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Clinical Ethics Consultation and Physician Assisted Suicide

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New Directions in the Ethics of Assisted Suicide and Euthanasia

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 64))

Abstract

In this paper I attempt to address what appears to be a novel theoretical and practical problem concerning physician-assisted suicide (PAS). This problem arises out of a newly created set of circumstances in which persons are hospitalized in jurisdictions where PAS, though now legally available to patients, remains morally contentious. When moral disagreements over PAS come to divide physicians, patients, and family members, it is quite likely they will today find their way to the hospital’s consulting ethicist, a member of an emerging group of professionals charged with the responsibility (so we are told) of resolving moral conflict in the clinic. What can or should an ethics consultant do to fulfill this mandate in such circumstances? I argue that the now predominant conception of clinical ethics consultation is importantly deficient in that it provides no final guidance to ethicists on how they should respond in such cases. The ethicist may only recommend—or assist others to reach—solutions to moral disagreements falling within the limits of established norms. Since the normative landscape of PAS appears to be changing, whether it falls within these limits is unsettled. I conclude that the accepted goals of ethics consultation require a revised and expanded conception of the ethicist's role in cases involving PAS. I close by outlining what that revised understanding would look like and the further questions it raises.

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Notes

  1. 1.

    While European countries for some time lagged behind the U.S. in this regard, things appear to be changing, particularly in the nations of Eastern Europe. See the contributions from many European clinical ethicists in Schildmann et al. (2010). See also McLean (2009), Reiter-Theil (2001), and Nagao et al. (2008).

  2. 2.

    Summaries of the report also appeared in Aulisio and Arnold (2000), Aulisio et al. (2003). This document was subsequently revised. See ASBH (2011).

  3. 3.

    See, e.g., Ackerman (1987), Thomasma (1987), Glover et al. (1986), and Veatch (1987).

  4. 4.

    There is “general consensus in the field,” according to the revised Core Competencies Report, “that ‘ethics facilitation’ is the best model for HCEC [health care ethics consultation]” (American Society for Bioethics and Humanities 2011, 6). The model of ethics consultation defended in the Core Competencies has been adopted by any number of hospitals, including the Veterans Health Administration (VHA). See Veterans Health Administration Integrated Ethics. It is also arguably embraced by the American Medical Association, which advises that “where there is a dispute, the [ethics] consultant’s role is one of negotiation and resolution.” See American Medical Association (2012, 2).

  5. 5.

    See also Aulisio and Arnold (2008, 422): The role of the ethics consultant “is to help the clinicians, patients, and families arrive at a decision that optimally respects and promotes the values of the appropriate decision-makers—most often the values of the once competent but now incompetent patient—within the bounds of medically acceptable options.” The ethicist facilitates the building of a “principled ethical resolution” of a moral problem by “helping involved parties identify a range of ethically acceptable options, and providing an ethical justification for each option” (Tarzian and ASBH Core Competencies Update Task Force 2013, 5).

  6. 6.

    This model is the centerpiece of a nascent movement to standardize the training of clinical ethicists by, for example, specifying minimum qualifications for consultants and establishing uniform curricula for credentialing programs. See Dubler et al. 2009; Tarzian 2015. For further support of the facilitated consensus model see Aulisio et al. (1999), Aulisio and Arnold (2000, 2008), DeRenzo (1994), and (Dubler 2011).

  7. 7.

    See data from Pro/Con.org. Retrieved July 3, 2014 from (http://euthanasia.procon.org/view.resource.php?resourceID=000132) and (http://www.procon.org/headline.php?headlineID=005198). For the text of the recent court ruling in New Mexico, see http://agoodgoodbye.com/wp-content/uploads/2014/01/199446010-Physician-aid-in-dying-Ruling.pdf.

  8. 8.

    See information at Patients Rights Council. Retrieved July 3, 2014 from http://www.patientsrightscouncil.org/site/failed-attempts-usa/.

