Sociology

The Nature and Scope of the Issue
The issue about physician assisted suicide (PAS) and euthanasia has been continuously the subject of debate among many health care professionals, pro life advocate, religious groups and those who uphold physician assisted suicide and euthanasia. The main issue concern on the ethics, morality and the legality of this clinical practice. Indeed, this issue has been very controversial not only because of the ethical and moral arguments but also because both sides of the issue assert for moral and ethical claims. A New York Times commentary written by Douthat (2006) favoring physician assisted suicide, refuted claims of anti-physician assisted suicides that this practice will soon extend to others because of budgetary concerns saying that the way of American death poles apart. Douthat emphasized that the goal of this practice should be absolute freedom, perfect control and ideal autonomy (Douthat)

The question is, why do health professionals violates their sworn responsibility If one looked at the situation from the perspective of the law, this is a criminal offense because no one has the right to take someone else life but God. Indeed, this was exactly the case cited in another New York Times article commenting on the issue. Brown (2009) stated that arrests were made against four officials of a supposed network on charges of physician assisted suicide. While Brown seemed to be simply narrating the case, he obviously demonstrated that physician assisted suicide is illegal and a criminal offense (Brown). From the patients condition however, physician assisted suicide and euthanasia is a humanitarian consideration. When a patient is terminally and suffering from painful incurable disease, each day that he or she is alive is an enormous burden because his or her remaining days are filled with severe and un-relievable pain or suffering. The moral argument here is that terminally patients suffering extremely from painful disease are forced to endure untreatable agony that could be relieved only through euthanasia. Thus the scope of the issue is whether it is ethical, moral, and legal to allow physician assisted suicide and euthanasia.

Definition of the issue
According to Edlin and Golanty (2010), in physician-assisted suicide, A terminally ill patient who is mentally competent must express a desire to die on a number of occasions. Then a second physician would be consulted. Finally if both physicians agree that the patient is mentally competent and has incurable, painful disease, physician would supply the patient needed to commit suicide or other wise end his or her life (p. 499). Given this description, the issue behind physician assisted suicide can be define as the moral and ethical argument regarding the taking of life of the terminally ill patient suffering from intolerable yet incurable pain.

Number of people affected
Generally, this practice is illegal in many countries, but it cannot be denied that it is being perpetuated in different hospital settings around the world. In the Netherlands for example, Edlin and Golanty noted that while physician assisted suicide is illegal, yet several thousand seriously ill patients die each year with the help of their physician (p. 499). They pointed out that in the United States studies show that of the more than two million people that die each year, almost half of hospitalized patients suffer serious pain in the days preceding death (p. 499). From these two countries alone, it may be safe to make an estimate of at least a million patients directly affected by the issue. Apparently, the sectors of society affected by this issue in the first place are the patients and their immediate families and relatives, the health care professionals involve in the case, the pro-life advocates comprised by religious groups and right to life proponents and those who seek to legalize physician assisted suicide and euthanasia, as well as every individual who might be interested in the case. In general it may be difficult to determine the exact number of people affected by the issue because those who are affected are not only the patients but the immediate families, relatives, and friends of the patients and the those for and against the issue.

Institution or organizations involved in the issue
The institutions involved in this issue first and foremost are the health care institutions such hospitals where physician assisted suicides usually take place, professional organizations within the bounds of medical practice such as the Oregon Medical association, the Supreme Court which recognizes the competent patients rights to refuse life-sustaining treatment, and the Church, particularly the Roman Catholic which strongly opposes the physician assisted suicide. Finally, the US Congress which legislated the Pain Relief Promotion Act which promotes pain management and palliative care.
Organizations involve in the issue include the American Medical Association and the American College of Physicians whose position on the issue were both against assisted suicide. The federal government is also keenly involved but its involvement is more on addressing the issue based on the merits of the case.

Policy Option
Currently, the most popular option for terminally ill patient suffering from incurable intolerable pain is the physician assisted suicide. However, on the legal aspect, the policy option regarding the issue is to respect life and that physician assisted suicide is illegal and a criminal offense. In an internet article titled A progressive Argument Against the legalization of Physician-Assisted Suicide it cited Dr. Robert Jones argument that any conclusion on the debate should wait until Congress come up with a law that will guarantee adequate health care access on every citizen, in order to avoid premature deaths brought by the practice of physician assisted suicide (par. 2)

In general, physician assisted suicide is an illegal clinical or medical practice in the United States. Dyck (2002) calls it an abrogation of central moral responsibility contending that too much emphasis on freedom and choice leads to devastating result (Dyck, par. 7). No wonder in the U.S., only two states had enacted a law that legalizes the practice of physician assisted suicide. In line with this, legalizing physician assisted suicide according to Stevens (2005) devalues human life.

