End-of-Life Care and the Physician-Assisted Suicide Debate

July 1, 2016

For many docs, end-of-life care is a sticky subject and one that has been forced upon them by expectations of the medical system.

Although death is a natural part of life, many doctors still struggle with providing their patients with the best end-of-life care. During their practice, a physician’s personal views regarding their preferred method of death are often pushed aside as they are forced to adhere to the expectations of the medical system. As a result, many terminally ill patients spend the last phase of their life in a hospital’s intensive care unit where they are connected to machines. Research suggests that most patients and doctors would not consider dying in a hospital their preferred method of death. 

Physician-assisted suicide is one of the most controversial medical treatment options that essentially grants a patient’s wish to die peacefully and with dignity. According to a study conducted by the University of Michigan, many doctors approve of the practice of physician-assisted suicide, and might even choose this alternative medical treatment if they were enduring any end-of-life suffering as a result of a terminal illness. Even though most doctors support physician-assisted suicide, some would not actually perform the procedure if they were presented with the opportunity and would instead refer their patient to a doctor who is willing to help a severely ill person end their suffering. Some doctors, however, are unwilling to approve of the legalization of the controversial medical treatment, especially if they have strong religious beliefs. The results of the University of Michigan study showed that 56 percent of doctors approved of legalizing the procedure while only one fifth of the doctors surveyed were completely against physician-assisted suicide.

Throughout the years, the AMA has strongly opposed physician-suicide. Although it is understandable that a person who is suffering from a debilitating illness may think that death is preferable to life, this organization believes that the U.S. Supreme Court should recognize and honor their ethical code, which states that physicians should never knowingly harm a patient. Instead of helping a patient end his life, the AMA has encouraged doctors to acquire more knowledge about easing suffering with effective pain management. Moreover, the organization has developed programs to educate physicians on several therapies and treatments that focus on improving a patient’s overall quality of life as they endure a terminal illness. 

Palliative care can help patients who are suffering from a debilitating medical condition endure severe physical and psychological pain when they opt for aggressive end-of-life treatment such as feeding tubes, dialysis, invasive tests, intubations, chemotherapy, and radiation. Most doctors recognize the potential consequences of these futile treatments, and their preferred death method reflects this understanding. A study that was published in PLOS ONE showed that approximately 88.3 percent of doctors surveyed say that they would choose minimally invasive treatments or would forgo medical care altogether if they were dying of a terminal illness. Additionally, most doctors would prefer to die peacefully at home with the support of a comprehensive palliative care program rather than a cold and sterile environment of a hospital that is far from family, friends, and other special loved ones. The purpose of palliative care is to help patients manage pain and symptoms alongside their chosen treatment plan. This specialized medical care also provides patients with emotional, spiritual, and family/caregiver support.

Although incorporating palliative care into a medical plan can be relatively simple, many doctors have difficulty advising patients against aggressive end-of-life treatment. Thanks to amazing advances in biomedicine, the medical system often urges physicians to extend the lives of their patients by performing all of the necessary cutting-edge procedures and prescribing medication that may ultimately do more harm than good. Sadly, over-treating their patients seems to be a doctor’s only option. The pressure from the hospital to use the fee-for-service model often prompts physicians to perform procedures regardless of the end result in order to generate more money. Many doctors would like to share their personal views about aggressive end-of-life treatment with their patients, but the default of the medical system often prevents physicians from voicing their concerns. As a result, most doctors simply encourage their patients to receive the latest technologically-advanced treatment that is the most likely to extend their life. 

For instance, resuscitation is often a form of aggressive end-of-life treatment that can involve efforts such as performing mouth-to-mouth breathing and frequent chest presses. The procedure can also consist of restarting the heart with electric shock and opening the airway with breathing tubes. Many people associate resuscitation with saving lives, but usually the treatment is ineffective. If a patient suffers from old age, severe illness, or a terminal disease, the chances of a successful outcome from resuscitation are extremely poor. A few of the common risks of resuscitation include sore chest, broken ribs, or collapsed lungs

According to many surveys, 80 percent of patients would prefer to avoid frequent hospitalizations and high-intensity medical care at the end of their lives. Sadly, many patients are urged to pursue aggressive treatments by misinformed family members who think that it’s best to do everything possible to extend their loved one’s life, regardless of the financial or human cost. Doctors play an enabling role too, despite their personal belief about the matter. A physician’s willingness to perform potentially painful procedures and treatments before talking candidly with patients and families about the realities of end-of-life care could have anguishing results. 
 

About the Author: Kathrina Jeorgette Flores is currently a 4th year medical student at Dona Remedios Trinidad Romualdez Medical Foundation. She expects to graduate from this institute in 2017. Since 2008, she has held a registered nurse license. Alongside her medical studies, she is passionate about supporting causes related to children, education, health, and disaster/humanitarian relief. She is a member of the Philippine Nurses Association and the Total OutReach for Community Health Brotherhood and Sisterhood. 

Additional information about Kathrina Jeorgette Flores can be found on her LinkedIn profile.