there are two posts in the discussion board that need to be replied at

Post 1

1. Summary of the two articles
Answer: The article Mortal Responsibilities: Bioethics and Medical-Assisted Dying (Campbell, 2019) discusses the right to die from moral, ethical, and professional integrity, and social responsibility relating the physician-assisted death in the US with the increasing prevalence of the legalized physician-assisted and medically-assisted dying in Canada.  The author disagrees with the popular assumptions that a) Physician-assisted death is the moral equivalent of withdrawing or refusing futile medical treatments, and b) physician-assisted death is moral equivalent of medically-assisted death. Instead, the author opines that there is a moral line between rights to refuse treatment and rights to physician-assisted death and that legalizing physician-assisted death does not resolve the ethical questions.  Additionally, he indicates that medically-assisted dying is not suitable for the US currently because it has ethically objectionable issues and takes risks in compromising professional integrity and public policy for end-of-life care.

The article End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic (Pattison, 2020) discusses that end-of-life care has been facing tremendous challenges during the COVID-19 pandemic.  For example, with the global shortage of medical equipment, medical space, and healthcare professionals, etc., healthcare teams should make rapid, creative and timely decisions for whom to be treated and whom not to be treated. Also, the decision should align with patients willingness. Under the current unprecedented scenario, healthcare teams should implement creative care to offer clear, accurate, and consistent communication with patients and families for end-of-life care to ensure the care quality for these sensitive, intimate, and vulnerable patients and to be palliative for the grief of bereavement. It is understandable that these great challenges exacerbate the burnout of critical care professionals.

2. Where does Texas stand on this matter?  Explain.
Answer: According to Health & Safety 166.45-51, Mercy killing or euthanasia is not condoned or authorized by Texas law, nor is any act or omission other than to allow the natural process of dying, and Withdrawal or withholding of life-sustaining procedures does not constitute offense of Aiding Suicide.  That is to say, in Texas, it is illegal to use physician-assisted death or medically-assisted death no matter how the individual is suffering.  Hence, individuals have to suffer the entire course of their fatal disease before death arrived naturally unless they are willing to violently end their own life.  Although Texas does not allow any active intervention to hasten death, it allows terminally ill individuals to have certain life-sustaining procedures withdrawn (FindLaw, 2016).  In addition, the Texas Medical Association supports the American Medical Associations position that physician-assisted suicide is fundamentally incompatible with the physicians role as healer. (McAshan, 2019)

3. Where do you stand on this matter? /What are your thoughts about this?  Do you think this is ethical or not?  Explain.
Answer: Personally, I support the legalization of the right for death with dignity, including both physician-assisted death and medically-assisted death. We do not have the right to choose the freedom to be born (the decisions are made by our parents), but we should have the freedom to decide how we live and die. I personally play a high value in the inherent dignity of life. For those who have terminal illnesses, they should have the freedom to choose how to end their lives and to avoid unnecessary suffering.  My grandfather passed away from lung cancer several years ago, I saw how he had suffered. It was heart breaking. He was in a coma for a couple of days, and he could not open his eyes, could not listen, could not speak, even could not breathe without a ventilator. Finally, we decided to withdraw all of his life-sustaining procedures to let him die with dignity since we did not want him to live with so much suffering, just because we wanted him to be alive. And I believe my grandfather would have agreed with us, and he even would seek physician-assisted death if he could have the capability to express himself that time.  After all, he was the typical person who embraces the quality of life.  When physician-assisted or medically-assisted death can facilitate terminal patients with peace of mind, and eliminate their agonizing suffering, it is the ultimate ethical act for the dying individuals. Choosing not to suffer to the bitter end is part of the right to pursue happiness as written in the US constitution; it is ones ultimate human right.  For some people, such as myself, simply maintaining our breath (with/without machine) with nothing else left, is our cruelest torture.  Moreover, in the states that allow physician-assisted death, data have demonstrated that only 32% of the individuals who had acquired the prescribed death medication did not end up using the medication (Death With Dignity, 2018); hence, an overwhelming majority (2/3) strongly believe in their decisions. Offering alleviating options for individuals to be happy for not prolonging their unbearable suffering to the bitter end is an embodiment of positive ethical values and the respect for life that embodies our life decisions to live or not to live. Denying such an option is to force unbearable agonizing suffering onto the dying individual, which, like forced labor, is unethical and inhumane.

