The first time I heard about Terry Schiavo was during her last few days of life. Her case rocked medical, legal, religious, and political communities and proceeded all the way to the US Supreme Court [1]. President George W. Bush and the Vatican tried to challenge court decisions to remove her feeding tube, turning the right-to-die debate into a worldwide media frenzy.
Since 2005, when Ms. Schiavo’s feeding tube was removed, similar cases involving patients in vegetative states have embroiled families, medical centers, doctors, and courts in complex ethical discussions [1]. Certainly, conflict surrounds these patients, but perhaps more widely publicized are the stories of conscious patients who have chosen to end their lives with the help of their physician. These patients, diagnosed with a terminal illness and facing less than 6 months of life, often suffer from debilitating and agonizing pain.
The Oregon Death with Dignity Act, passed in 1996, was the first state law that legalized Physician Aid-in-Dying (PAD)[2]. Since then, Washington and Vermont have followed suit, and a lower Montana court has determined that the Montana State Constitution allows for physician-assisted death [3]. In these states, physicians can legally prescribe lethal doses of medications, which patients administer themselves. Euthanasia, a term that is often confused with PAD, stands in stark contrast and involves a physician administering the lethal dose. Euthanasia is illegal in all fifty states [3].
The ethical principles guiding a physician in this situation seem to be in direct conflict. Respect for patient autonomy and compassion tip the scales towards the patient’s wishes. The patient has the ultimate right to choose their treatment and should be allowed to end terrible suffering if he/she is unhappy and in pain. However, beneficence and non-malfeasance demand that the physician only do the patient good and not harm, in direct contrast to intentional overprescription of a medication. As with many other ethical quandaries, the physician is forced to grapple between two seemingly plausible choices. Often, the decision comes down to the personal ethical and religious beliefs of the physician.
Arizona physicians do not have the legal option to help their patients end their life. For now, they are somewhat shielded from this difficult choice, at least in the public eye. Patients must travel to a state that allows PAD if they wish to legally end their lives. However, as right-to-die advocacy groups push ever harder for the legalization of PAD, Arizona physicians may find themselves faced with what seems to be an impossible choice, seemingly in contrast to the physician-adopted motto of “Do no harm.”
- Arthur C. Ten Years After Terri Schiavo, Death Debates Still Divide Us: Bioethicist. NBC News. 2015. http://www.nbcnews.com/health/health-news/bioethicist-tk-n333536. Accessed January 8, 2017.
- Terminology. Death with Dignity. https://www.deathwithdignity.org/terminology/. Accessed January 8, 2017.
- Starks H, Dudzinski D, White N. Physician Aid-in-Dying: Ethical Topic in Medicine. Ethics in Medicine. 2013. https://depts.washington.edu/bioethx/topics/pad.html. Accessed January 8, 2017.
Bridget Ralston is a member of The University of Arizona College of Medicine – Phoenix Class of 2020. She graduated from Santa Clara University in 2015 with a Bachelor of Science in Chemistry and a French minor. She de-stresses by whipping up delicious treats (and subsequently devouring them), playing soccer, and cuddling with her cat, Tuxedo. She has a particular interest in healthcare for underserved communities.