views can limit a family’s objectiveness regarding the use of PAS (Physician Assisted Suicide). Local officials in some cases used sacrilegious spiritual aspects as a way of combining belief and legal actions as a method to prevent legal assisted suicide. Setta and Shemie (2015) suggest such anti-PAS laws and religious doctrine limit the scope of early grief counseling and which may aid in the rapid recovery from grief for families. Currently, four states have laws in favor of assisted suicide California, Oregon, Vermont, and Washington (Stillman, 2016). The use of Intergroup theory may provide a means of effective collaboration to find a middle ground when constructing laws and viable support structures for families. Researching the connections of social aspects may provide a scope of the issue physically, emotionally, and psychologically. Examining the social aspects surrounding assisted suicide including religious elements, education, social expectations, and economic problems may lead to a better understanding of the difficulties legalizing assisted suicide in the U.S.

The well-publicized trials of Dr. Kevorkian and assisted suicide to come to mind as many contemplate the argument of assisted suicide in the U.S (Siu, 2010). The Hemlock society which supports the actions of Dr. Kevorkian presented Dr. Kevorkian as a model of the future of PAS ( Siu, 2010). During the trials of Dr. Kevorkian, several social issues including end of life dignity, humane treatment, and pain were factors brought to light (Siu, 2010). The needs of the patient from a perspective of decency and suffering followed by humane treatment seem to come to the forefront of many arguments about assisted suicide. Siu (2010) presents the story of Janet Adkins, a fifty-four-year-old individual with Alzheimer’s disease as the first known case with Dr. Kevorkian. MRS. Adkins sought out Dr. Kevorkian where he constructed a device by which she could end her own life (Siu, 2010). The legal issue fell to the logistics of assisted suicide, and in this specific case, Dr. Kevorkian was acquitted (Siu, 2010). The law indicated that providing mechanical means for suicide was not part of the current law, therefore, not punishable.

Laws constructed as they were in 1990 protected the doctor in the event of extraordinary circumstances; however, the law was poorly written and did not include family or other social considerations (Siu, 2010). The loophole suggests to administer the drugs physically is not the same as providing the drugs to end one’s life. Nine years later in 1999; however, courts convicted Dr. Kevorkian due to the direct administering of the drugs aiding in the case of Thomas York’s suicide (Siu, 2010). The social idea that death is a natural part of life may have little comfort to those spending their last weeks or months in excruciating pain. The individuals may choose permeant relief of pain under decisions made of sound mind and body to end their life by choice. The case of Janet Adkin’s supported the suggestion of dignity at the end of life as Janet freely chose and understood the ramifications (Siu, 2010). MRS. Adkins indicated several times that the choice of assisted suicide fell to her alone as it was a right for one to choose their time of death under special circumstances such as incurable disease (Siu, 2010).

Social norms regarding assisted suicide fall into several categories such as social norms and detailed religious views that sometimes sway the opinion of the general public. Siu (2010) indicates the consideration of both social norms and religious institutions vilified Dr. Kevorkian suggesting that coercion was used to generate a sense of hopelessness for the patient. The suggestion was contrary to the findings in the case of Janet Adkins by which the patient sought out Dr. Kevorkian to aid in performing the PSA. The use of such tactics by anti-PAS groups seem to be a way of striking fear in public (Holden, 1993). The second and deeper underlying issue was that of religious preference which some find PAS violates the natural order and is in defiance of the word of God. Defying religious protocol via PAS was considered an unforgivable act by many and those considering such avenues as sinners (Burdette, Hill, and Moulton, 2005).

The Eastern and Western perspectives regarding suicide vary greatly. Lizardi and Gearing, (2010) indicates both schools of Buddhism Theravada and Mahayana suggest to commit suicide openly is to succumb to a delusional perception brought on by extreme suffering. Lizardi and Gearing, (2010) indicates the action of suicide from the Buddhist perspective does not hinge on sinfulness but the act of harming a living being (Lizardi and Gearing, 2010). However, this perspective falls away when the action self-inflicted becomes self-sacrifice for those who are suffering (Lizardi and Gearing, 2010). The view of Buddhist doctrine may find ground for PAS depending upon the situation for which the suffering of the family would outweigh the individual’s action. Though this conflicts with the Christian ideology the common ground of limiting the plight of a living being is the foundation of both perspectives.