4. If Texas were to pass a death with dignity act, what actions would you take/recommend as the chief administrator of a healthcare system to ensure your system is in compliance with the law?
Answer: If Texas were to pass a death with dignity act, as the chief administrator of a healthcare system, I would take the following actions to ensure my system is in compliance with the law:

Our hospital should devise a detailed guideline/policy for how to legally implement physician-assisted dying with sufficient legal counsel.  For example, the decision of physician-assisted dying implementation must be approved by a physician-assisted dying committee to ensure that the patients have terminal illnesses and do not want to continue their life with unbearable suffering.  Also, the decision should also be requested and/or approved by the families and/or lawyers of the patients.  The patients would reserve the right to choose if they eventually accept the death assistant.  After all, the ultimate goal of the death with dignity act is to improve end-of-life care.

Our hospital should develop a culture of collaboration among providers across disciplines and integrating educational resources that helps patients and providers working together to plan the end-of-life process.  The implication of the death with dignity act is complex on many domains.  Therefore, each step in the interventions should involve detail, sensitive, accountable medical, legal, and social interactions to ensure a high quality of care.  Our hospital and providers should regard physician-assisted dying as a last resort, so that we should guarantee that patients who made requests for physician-assisted dying already are engaged in hospice or have received palliative care and consultations (Death With Dignity, 2018).

Reference

Campbell, C. S. (2019). Focus: Death: Mortal Responsibilities: Bioethics and Medical-Assisted Dying. The Yale journal of biology and medicine, 92(4), 733.

FindLaw (2016). Texas Euthanasia Laws. Retrieved on April 12, 2021, from https://statelaws.findlaw.com/texas-law/texas-euthanasia-laws.html

McAshan, B.R. (2019). Doctors debate physician-assisted suicide in context of Jewish Holocaust history. Retrieved on April 12, 2021, from https://www.tmc.edu/news/2019/01/the-center-for-medicine-after-the-holocaust-hosts-physician-assisted-suicide-discussion/

Pattison, N. (2020). End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic. Intensive & critical care nursing, 58, 102862.

Death With Dignity. (2018). The Impact of Death with Dignity on Healthcare. Retrieved on April 12, 2021, from https://www.deathwithdignity.org/news/2018/12/impact-of-death-with-dignity-on-healthcare/

Post 2:

Death with Dignity Discussion Post

Death with dignity can be defined as an assisted death or suicide facilitated by a qualified person, preferably a doctor or a physician. Death with dignity is similar to mercy killing because the medical expert involved introduces the means to end the volunteers life indirectly. In the United States, assisted death is a highly controversial topic and is only legally allowed in 11 jurisdictions: Oregon and the District of Columbia being among them.

Death with dignity is governed by the constitution of the various states it is approved. In the District of Columbia, the death with dignity act of 2016 was passed into law on the 18th of February 2017. The act dictates that anyone wishing to end their life must be medically confirmed to have less than 6 months to live, and they must also be residents of DC (Death with Dignity Act of 2016, n.d). The act clearly outlines the roles of all the parties involved, i.e., the patient, physician and pharmacist. In Oregon, the death with dignity act was passed in 1997 (Oregons Death with Dignity Act (DWDA), n.d). The act allows terminally ill Oregon residents to voluntarily end their lives through a lethal dosage medication prescribed by a qualified physician.

The Covid-19 pandemic has brought extreme changes in the context of patient care and general healthcare. With the minimal recommended contact between patients and loved ones, it has become harder for caregivers to understand patient needs and preferences (Smith, 2020). Most patients in critical and paralyzed conditions cannot communicate with families, limiting communication to only caregivers and families, and as a result, decision-making regarding assisted death can be challenging. I believe assisted dying is pertinent as suffering during sickness can be excessive and can only be cut short by death. Additionally, love liberates and if a family loves a suffering person, the best favor is to mitigate this pain by assisted dying. However, such decisions must depend on the patients will.

Texas currently has minimal activity concerning the death with dignity act. The jurisdiction has never officially considered adopting this act, although several citizen groups are working around the clock to legalize assisted dying. However, if Texas adopted the death with dignity act, I would ensure that the provisions in the act are strictly followed as chief healthcare system administrator. By capturing detailed data on how such practices affect my constituents, I would better understand whether the act is beneficial or not. Finally, I would ensure proper medical and mental examination to ensure the suitability of affected patients willing to go down this road.

References

Death with Dignity Act of 2016. (n.d). DC Government. https://dchealth.dc.gov/page/death-dignity-act-2016

Oregons Death with Dignity Act (DWDA). (n.d). Oregon Health Authority. https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/faqs.aspx

Smith, T. (2020, June 2) End-of-life care challenges during COVID-19: What doctors must know. American Medical Association. https://www.ama-assn.org/delivering-care/ethics/end-life-care-challenges-during-covid-19-what-doctors-must-know