Riley, M.
http://medicalstudentblog.co.uk
Our current acceptance of a right to die, especially for those who are unconscious and need a proxy decision maker, is a rather slippery slope that may, in the future, be used not to protect individual autonomy or privacy but rather to serve as a facade to rid us of individuals whose lives we do not value.
The abovementioned statement is incorrect because it does not adequately acknowledge the sociopolitical framework that dictates the healthcare system and the responsibility of the proxy decision maker. The “slippery slope” argument is myopic in that it disregards the healthcare system’s primary focus: that is, the individual’s rights.
Historically, death has been difficult to define, and the advent of modern medicine has still left quandaries as to how and when a person may be declared dead. Throughout the 18th and 19th centuries, fear of burial alive was so prominent that safety coffins of various models were used; designed so that anyone regaining consciousness after assumed death may have a means of rescue (Australian Museum, 2009). As medical science evolved, cardiopulmonary death became the primary focus for the diagnosis of death; whereas today the cardiopulmonary death must be concluded to be irreversible (Fremgen, 2009) in order for an individual to be declared dead. However, current debate focuses on neurological cessation, either total brain death or reptilian brain death, as indicative of death (Fremgen, 2009; Garrison & Schneider, 2003). Even in the context of upper brain death, medical professional and courts may decline to declare an individual as dead and hence to cease treatment or begin harvesting of organs. One such case involved an anencephalic child (born without a cerebral cortex but with a functioning medulla oblongata): the child was not declared dead even though there was no chance of survival; no chance of higher thought; no chance of recovery (Garrison & Schneider, 2003). The infant was essentially in a vegetative state with random cardiopulmonary responses. Even though the child was born without a brain, the brain-stem activity was sufficient so that there was no standard for the determination of death (Garrison & Schneider, 2003). Given the extreme circumstances of this case, one would conclude that, due to the social, medical and legal safeguards in place, the individual right to life would outweigh any potential slippery slope implications.
There are many safeguards within the social and legal structure to prevent convenience killings in lieu of undesirable social entities. The decision made by proxies, particularly in the case of an unconscious patient, is a complicated and carefully considered process. In an effort to observe the patient’s autonomy, family is consulted in order to address what the patient’s wishes would have been (Fremgen, 2009; Garrison & Schneider, 2003). “Medical ethics became associated with strict advocacy for individuals… (Wynia, Kurlander & Green, 2006).” This quotation significantly indicates the role of the proxy in the end-of-life decision making process: to advocate for the individual.
Within the American legal system, there has been a rejection of the physician as the ultimate decision-maker, reflecting that the patient’s best interests should be defined by the patient as referenced by goals and values as well as the medical situation (Garrison & Schneider, 2003). The courts seek evidence as to the patient’s wishes, maintaining that clear and convincing proof of intent as a standard to determining a course of action (Garrison & Schneider, 2003). Because of the judicial safeguards in place, as well as the systematic focus on individual rights and autonomy without consideration for the general public indicate that the acceptance of right to die would not lead to an escalation into social cleansing.
References
Australian Museum. (2009). Safety coffins. Retrieved 6 December 2009 from http://australianmuseum.net.au/Safety-coffins.
Fremgen, B. (2009). Medical law and ethics (3rd ed.). Upper Saddle River, NJ: Prentice Hall Health.
Garrison, M. & Schneider, C. (2003). The law of bioethics: individual autonomy and social regulation. St. Paul, MN: Thomson West Group.
Wynia, M., Kurlander, J., Green, S. (2006). Physician professionalism and preparing for epidemics: challenges and opportunities. In Balint, J., Philpott, S., Baker, R., & Strosberg, M., (Eds.), Advances in bioethics (Vol. 9). Oxford, UK: Elsevier.
