Question

Mr. Smith is 85 years old and has several medical problems. He has spent the past several months in and out of hospitals and rehab. He tells his doctors: “My body is all worn out. I’m worn out. Don’t want to do this anymore, Doc. They say I can’t go home and be safe. And I’m NOT going to a nursing home. No way! Just stop that little gadget that shocks me and the part that keeps my heart going. I want them stopped. Yes, the pacemaker, too. A magnet will stop it, right? Just do it. Please. I'm tired of fighting.”

Mr. Smith had received cardiac resynchronization therapy a few years ago, with included a pacemaker for heart rhythms on which he was 100% dependent, and an internal defibrillator which had shocked him more than once. His doctors concluded they didn't need an ethics consultation for the decision to deactivate the defibrillator and a “Do Not Attempt Resuscitation” order was placed in the medical chart. They reasoned "If he doesn't want to be shocked again, that’s his decision. And if it went off again after he’d requested it stopped, that could be a kind of torture." However, they were unsure about the pacemaker, as Mr. Smith would die within a few minutes if it was stopped.

Answer the following questions:

1) What laws are in place to ensure that Mr Smith's decision about deactivating his internal defibrillator are respected? Provide both the name of the Act and at least one court case on point.

2) But what about the pacemaker? Mr. Smith wants it stopped as well. Do you think it should be? Would it be ethically right to do so? Provide a discussion in light of patient autonomy versus physician-assisted suicide.

3) What is the current state (legal status) of physician-assisted suicide in the United States?

Please answer the question as soon as possible.

Answer 1

Question 1.

The current legal status of physician assisted suicide in USA lies in Oregon's Death With Dignity Act (DWDA).

In March 2002, Ms.B , a 43 year old quadriplegic in the United Kingdom , first won the right to have her ventilator turned off against the wishes of her hospital . The court agreed to insulate the National Health Service (NHS) from legal liability in withdrawing life support , creating a landmark judgment regarding end of life care it reasoned , as US courts have long maintained , that a competent patient could refuse ongoing treatment regardless of the consequences , even if these consequences include death.

Question 2

Patient has the right over his body his life and death. The court is allowed terminal sedation even if it causes death of the patient. So here the patient has the right to stop the pacemaker.

Question 3

The current legal state of physician assisted suicide in the United States lies in Oregon's Death With Dignity Act ( DWDA) . Citing the due process protections of the 14th amendment of constitution , US supreme court rulings in 1997 allowed Oregon to proceed with the DWDA , identifying euthanasia and PAS as issues that were neither prohibited nor supported by the constitution. The DEDA allows PAS for terminally ill patients . Under the oversight of the Oregon Health Divisions , physicians may write a prescription for a letal dose of sedative for mentally capable , adult Oregon residents with a prognosis of less than 6 months of life. A request for PAS must be reproducible and made in the presence of witnesses; the patient must understand the alternatives; and the patient must not have impaired judgment. The DWDA notwithstanding , PAS has stalled as an item of legislation in the United states.