Burdette, Hill, and Moulton (2005) explain that the Christian religious view of assisted suicide falls into two specific ideologies. The first ideology insists that man has control over his realm and therefore is the key to deciding the time of life and death. Individuals with this religious ideology tend to allow for assisted suicide and are also interested in palliative care that accompanies the end of life events (Burdette, Hill, and Moulton, 2005). The second ideology falls in the realm that God is the creator and the giver of life. The “God” therefore, is the giver of life and by all accounts is the only one who may remove the essence of life from humans. Though such a religious perspective based on logic supported by doctrine does not take into account physical suffering only the philosophical perspective.

The perspectives are at odds and socially both have strong ideologies but, are open to interpretation and the religious and ethical view of the individual (Burdette, Hill, and Moulton, 2005). The standpoint of specific beliefs both Eastern and Western often influences ideologies and beliefs which formulate ideas regarding human behavior and expectations. The case of assisted suicide suggests that the reasoning and basic understanding of a religious perspective directly affect the sense of acceptable ethical (Burdette, Hill, and Moulton, 2005). The Christian religious aspect may also override humane treatment of those in their final days as assisted suicide, viewed as a violation, is seen to conflict directly with laws implemented by the given creator (Burdette, Hill, and Moulton, 2005). Though religious aspects are essential one should also consider the opposing practical factors as well.

Death from a human perspective is a condition of life by which it’s an inevitability for some is always at some far-off time and place. Many individuals do not consider issues such as a degenerating and unrecoverable disease which would leave them incapacitated. Interfering with this natural order for some may provide extreme psychological difficulty. Religious views and given violations of such personal ideologies may result in a sense of cognitive dissonance when considering PAS (Goldhill, 2017). Cognitive dissonance from a religious context would suggest that the natural order or ideology by which one achieves ethics/morality would come into question under the use of PAS (Goldhill, 2017). The moral implications may result in a condition by which a loss of morality ensues as the moral foundation of one’s life is violated (Goldhill, 2017). The idea that their actions would be a sin in the eyes of God may be more than the subject could bare depending upon the depth of religious influence on their lives (Burdette, Hill, and Moulton, 2005). The individual may respond irrationally or at odds with family members under such conditions (Goldhill, 2017). The individual considering PAS would then have to come to terms with the combing of religious aspects and those of dignity, and quality of life in their final days. Control over one’s final moments though difficult to contemplate may be a bit more comforting if options are available in such difficult times. Osborne (2009) indicates under Erikson’s Developmental Stages Model that growing old and impending death can be a difficult time for the elderly or a terminal patient.

Osborne (2009) states “Death anxiety is also accompanied by the anxiety of fate, not knowing when or how one will die” (p. 297). The fear of death anxiety can infiltrate every area of the individual’s life leading to a similar situation of bipolar actions found in the earlier developmental stages of youth. Osbourne (2009) indicates that as a person nears deaths regardless of the reason a sense of guilt may overtake the individual and fears of an unfulfilled life or last contact with loved ones may become overwhelming (Osborne, 2009). The individual may also be drawn at this time toward a sense of inner contemplation as to who they are aside from the role they play in life (Osbourne, 2009). The importance at this time is to assure the individual that their identity is more than the position they assumed, and they should explore their joys and beliefs even in their final days (Osbourne, 2009). Those who are overtaken by a terminal illness may also fall into a deep depression as conditions worsen (Osbourne, 2009). The sense of a loss of control is the engine driving depression resulting in a state by which the patient withdraws from support systems (Osborne, 2009). Control over the end of one’s life would provide time for closure and contemplation for the future of their loved ones settling regrets and addressing lost moments yet to come (Osbourne, 2009).

Consider for a moment the advantages of a pre-destined time in which family and friends would be aware of an elderly family member choosing PAS. The loose ends of a sudden demise or legal ramifications could fall to the wayside with proper planning and the final day could then be a celebration of one’s life. The individual in question could say goodbye to loved ones feeling complete and understanding the situation thus removing regrets of an untimely ending. The family in question may have grief counselors at their disposal, and medical professionals could explain the painless nature of the procedure in full. The alternative to the situation can be much more difficult as an untimely passing promotes feelings of regret, grief-stricken, and without proper planning, the legal issues add to an already complicated process. Considering the needs of the patient from aspects of suffering and psychological requires an objective stance from friends and family (Osbourne, 2009). Allowing the patient to deteriorate day to day as pain increases and drugs to counter pain also increase does not consider the quality of life issues in the final days (Osbourne, 2009). Incapacitated patients become the responsibility of family members as they grapple with the time and moment to remove lifesaving technology. These decisions can be the most difficult for family members with a deep emotional attachment to the patient (Osbourne, 2009).

