Lamisa Saiyara Siddique :
“Who has the right to tell me that I don’t deserve this choice?”
Brittany Maynard, a 29 year old woman who had end-stage brain cancer, questions the society. In my opinion every patient has the right to die with dignity when confronted with terminal illness.
Researchers that worked directly with terminally ill patients found significant number of patients supporting PAS. In a study amongst multiple sclerosis (MS) patients, those with worsening symptoms favored PAS more than those with milder symptoms. in the same study when given the hypothetical situations of intolerable pain and deteriorating quality of life, almost half of the respondents chose PAS. This is consistent with another study where terminally ill patients reported that they would choose PAS if symptoms aggravated. The common reasons given to legalize PAS were pain and an individual’s right to choose.
This is where the importance of autonomy comes in. As medical professionals we are taught that a patient’s autonomy is one of the coveted codes of medical ethics. If the patients are mentally competent, well-informed about their condition, treatment and outcomes then they can refuse the treatment. Even the British Medical Journal has placed patient’s right to choose how they die at the face of an adverse illness at the highest pedestal.
There is an argument that PAS reduces the doctor’s job to an executioner’s. But both patients and general population favored PAS over active euthanasia to protect a doctor’s integrity. They felt direct involvement of the physician to end the patient’s life is ill-suited to the profession. Therefore PAS does not demean a physician. Moreover, the criteria used, especially in the US, to be eligible for PAS protect the ethical code of non-maleficent intent: numerous doctors verify the eligibility and same lethal drug is given to all. PAS also enables the patient to take the medication at their own liking or cancel it altogether. Thus further protecting patient autonomy.
In the UK where euthanasia laws are stringent, over 300 suicides per year is committed by patients with incurable diseases. About 25 UK residents travel to Switzerland every year for assisted dying. Such suicides are mostly done in private and without consulting family members which causes greater emotional distress for both the patient and the family. Suicide rate in MS patients are 13 times higher then general population’s.
This shows that strict laws are driving incurably ill people, who do not have the means to travel to another country or migrate to another state, to choose suicide. This infringes on patient welfare and therefore ethic of beneficence is no longer preserved.
Financial burden could coerce a patient to choose PAS but research show that even when palliative care is funded by the state, majority still voted for PAS. This shows that the physical burden of the disease mainly influences life-ending decisions.
In developing country like Bangladesh where palliative care is very very limited, terminally ill patients deserve to have at least the option of ending their lives. Instead of withering away in a facility, they should have the choice of dying with dignity. After all, doctors don’t only cure, they also end suffering.
(Lamisa Saiyara Siddique is student of International Medical University, Malaysia)