  9. 9.

    Retrieved July 3, 2014 from http://www.deathwithdignity.org/advocates/national. See also, “‘Aid-In-Dying’ Movement Takes Hold in Some States,” New York Times, Feb. 7, 2014. Retrieved July 10, 2014 from http://www.nytimes.com/2014/02/08/us/easing-terminal-patients-path-to-death-legally.html?_r=0. The text of the Connecticut bill is representative. See State of Connecticut General Assembly Bill 1138, January, 2009 Session. Retrieved July 3, 2014 from http://www.cga.ct.gov/2009/TOB/S/2009SB-01138-R00-SB.htm.

  10. 10.

    See “Views on End-Of-Life Medical Treatments,” Pew Research Religion and Public Life Project, November 21, 2013. Retrieved July 3, 2014 from http://www.pewforum.org/2013/11/21/views-on-end-of-life-medical-treatments/.

  11. 11.

    “Large Majorities Support Doctor Assisted Suicide for Terminally Ill Patients in Great Pain,” January 25, 2011. Retrieved July 3, 2014 from http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/677/ctl/ReadCustomDefault/Default.aspx.

  12. 12.

    “U.S. Support for Euthanasia Hinges on How It’s Described.” Retrieved July 24, 2014 from http://www.gallup.com/poll/162815/support-euthanasia-hinges-described.aspx.

  13. 13.

    A HuffingtonPost/YouGov poll from 2013 reported that 50 % of Americans say it should be legal for a doctor to assist the terminally ill in suicide. “Assisted Suicide Legalization Supported by Half of Americans,” June 23, 2013. Retrieved July 10, 2014 from http://www.huffingtonpost.com/2013/05/22/assisted-suicide-legalization_n_3314849.html. An NPR-Truven Health Analytics survey pegged the number of Americans in favor of assisted suicide at 55 %. “Americans Support Physician-Assisted Suicide for Terminally Ill,” December 28, 2012. Retrieved July 10, 2014 from http://www.npr.org/blogs/health/2012/12/27/168150886/americans-support-physician-assisted-suicide-for-terminally-ill.

  14. 14.

    For the text of the bill, see http://www.scottish.parliament.uk/parliamentarybusiness/Bills/69604.aspx.

  15. 15.

    See “French Panel Recommends Legalizing Assisted Suicide for Terminally Ill,” Deutsche Welle, December 16, 2013. Retrieved July 1, 2014 from http://www.dw.de/french-panel-recommends-legalizing-assisted-suicide-for-terminally-ill/a-17300805.

  16. 16.

    See “67 % of Canadians Support Legalizing Assisted Suicide: Poll,” National Post, December 29, 2011. Retrieved July 1, 2014 from http://news.nationalpost.com/2011/12/29/67-of-canadians-support-legalizing-assisted-suicide-poll/.

  17. 17.

    See “Large Europe Majorities for Assisted Suicide,” Reuters, Nov. 30, 2012. Retrieved July 1, 2014 fromhttp://www.reuters.com/article/2012/11/30/us-euthanasia-europe-survey-idUSBRE8AT0EG20121130.

  18. 18.

    See Pope (2009). See also Lewy (2011). See “Canada Court Strikes Down Ban on Aiding Patient Suicide,” New York Times, Feb. 6, 2015. Retrieved July 23, 2015 from http://www.nytimes.com/2015/02/07/world/americas/supreme-court-of-canada-overturns-bans-on-doctor-assisted-suicide.html?_r=0.

  19. 19.

    Taken from policy statement on “End of Life Care,” San Antonio Regional Hospital, Upland, CA. Copies available from author.

  20. 20.

