Author: Megan Murphy

Bioethical Controversies Surrounding Physician-Assisted Suicide

Physician-assisted suicide, or voluntary euthanasia, has sparked highly controversial opinions surrounding the right to control one’s own death. Physicians incessantly weigh benefits of a procedure against risks of harm and face ethical dilemmas when balancing beneficence and the duty to do no harm, non-maleficence.

Some physicians believe that by assisting in death, they are abandoning their medical and ethical duties. Typically, patients seeking assisted suicide experience inability to engage in pleasurable activities, a loss of dignity, and a loss of autonomy. For terminally ill patients, if all curative medical interventions have been exhausted, some physicians begin the next step of administering relief in depression or other mental illnesses even when it only provides a short period of improved life quality.

However, other physicians believe that they are helping patients by providing them the choice to die on their own terms. The honor in having the right to a dignified death is strongly supported by secular humanism, an officially recognized belief by the Belgian government, which has the most liberal laws surrounding euthanasia.

The Netherlands, Belgium, and Switzerland allow physician-assisted suicide to be administered to not only terminally ill patients, but also patients suffering from mental illnesses. The National Institute of Health looked into physician-assisted suicide records in the Netherlands and found that 37 of 66 assisted deaths were cases that mentally ill patients refused recommended treatment options.

In countries like Belgium where psychiatric care is minimally funded, physicians have been pushed to accept the limits of psychiatry. There, when patients request euthanasia, physicians may classify patients mental illnesses as terminal and comply with requests to die.

When a patient requests euthanasia, Belgian doctors have the right to conscientious objection. However, lawmakers are attempting to change the current law by requiring all doctors to respond to the patient’s request in a very short amount of time and to refer the patient to another doctor that will fulfill their death request.

Not only is this controversy difficult for physicians, but also it is a huge problem for religious institutions that do not support self-inflicted death. The Catholic Health Association believes that suicide and euthanasia will never be morally acceptable opinions and therefore, “Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way.”

In the United States, the most fundamentally protected rights are those embodied in the Constitution, including an individual’s right to preserve autonomy and retain bodily integrity by refusing life-sustaining medical treatment. Cruzan. However, in Vacco v Quill, the Supreme Court decided that although a competent individual can refuse unwanted medical treatment, there is not a constitutionally protected right for individuals to choose to die. The right to die is left for the states to determine.

Currently, only four states including Oregon, Washington, Vermont, and most recently, California, have implemented statutes allowing physician-assisted end of life options for terminally ill patients. In Montana, the Supreme Court decriminalized physician-assisted suicide upon the request of a terminally ill and competent patient. The court determined that the right to die with dignity is not contrary to public policy and physicians are not committing a crime by prescribing a lethal dose of medication as long as the terminally ill patient makes the final decision to take the lethal dose on his own, without any assistance.

This year, Canada and Columbia have also decriminalized physician-assisted suicide. The debate continues in England as well as here in the United States, where an additional 23 states anticipate hearing proposals regarding the right to die.

Marijuana Reform

Currently, the Department of Veterans Affairs does not allow doctors to even discuss the use of medical marijuana to veterans irrespective of state law legalizing medicinal marijuana use. Lawmakers in Illinois and New York that have legalized medical marijuana are urging changes to current policy in order for VA doctors to use modern medicine treatment options for veterans suffering from PTSD.

Nearly half of the states across the United States have passed laws allowing marijuana to be used for medicinal purposes. Despite state action, marijuana still continues to be prohibited under federal law.

Since 1970, the federal government has categorized marijuana as the most dangerous type of drug: a Schedule I controlled substance. Schedule I is defined as drugs with no currently accepted medical use, high potential for abuse, and high risk of dependence. However, commonly known medicinal marijuana benefits include reduced pain and anxiety, treatment of conditions including seizures, PTSD, chemotherapy-induced nausea, glaucoma, AIDS wasting syndrome, neuropathic pain, multiple sclerosis, and insomnia.

Regardless of doctors recommending marijuana to combat negative health effects, the federal government continues to categorize it as a Schedule I controlled substance along with heroin, ecstasy, and LSD.

In 2011, the Drug Enforcement Administration (DEA) denied categorizing marijuana as a Schedule II drug because there has not been enough research on the drug. Recently, in December 2015, the Food and Drug Administration (FDA) recommended that marijuana’s classification be changed.

Currently, marijuana requires an excessively strict process for approved research. The FDA requires researchers to be approved as an Investigational New Drug (IND), which renders the drug safe and effective for their intended use. Additionally, the DEA must review the application and issue special licensure and registration because of its classification as a Schedule I controlled substance. Lastly, the National Institute on Drug Abuse (NIDA) is responsible for supplying the research grade marijuana to the approved researchers.