On the argument regarding the patients autonomy, Henden (2004) contended that physicians who agree on assisted suicide do not really know how to relieve the patients suffering. Thus, he insist that what is most needed is palliative care training rather than to assist patient to prematurely death. That is, the patient should be given appropriate palliative care and allows him or her to live his or her remaining days or months. In view of the condition of terminally ill patient suffering from incurable intolerable pain, this paper adopts a position in support of physician assisted suicide. Morrison, Meier, and Capello (2003) aptly stated that it is the lack of focus on palliative care that many dying patients experience pain, depression, and under utilization of pain medications and substandard detection or management of other symptoms (p. 349). This position is based on the internalization of the condition of patients with terminal illness suffering intolerable as part of the disease.

Arguments
In favor of Physician assisted suicide
Perhaps, one of the strongest arguments in favor of the issue at hand is the argument based on the notion of individual autonomy and self determination. According to this argument, just as the patient has the right to determine the course of her own life, a person also has right to determine the course of her own dying (Patel and Rushefsky 2002, p. 57). Proponents of this argument held that as long as a terminally ill person suffering from incurable intolerable pain freely and rationally chooses to seek assistance in ending his life, such assistance should be available from a person (normally a physician) who is willing to provide it (Patel and Rushefsky, p. 57). Center to this argument is the autonomy which is fundamental American value and should not be dismissed. In view of the above, Rosenblatt (2010) asserts that the state of Montana supports PAS citing that human dignity rights tolerate patients to die to die with dignity (Rosenblatt)

On the light mode, Pozgar, G.D. (2007) cited that the term euthanasia which is often associated physician assisted suicide is derived from a Greek word euthanatos meaning good death or easy death (p. 370). According to Alters and Schiff (2006) under the Patient Self Determination Act, patients have the right of a good death which will relieved him or her of unbearable pain and enormous cost on the family of the patients (p. 441).

The second most powerful arguments in favor of physician assisted suicide is linked on the courts decision to recognize the right of a competent person to refuse or request withdrawal of life-sustaining treatment, allowing one to die a natural death. Patel and Rushefsky (2002) stated that the courts have also recognized the right of a health care surrogate or family member to make such a request in case of incompetence on the part of the patient (p. 58). Thus, by implications, proponents of PAS argued that the purpose of life sustaining treatment and physician assisted suicide are designed to produce the same resultthe death of a patient (p. 58), therefore there is no ground to make a constitutional distinction between assisted suicide and the removal of life support.

On the physicians side, Kuhse and Singer (2006) argued that doctors like them have two primary duties to ensure the well-being of our patients, and to respect their autonomy (p. 393). They explained that their first duty is to seek to restore patients to health, however, if they cant they should try to reduce their suffering.  

Opinion
Did you change your mind as a result of your research
Yes Based on what I have learned from the issue, most of the institution and organization that are against PAS argues simply on the basis of their conviction of the sanctity of life. But they seemed to be unsympathetic to the real condition of terminally ill patients suffering from extreme pain. The change of perspective that I got from this research was that I realize the value of death. That death is inevitable and no one can escape it. The best way therefore to face the situation described and discussed above is to accept that death is part of our lives and it would better to die a peaceful death than suffer intolerable pain a long time and die. This kind of death is indeed more dignified compared to suffering days or moths of extreme pain before dying.  

Did you become more entrenched in your position
Yes Because it is a reality that human body is weak and we could at any time get sick. Every human being has the potential to get sick of the most dreaded disease such as cancer. It is a reality also that our days are numbered and we could die anytime anywhere we are, or what ever we are doing. Since we do not know what holds our future, we prepare for it, we invest, and we plan. But the most important thing is we know that we really cannot live much longer. So my position on this issue is that I would rather go for the avoidance of prolonged pain. Death is inevitable any way. In this way, I could show more sympathy to love ones in this physical condition. Of course I understand the feeling of the immediate families, but it would selfish for them if they would care for their feelings.

Have you become ambivalent or confused
No The discussion provides a new avenue for learning a practical knowledge. This is something that settles my mind about living and dying. The issue is not really complicated but it is highly debatable. It is interesting and it made me more definite on my view about the issue. That is, I have a more balanced outlook on the issue.