    Relevant provisions of the Washington Death with Dignity Act are illustrative. See Revised Code of Washington, Sec. 70.245.190: “Only willing health care providers shall participate in the provision to a qualified patient of medication to end his or her life in a humane and dignified manner… A health care provider may prohibit another health care provider from participating under [the law] on the premises of the prohibiting provider if the prohibiting provider has given notice to all health care providers with privileges to practice on the premises and to the general public of the prohibiting provider's policy regarding participating…” Retrieved July 3, 2014 from http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245. See also Oregon Death with Dignity Act, Oregon Revised Statutes, Sec. 127.885 §4.01, (4) and (5a); and Vermont Statutes Annotated, Title 18 chapter 113, sec. 1.

  21. 21.

    See “Healthcare Facilities Scrambling to Deal with Dignity Act,” Seattle Times, Feb. 2, 2009. Retrieved July 3, 2014 from http://seattletimes.com/html/health/2008696811_death02m.html. See also “Island Hospital Readies Plan for Death with Dignity Act,” Skagit Valley Herald, Feb. 26, 2009. Retrieved July 3, 2014 from http://www.goskagit.com/news/island-hospital-readies-plans-for-death-with-dignity-act/article_70db5389-2bd9-52d0-91ca-e6420b12bfb6.html?mode=jqm; “Death with Dignity at WGH,” Whidbey News Times, March 3, 2009. Retrieved July 3, 2014 from http://www.whidbeynewstimes.com/news/40682408.html; “Grace Cottage Opts Out of Assisted Suicide Law—For Now,” Battleboro Reformer, June 22, 2013. Retrieved July 3, 2014 from http://www.reformer.com/localnews/ci_23515442/grace-cottage-opts-out-assisted-suicide-law-now. “Cancer Center Goes Public with Assisted Suicide Protocol,” Amednews.com, April 22, 2013. Retrieved July 3, 2014 from http://www.amednews.com/article/20130422/profession/130429973/2/.

  22. 22.

    See “Death With Dignity Act,” Washington State Hospital Association. Retrieved July 3, 2014 from http://www.wsha.org/0302.cfm.

  23. 23.

    “Cancer Center Goes Public with Assisted Suicide Protocol,” Amednews.com, April 22, 2013. Retrieved July 3, 2014 from http://www.amednews.com/article/20130422/profession/130429973/2/.

  24. 24.

    See American Medical Association (2012), Opinion 2.211. Available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?. See also American College of Physicians (2012), “Care of Patients Near the End of Life: Physician-Assisted Suicide and Euthanasia”; American Nurses Association (2013).

  25. 25.

    See American Society for Pain Management Nursing (2003), American Medical Director’s Association (1997), American College of Medical Quality (2000).

  26. 26.

    See Vermont Medical Society (2003). The text of the Society’s policy states “there should be no laws concerning physician-assisted suicide.”

  27. 27.

    See “CMA changes stance on physician aid in dying, takes neutral position on end of life option act.” Retrieved July 23, 2015 from http://www.cmanet.org/news/detail/?article=cma-changes-stance-on-physician-aid-in-dying.

  28. 28.

    See, e.g., “Jahi McMath Case Renews Moral Debate Over Brain Death Diagnoses,” National Catholic Register, January 14, 2014. Retrieved August 21, 2014 from http://www.ncregister.com/daily-news/jahi-mcmath-case-renews-moral-debate-over-brain-death-diagnoses/-ixzz3B4Ma64GQ. See also Miller and Truog (2014).

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  1. Department of Philosophy, California State Polytechnic University, Pomona, USA

    David M. Adams

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  1. Department of Philosophy, California State Polytechnic University, Pomona, California, USA

    Michael Cholbi

  2. Dept. of Behavioural Sciences and Philos, University of Turku, Turku, Finland

    Jukka Varelius

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Adams, D.M. (2015). Clinical Ethics Consultation and Physician Assisted Suicide. In: Cholbi, M., Varelius, J. (eds) New Directions in the Ethics of Assisted Suicide and Euthanasia. International Library of Ethics, Law, and the New Medicine, vol 64. Springer, Cham. https://doi.org/10.1007/978-3-319-22050-5_8

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