Stillman (2016) describes a lawful factor that is taking shape as laws are being put in place to allow children to call into question the legality of actions by a parent wishing assisted suicide. The basis for the rule is that children have the right to question their parent’s behavior if the financial burden is the premise for the assisted suicide and not only a reduction in suffering (Stillman, 2016). The legitimate fear is that parents lack a full understanding of the children’s financial capabilities and therefore, cannot cognitively make a correct choice (Stillman, 2016). The purpose is to prevent PAS from being used to remove a financial burden from the family instead of considering the respect for life itself. The law is calling in question social norms and religious beliefs regarding aging family members. Siu (2010) suggests the education levels of the public and health care officials also play a part in the understanding of the assisted suicide phenomena. A population with a lack of medical knowledge may have a minimal scope of diseases the severity of ailments (Siu, 2010). The information gained in the non-medical realm may come as a matter of hearsay or the latest social media post. Evans (2015) explains as nurses and doctors make their way through training gaining experience their attitudes toward assisted suicide tend to change. Medical professionals in the early stages of training tend to be complete opponents to assisted suicide but, as the severity and pain involved with diseases comes to light many modify their position (Evans, 2015).

The findings regarding medical professionals were intriguing, and as such, I sought out three local oncologists to compare the outcomes. The three doctors were all provided disclosure statements and a summary of the purpose of the research paper. All three physicians in question wished not to disclose their full name only last name and first initial. The individuals also requested I did not include their place of employment just that they were in oncology researchers. The physicians agreeing to the terms filled out the survey and responded in entirety.

All physicians were asked identical questions via questioner, and the two items were as follows:

1.) From a physician’s perspective would you consider the use of PAS (Physician-assisted suicide?

2.) Do you think PAS should be a legal option for families or patients suffering from a Terminal illness or old age?

Physician A is fifty-five years of age and has been practicing medicine for more than twenty years. Regarding question one, the physician believed PAS might be a useful option for individuals in a terminal or debilitating situation (T. Gibson personal communication, March 17, 2019). Further, amending the law and hypocritic oath of “do no harm” is difficult as one would have to draw a line between harm and reducing pain. Physician B forty-two years of age had been practicing medicine for less than ten years and believed under no circumstances should PAS be allowed. The physician thought such a situation would inevitably lead to unethical medical practices (A. Bova personal communication, March 29, 2019). Physician C thirty-four years of age believed their experience was not to the point where they could make such a determination. However, the individual also stated several religious perspectives for not allowing a process such as PAS. The spiritual aspects provided (God’s plan, sin, and self-harm) suggested that physician C believed the actions to be unethical (E. Alsbaugh personal communication, March 12, 2019). Osbourne (2009) suggests this may not only be from experience as a physician but also part of progressing through Erikson’s model as the physician comes closure to death themselves. The older physicians tend to relay expertise and wish to convey information to younger physicians may persuade the younger physicians via expertise to change their perspective. The findings suggest the physician ages/gaining experience, the more the physician becomes open to PAS. Further research would also have to account for the religious dedication of the physician in question.

Holden (1993) explains the necessity for advocacy groups to aid in promoting a clear understanding of the reasons for assisted suicide. Holden (1993) suggests as in the case of the Hemlock Society those who are older and highly educated tend to embrace the idea of assisted suicide. Holden (1993) research also indicates that those with less education, deeply religiously influenced, and lower income tends to oppose assisted suicide entirely. Social aspects of belief in the afterlife along with religious perspectives are the primary influence by which social attitudes are formed (Holden, 1993). There are extenuating circumstances as some individuals who were analyzed acquired unique personal perspectives via near-death experiences (Holden, 1993). Those who had positive near-death experiences became proponents of assisted suicide. Individuals who shared their stories at times influence others that were otherwise opposed to supported suicide measures including palliative care (Holden, 1993). There is a delicate balance in PAS where one must both address myth and the actual process by which the PAS is conducted (Holden, 1993). Transparency for all parties involved of the exact process would discourage unbridled contemplation of various conspiracy theories, identify fail-safes in the case of individual changes their mind in the last moments, and give the family ample time for legal objections to the PAS (Holden, 1993). While having such discussions could also encourage early forms of grief counseling and set family members at ease to their loved one’s decision.

