Running head: LIFE SUSTAINING MEASURES VS.

PHYSICIAN ASSISTED SUICIDE

Life sustaining measures vs. Physician assisted suicide
Cassaundra Braden
Ferris State University

LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 2

Abstract
Many long term care facilities use life sustaining measures to keep patients alive when
their quality of life is low. This paper compares the options available to people who are trying to
decide how to deal with a loved ones end of life along with the options available. A comparative
analysis was done on life sustaining measures and physician assisted suicide to determine which
option is best for people near the end of life. To determine the solution, information was
gathered from eleven different sources. The information was compared and contrasted to
determine which would be a better option for your family member.

LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 3

Table of Content

Abstract2
Introduction..4
Life sustaining measures..............4
Types of life sustaining measures .......4
Artificial ventilation ....4
Mechanical ventilation.....4
Artificial nutrition and hydration........4-5
Dialysis...5
Chemotherapy..5
Radiation therapy.5
Advantages of life sustaining measures....5-6
Disadvantages of life sustaining measures .....6
Physician assisted suicide ...6
Types of physician assisted suicide.6
Active euthanasia ............6
Passive euthanasia ..........6
Physician assisted....7
Advantages of physician assisted suicide........7
Disadvantages of physician assisted suicide7
Conclusion ......7
Reference......8-9

LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 4

Introduction:
Life sustaining measures can be defined as any medical device or procedure that increases your
life expectancy by restoring or taking over a vital bodily function. With physician assisted
suicide, or PAS, the terminal patient wants to die and is seeking a doctor to assist them in doing
so (Zanskas & Coduti, 2006). The question to be answered is; which is the best option for my
loved one?


Life sustaining measures:
As stated above, life sustaining measures ensure continued life in patients whose bodies cannot
provide this on their own. There are various procedures used depending on the body organ that
is malfunctioning. Generally, any procedure will involve a machine and various tubes
connecting the patient to it. This is an option for those whose quality of life is undetermined or
families and patients who are not yet ready to let go.


Types of life sustaining measures:
Artificial ventilation
Artificial ventilation is used when the body cannot sustain a certain volume of air to be inhaled
and exhaled to maintain the correct levels of oxygen and carbon dioxide within the tissues
(Blakemore, 2001). Tissue damage, which will eventually lead to death, occurs if the level of
oxygen becomes too low or the amount of carbon dioxide becomes too high. The body is
therefore critically dependent on breathing to maintain life. When the lungs become inadequate,
or stop altogether the patient must receive artificial ventilation to survive. This is done by
mouth-to-mouth breathing or resuscitation.


Mechanical ventilation
Mechanical ventilation is used to sustain life in a patient not able to breathe on their own. The
patient is first anaesthetized and given a muscle relaxant which stops the breathing. The
endotracheal tube is then passed down between the vocal cords and into the patient's windpipe.
A machine then delivers oxygen in periodic bursts at positive pressure which forces air into the
lungs. Each time the positive pressure is withdrawn the patient breathes out because of the
passive recoil of the lung tissue. This type of artificial ventilation is now the most common type
in medical practice.


Artificial nutrition
Artificial nutrition and hydration is another life sustaining measure. A feeding tube is often put
in place for patients when swallowing is considered unsafe due to a neurological condition such
as stroke, multiple sclerosis, or motor neuron disease (Gastronomy, 2012). A procedure is done
where an opening is made into the stomach from the outside. It is usually performed to allow
food and fluid to be introduced into the stomach through a tube. This is called a percutaneous
LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 5

endoscopic gastrostomy tube, or PEG tube. These are very common in long term care facilities
to maintain adequate nutritional status in patients.


Dialysis
Many patients in long term care facilities undergo dialysis treatment multiple times a week.
Generally, the procedure lasts 3-4 hours and the patient must relocate to another facility for this
process. Hemodialysis is done by removing blood from the body, circulating it through a
purifying dialyzer, and then returning it to the body (Kowalak, 2012). Various access sites can
be used for this procedure, and access can be temporary or long term depending on the patient's
requirements. Arteriovenous (AV) fistulas are the preferred access because they last longer and
are associated with fewer complications than other hemodialysis access sites. To create a fistula,
the surgeon makes an incision into the patient's wrist or lower forearm, followed by a small
incision in the side of an artery, and then another in the side of a vein. A surgeon will suture the
edges of the incisions together to make a common opening. This fistula will take 4-6 weeks to
heal before it may be used.


Chemotherapy
Very often the cause of body malfunction can be related to various types of cancers. The
treatment for this is either chemotherapy or radiation therapy. The term chemotherapy refers to
treatment of cancer by powerful chemicals. Powerful medications will kill cancerous cells in the
body, whilst leaving surrounding cells functioning healthily (Blakemore, 2012). Patients are
connected to an intravenous line or sometimes a port is already established in the chest,
connected to the heart. The procedure begins by giving medications that decrease the side
effects of the chemotherapy medication. This usually involves antiemetic drugs to help with
nausea. The patient then begins the medications derived to treat the cancer. They may be
connected to the IV for numerous hours.