The FDA’s lack of approved research rests on their claim that the purity and potency of the drug may vary considerably. Although NIDA requires strict testing and compliance for any FDA approved marijuana research, states are lacking in uniformity of testing procedures.

The FDA wants the potency levels for using marijuana well defined so that patients and doctors may control the exact dose. Recently, new mechanisms for testing potency have been developed, but certain states only require some of the cannabinoids to be tested. For example, in Connecticut every production facility is required to test only THC and CBD levels, but the other cannabinoids are not being tested.

The FDA also wants the purity of marijuana to be ensured. Medicinal marijuana is prescribed to people who suffer from some adverse health condition; the patients are not typical healthy individuals with strong immune systems. Thus, there is a need for marijuana to be free of E Coli, pesticides, and mold. Despite this, states continue to lack uniformity in testing purity.            In California, for example, the grower or the dispensary facility may test the marijuana. This may result in growers selling unclean marijuana to distributers. Conversely, in Connecticut, every production facility must have every strain and every product tested to ensure the marijuana is clean.

Although medicinal marijuana dispensaries provide information and individualized consultations, uniform testing, research, and amended laws governing such practices are necessary to fully understand the effects of marijuana.

Federal Funding Towards Preventative Care

Planned Parenthood Foundation provides easily accessible and affordable birth control, preventive health care measures, including breast and cervical cancer screenings, and medically safe and legal abortions resulting in vast improvements to the health of millions of women and children. The controversies surrounding Planned Parenthood does not negate the evidence that women, men, children, and families have reaped great benefits to their health since the Supreme Court’s decision in Roe v. Wade.

The Center for Medical Progress, an anti-abortion group based in California, released eight videos alleging Planned Parenthood violated federal law; first, selling fetal organs and tissues and, second, manipulating abortion procedures to procure intact fetuses. This conservative, anti-abortion group hired actors to go undercover as pro-choice, record and interview Dr. Deborah Nucatola, Senior Director of Medical Services at Planned Parenthood Foundation. David Daleiden led this manipulative deceitful attack as another attempt to terminate the foundation’s federal funding.

The Partial-Birth Abortion Ban Act of 2003 prohibits partial-birth abortions procured by intact dilation and extraction, (“intact D&E”). Under this law, 18 U.S.C. §1531,”Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both.” In the Supreme Court decision of Gonzales v. Carhart, Justice Kennedy wrote the majority opinion upholding the Partial-Ban Abortion Act solely when the physician intends to perform an intact D&E, not the more common partial-birth abortion.

Differences exist between the more common partial-birth procedure known as dilation and evacuation and the illegal intact dilation and extraction method. The former first ensures fetal death has occurred before beginning the surgical abortion procedure. Whereas, the latter, “the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother.”

Congress’s intention behind the Act is that no partial-birth abortion exists that is medically necessary and consequently cannot put the safety of a mother first. However, the Supreme Court in Gonzales v. Carhart, only upheld the Partial-Ban Act solely to intact dilation and extraction and, furthermore, left open the possibility of an as-applied challenge if rendered medically necessary.

The paramount goal of an abortion is safety and care for the mother and her health. Mr. Daleiden alleges that Planned Parenthood is performing illegal partial-birth abortions. In one of the videos, Dr. Nucatola explains their success in receiving fetal organ tissue because the doctors perform abortions by using ultrasounds to ascertain the best location to grab the fetus with forceps. Any diversion of an abortion procedure for the purpose of gaining organ research is extremely unethical and it would defeat the primary purpose of the foundation providing safe, legal abortions.

Mr. Daleiden also alleges, “Planned Parenthood’s criminal conspiracy to make money off of aborted baby parts.” It is against federal law to sell fetal tissue. The foundation claims it makes no profit, but rather, the actual costs, including the cost to transport tissue to research centers, are reimbursed, which is standard across the medical field. Dawn Lagues, Planned Parenthood Executive Vice President, stated, “this was always about one thing – honoring the desire of women to contribute to lifesaving research. It was never about money.” Participating in this not-for-profit research is a voluntary and legal way to contribute towards creating successful vaccinations for diseases including Parkinson’s, polio, rubella, and chicken pox.

Irrespective of Planned Parenthood’s letter to Congress that proves the videos are heavily edited and inaccurate, the foundation announced they no longer will accept legal reimbursements from research in hopes to end another political anti-abortion attack.

Federal funding is imperative to Planned Parenthood providing women access to preventive care, life-saving screenings, and family planning services. While Federal funding is prohibited from paying for any abortions, these anti-abortion attacks on such an honorable and respected foundation will have devastating impacts. Restricting woman’s right to access medically safe, legal abortions and accessible preventive health screenings jeopardizes the health of women, their families, and our nation.