Bryans, Cornish, and McIntosh (2009) introduce Bronfenbrenner’s ecological theory as a possible means by which to construct a support system for the patient. The patient becomes the center of the microsystem (Bryans, Cornish, and McIntosh, 2009). The meso and exo-systems encompass the family, physicians, and religious support systems (Bryans, Cornish, and McIntosh, 2009). The macro system for the patient depending upon location may add difficulty depending upon local laws either supporting or denying PAS (Bryans, Cornish, and McIntosh, 2009; Stillman, 2016). The decision and convincing of the family fall mostly to the patient and at this time financial and long-term vs. short term ramifications and life insurance payments come to light (Frey and Hans, 2016). With only currently partial lawful support US-wide for PAS life insurance and healthcare may not always support the process and must be investigated (Frey and Hans, 2016). The need for family counseling at this time would be most beneficial as special circumstances arise in family dynamics (Evans, 2015). The least discussed yet most important is the instance of young children involved in the case a parent with a terminal illness were to choose PAS (Buxbaum and Brant, 2001; Evans, 2015). Counselors involved must be aware of the extraordinary support for such special situations are available for both family and medical providers (Buxbaum and Brant, 2001).

Stillman (2016) proposes laws are changing, but they have a long way to go in fully supporting PAS nationwide. Pettigrew (1998) states “attainment of common goals must be an independent effort without intergroup competition” (p. 67). Using inter-group theory as the basis for negotiating the requirements of PAS may bridge the gap between lawmakers and medical practitioners (Pettigrew, 1998). Building a foundation for change may encompass serval social aspects to finding a means for change (Pettigrew, 1998). Designing a program to aid in the transitions to all fifty states accepting assisted suicide will fall to promotion via educational practices. The educational means may be the best approach regarding such a change as a religious aspect are more ideological and based in generational upbringing. Addressing opponents, one should not avoid spiritual elements but instead, meet spiritual aspects with scientific reasoning. The scientific approach should encompass an empathetic understanding of deadly diseases and the pain involved in the process of dying. The natural process is an essential area of emphasis in changing the minds of an entrenched anti-PAS the key may come in finding a common foundation (Pettigrew, 1998). Removal of pain and humane treatment may be the common ground (Pettigrew, 1998). Once, the common ground is established explaining the patient's wishes and needs without sensationalizing is important one must emphasize practicality and the psychological state of the patient. Lastly, laws may be implemented to protect the rights of the patient and the families involved. Providing a clear path for changing may be very difficult, but the long-term change will allow families to say goodbye to loved ones and provided a dignified means of death.

The future of PAS may lie in the way future generations perceive both the life cycle and how one approaches death. The key may be removing the stigma and fear from natural process though ideologies can supply supportive religious perspectives; the support systems can also interfere with scientific supporting information. The supporting research may come in the way as a simple step by step recording of the process of a patient from start to finish in the PAS process. Future generations may benefit most as scientific data dispelled misgivings, and individuals could achieve a complete understanding of the process. Grief counselors would have to adapt models and theories to accommodate early grief counseling before the patient passing away. Such a process is counter to many current models that require a specific trauma, loss, and recovery process.

The life and death process, though a natural point of fear for most individuals may ease with a complete understanding. The not knowing what lies beyond the threshold is the heart of such concern. Though several psychological theories and models such as Erikson’s model showing the progression of life and understanding of Bronfenbrenner’s ecological support structure are beneficial. The religious, social, and economic contexts all require a point of concern but must find a balance when making such a difficult decision. The social aspects cannot be the only factor concerning the patients’ needs in the face of unbearable pain. The needs of the patient should come before all else and easing the pain the most important at every turn. The act of understanding the needs of the patient from all perspectives including, dignity, suffering, religious, and choice require the use of inter-group theory to come together to find a balance. Lawmakers and healthcare providers have a rough road ahead regarding PAS. Though with consideration for the needs of the patient the perspective of “do no harm” may also consider psychological pain of a life lost to terminal illness. The terminal patient choosing PAS is in effect gaining control of life’s one final choice. The patient is taking control of the final moments determining not to succumb to cachexia and an undignified end. Instead, the patient chooses an end with dignity, memories, and special moments secured by choice of PAS.