Radio therapy
Many forms of cancer are destroyed by radiotherapy. Radiation therapy is commonly applied to
the cancerous tumor because of its ability to control cell growth. Radiation works by using
penetrating rays such as X-rays, beta rays, or gamma rays, which may be produced by machines.
These rays damage the DNA of exposed tissue leading to cellular death. To spare normal
tissues, such as skin or organs which radiation must pass through to treat the tumor, shaped
radiation beams are aimed from several angles of exposure to intersect at the tumor. This
provides a much larger radiation dose there than in the surrounding, healthy tissue
(Radiotherapy, 2012). In some cases radioactive material in the form of needles, wires, or
pellets, may be implanted in the body to treat the cancer.


Advantages of life sustaining measures:
When normal body function is no longer efficient in maintaining life in an individual technology
takes over. There have been monumental advances in medicine and the health care field as a
LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 6

whole. If there is a health concern, there is more than likely a treatment to cure it prolonging life
with it. In most cases there are multiple options to overcome any potentially life threatening
obstacle. This allows for more families to remain whole for longer, or in some cases buys them
enough time to accept the inevitability of death.


Disadvantages of life sustaining measures:
Much is to be debated on the quality of life in individuals who receive life sustaining measures.
All of the treatments listed above are unpleasant and often unbearable. For the patient
undergoing these measures there is often pain and side effects that are difficult to tolerate. Some
of the individuals experiencing life sustaining procedures are unable to communicate the effects
of the treatment on them physically and emotionally. Often the toll on the families is also
emotionally challenging.


Physician assisted suicide:
Physician assisted suicide, or PAS, is a term often used interchangeably with euthanasia.
However, euthanasia refers to ending the life of the patient to alleviate symptoms seen as non-
tolerable with or without the knowledge of the patient. There is little to no dignity left in the
dying patient. It is not uncommon for patients who are suffering from chronic progressive and
terminal conditions to consider hastening death, leading to requests to their physicians for
assistance in dying. Assisted suicide currently is legal only in the state of Oregon. Physician-
assisted suicide occurs when a physician facilitates a patient's death by providing the necessary
means and/or information to enable the patient to perform the life-ending act (Fine, 2012).


Types of physician assisted suicide:
Active euthanasia
Active euthanasia is the action of directly causing the quick and painless death of a person. It is
usually understood that euthanasia is performed only with the intention of relieving suffering,
and where death is perceived as the greater good or lesser evil for the patient (Blackburn, 2012).
Active euthanasia means acting to bring the death about. To be active, the physician actively
assists for the patient to die, for example, by administration of a lethal injection.


Passive euthanasia
Passive euthanasia means not preventing death or omitting to prevent it when intervention was
within the agent's powers. In other words in order to be declared passive euthanasia the
physician is withholding or withdrawing treatment necessary to maintain life (Zanskas & Coduti,
2006). Generally there is no patient request, but the physician or other health care professional
decides to hasten the patient's dying process to relieve suffering usually by discontinuing life
sustaining measures.

LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 7


Physician assisted
Physician assisted suicide refers to suicide carried out with the assistance of a doctor whose role
is typically to provide a lethal dose of a drug at the explicit request of the patient (Physician,
2012). In PAS the doctor is providing advice and or drugs to the patient to enable the patient to
take his or her own life.


Advantages of physician assisted suicide:
Euthanasia is something many people would wish for themselves if life were to become
unbearable. In the United States, the public increasingly accepts physician-assisted suicide and
euthanasia as moral practices and believes that these practices should be legal.

It is commonly
said that hospitals and physicians over-treat sick patients in their last days, making the dying
process a painful journey, and medicine's inadequate and ineffective treatment of suffering.
These views also reflect a demand for more control in decisions about the end of life (Federman,
2012). In many systems of law it would be illegal to give a suffering person a painless death
when, if a cat or dog were in the same condition, it would be illegal not to do so.


Disadvantages of physician assisted suicide:
One set of worries concerns its expansion to form an environment in which old people are
encouraged to go quietly, and to feel guilty about hanging on. Simon Stevens discusses
euthanasia in the future as such an overwhelmingly popular option that it would devalue the lives
of older people and the disabled who will be pushed into ending their lives by their families to
avoid being a burden. Stevens asked what dignity is there in running away from your problems
and life? Suicide is a state of despair when other solutions seem impossible but it is no solution
(Stevens, 2009). End-of-life care is available through hospice and palliative care programs so
some may say there should be no reason anyone would need to seek PAS.


Conclusion:
After considering the positives and negatives of life sustaining measures and physician assisted
suicide; one conclusion can be made. No matter which option is chosen, it will be the best
option for the family. Every circumstance is different and nobody can understand what another
person is going through. Sometimes there is still hope left or a family member or loved one is
not ready to let go. In this case, lift sustaining measures will be the best option. When the end of
life and issues surrounding it are too much to bear, physician assisted suicide may be the option
for your family.

LIFE SUSTAINING MEASURES VS. PHYSICIAN ASSISTED SUICIDE 8

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