Physician-assisted suicide (PAS)-Jack Kevorkian: Moral Leader Or Doctor Death Case Study

Describe the case in your own words and highlight the ethical issues at stake. How would you respond to the central issues? What principles and/or theories are you relying on in reaching your decision?

Physician-assisted suicide (PAS) remains a contested issue in the United States. As recently as October 2005, the Supreme Court heard oral arguments in the case of Gonzalez v Oregon, initiated in November of 2001 when then-Attorney General John Ashcroft declared that PAS was not a “legitimate medical purpose” and suggested that any doctor who participated in an assisted suicide would be in violation of the US Controlled Substances Act and would lose his or her federal drug license. On November 7, 2001, Oregon sued John Ashcroft and the Justice Department, claiming Mr. Ashcroft had unconstitutionally pre-empted the Oregon Death with Dignity Act, passed in 1994, which permits PAS in the state of Oregon. (Oregon won both in district court and on appeal; the decision of the Supreme Court is expected in June 2006) [5,6].

In the practice of PAS, a physician provides the patient with a lethal dose of medication, which the patient then uses to end his or her life. PAS should be differentiated from other end-of-life practices, such as euthanasia, terminal sedation, withholding/withdrawal of lifesaving treatments, and palliative sedation.

Euthanasia is the direct termination of a patient’s life by a physician,through lethal injection for example; this is the practice for which Dr. Kevorkian was tried and convicted. Terminal sedation refers to the sedation of a terminally ill patient to the point of unconsciousness, with all life-support and nutritional systems subsequently withdrawn. Competent patients, or medically incompetent patients with advance directives, may decide to forgo further medical care for their illnesses or injuries, a decision which both states and physicians universally recognize as legitimate even if the end result will be the death of the patient [9]. Palliative sedation is the administration of high doses of pain medication—doses that might inadvertantly result in death—to relieve extreme suffering. The intent of palliative sedation, however, is to provide comfort to patients suffering from diseases in their end stages [10].

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