References

Beck-Cross, C., & Cooper, R. (2015). Micro- and Macrosystem Predictors of High School Male Suicidal Behaviors. Children & Schools, 37(4), 231. https://doi-org.proxy-library.ashford.edu/10.1093/cs/cdv028

Bryans A, Cornish F, & McIntosh J. (2009). The potential of ecological theory for building an integrated framework to develop the public health contribution of health visiting. Health & Social Care in the Community, 17(6), 564–572. https://doi-org.proxy-library.ashford.edu/10.1111/j.1365-2524.2009.00856.x

Burdette, A. M., Hill, T. D., & Moulton, B. E. (2005). Religion and Attitudes Toward Physician-Assisted Suicide and Terminal Palliative Care. Journal for the Scientific Study of Religion, 44(1), 79–93. https://doi-org.proxy-library.ashford.edu/10.1111/j.1468-5906.2005.00266.x

Buxbaum L, & Brant JM. (2001). When a parent dies from cancer. Clinical Journal of Oncology Nursing, 5(4), 135–156. Retrieved from http://library.ashford.edu/EzProxy.aspx?url=http://search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=true&AuthType=ip,cpid&custid=s8856897&db=ccm&AN=107052630&site=ehost-live

Danigelis, N., Hardy, M., & Cutler, S. (2007). Population Aging, Intracohort Aging, and Sociopolitical Attitudes. American Sociological Review, 72(5), 812-830. Retrieved from http://www.jstor.org.proxy-library.ashford.edu/stable/25472493

Evans, L. (2015). Nurses’ attitudes to assisted suicide: sociodemographic factors. British Journal of Nursing, 24(12), 629–632. Retrieved from http://library.ashford.edu/EzProxy.aspx?url=http://search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=true&AuthType=ip,cpid&custid=s8856897&db=ccm&AN=109814321&site=ehost-live

Frey, L. M., & Hans, J. D. (2016). Attitudes toward Assisted Suicide: Does Family Context Matter? Archives of Suicide Research: Official Journal Of The International Academy For Suicide Research, 20(2), 250–264. https://doi-org.proxy-library.ashford.edu/10.1080/13811118.2015.1004477

Goldhill, S. (2017). A Mother’s Joy at Her Child’s Death: Conversion, Cognitive Dissonance, and Grief. Victorian Studies: An Interdisciplinary Journal of Social, Political, and Cultural Studies, 59(4), 636–657. Retrieved from http://library.ashford.edu/EzProxy.aspx?url=http://search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=true&AuthType=ip,cpid&custid=s8856897&db=mzh&AN=2018580218&site=ehost-live

Holden, J. (1993). Demographics, Attitudes, and Afterlife Beliefs of Right-To-Life and Right-To-Die Organization Members. Journal of Social Psychology, 133(4), 521. Retrieved from http://library.ashford.edu/EzProxy.aspx?url=http://search. ebscohost.com.proxy- library.ashford.edu/login.aspx?direct=true&Auth Type=ip,cpid&custid=s8856897&db=f5h&AN=9310077533&site=ehost-live

Kaufman, S., & Fjord, L. (2011). Medicare, Ethics, and Reflexive Longevity: Governing Time and Treatment in an Aging Society. Medical Anthropology Quarterly, 25(2), 209-231. Retrieved from http://www.jstor.org.proxy-library.ashford.edu/stable/23012129

Lizardi, D., & Gearing, R. E. (2010). Religion and suicide: Buddhism, Native American and African religions, atheism, and agnosticism. Journal of Religion and Health, 49(3), 377-84. doi: http://dx.doi.org.proxy-library.ashford.edu/10.1007/s10943-009-9248-8

Osborne, J. W. (2009). Commentary on retirement, identity, and Erikson’s developmental stage model. Canadian Journal on Aging, 28(4), 295-301. doi: http://dx.doi.org.proxy-library.ashford.edu/10.1017/S0714980809990237

Pettigrew, T. F. (1998). Intergroup contact theory. Annual Review of Psychology, 49, 65-85. doi: 10.1146/annurev.psych.49.1.65

Setta, S. M., & Shemie, S. D. (2015). An explanation and analysis of how world religions formulate their ethical decisions on withdrawing treatment and determining death. Philosophy, Ethics, and Humanities in Medicine, 10. https://doi-org.proxy-library.ashford.edu/10.1186/s13010-015-0025-x Siu, W. (2010). Communities of interpretation: euthanasia and assisted suicide debate. Critical Public Health, 20(2), 169–199. https://doi-org.proxy-library.ashford.edu/10.1080/09581590902897386

Stillman, A. (2016). Moving the Needle: A Call to Change Age Restrictions in American Physician-Assisted Suicide Laws. Southern California Interdisciplinary Law Journal, 26(1), 275–298. Retrieved from http://library.ashford.edu/EzProxy.aspx?url=http://search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=true&AuthType=ip,cpid&custid=s8856897&db=a9h&AN=123787142&site=ehost-live