Arras made a good point about the uninsured and poor, stating that, “Minorities and the poor already suffer from the effects of discrimination in our health care system, it is reasonable to expect that any system of PAS and euthanasia will exhibit similar effects, such as failure to access adequate primary care, pain management, and psychiatric diagnosis and treatment. Unlike Dr. Kevorkian’s “patients”, these victims will not get their pictures in the papers, but they all will have faces and they will all be cheated of good months or perhaps even years.” More focus should be on the minorities and poor, since they do not have stable financial means, or even any financial means, to help get counseling, pain relief, etc., and yes, they are then robbed of the life they deserve of fulfillment. Arras’ point about the uninsured, poor and minority, brought to my attention things that I did not even think about, which made me wonder why Dworkin and the other authors of the Philosopher’s Brief did not take this into consideration. The author’s of The Philosopher’s Brief are ‘united on their conviction that respect for fundamental principles of liberty and justice, as well as for American constitutional tradition, requires that the decisions of the Courts of Appeals be affirmed.’ But what surprised me is that when talking about liberty and justice, no where did they mention about the uninsured and poor.
The author’s discussed points about how individuals in a free society must be allowed to make life decisions for themselves, based on faith, conscience, and convictions, protected by the courts. Also, the author’s discuss the case of how Cruzan support the liberty interest, which states if a competent patient has a constitutional right to refuse life-sustaining treatment, then the court implied the state could not override that right. Cruzan also supports that a state may not burden a terminally ill patient’s liberty interest in determining the time and manner of his death by prohibiting doctors from terminating life support. Also, given were examples of different situations where people had certain diseases that were not curable and what their decisions were with regards to ending their lives without suffering….If these authors feel so strongly about respect for fundamental principles of liberty and justice, why did they leave out such an important group of people, which includes minorities and the poor? The article was worded to point towards a certain group of people that have the means to make the decisions they wish, but not to the less fortunate.
Suppose a poor person that lives on the streets, scrounging for food and a place to sleep at night, has cancer, chronic pain, or some other disease and cannot go into a clinic for help because they have no money. Do we disregard them and let them suffer and die as a human being that deserves respect and help, just like anyone else? Where is the liberty and justice there, which the author’s are so united about?
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You ask in the last paragraph:
ReplyDelete"Suppose a poor person that lives on the streets, scrounging for food and a place to sleep at night, has cancer, chronic pain, or some other disease and cannot go into a clinic for help because they have no money. Do we disregard them and let them suffer and die as a human being that deserves respect and help, just like anyone else? Where is the liberty and justice there, which the author’s are so united about?"
I don't see how this is relevant. The issue at hand is PAS--physican assisted suicide. It is true that poverty--and the myriad negative effects of it--calls for action. But this is a different issue from PAS as a person on the streets does not ask a physician to assist his/her suicide. There is no law that I know of that prohibits suicide, as opposed to assisted suicide. The case can be made, from a moral perspective, perhaps also based on the similar considerations that motivate those authors who "feel so strongly about respect for fundamental principles of liberty and justice" that morality calls for the elimination of poverty and affordable healthcare. This, however, is a different issue from that of PAS.
Although Arras does bring up the point of how a new policy permitting PAS "would not be conducive to humane decisions untainted by subtle economic coercion", I do not believe that this was a large potential problem that he was trying to address. It is my belief that Arras was trying to come up with potential flaws with the three requirements that must be met in order to justify this social policy:
ReplyDelete1. that all requests made are voluntary
2. that all other options have been explored and discussed
3. a sort of checks and balances system where physicians must monitor these practices and report abuses.
The fear that some legislative proposal would be implemented within a social system that already has deep roots in discrimination against the poor and minority groups (2nd requirement) was what had given rise to Arras pointing out this disparity between rich and poor. I believe that he was merely trying to state that it will be unreasonable for us to assume that physicians will provide the time and humane comfort to discuss alternatives with those who can not afford their primary care. (good care= lots of time and time= money!)
This issue, as Lebenswelt has pointed out, is not an issue relevant to PAS, but rather one that addresses the need for the social reform that Arras later suggests.
I personally agreed with Arras in that we as a society are not ready for PAS. Although I believe that it is a constitutional right for us to determine when and how we die, I feel that we as a society must first undergo this clinical and social reform before opening the doors to all these other social issues.
I tend to agree with both cchristi and lebenswelt on this one, ilovelucy. Like them, I don't believe that the author's intention was to reflect on the disparity suffered throughout health care for the less fortunate and/or minorities, but rather to discuss arguments both for and against PAS.
ReplyDeleteSeems Arras leans more heavily for the arguments posed against PAS than for, to which I agree. Just as the author offered, I think that we all can agree that issues surrounding "how we die in America" deserve attention because simply put, like it or not, we are all going to be faced with that decision either for ourselves or someone we love. I work with patients in a dialysis center and often hear them say things like "I can't take much more of this" or something along those lines - as Arras mentioned, my guess is that many of these patients are depressed and in pain due to the illnesses they are faced with - not just end stage renal disease. I believe that if they were offered better pallative care, and medication or psychological therapy to address their depressed states, that those who claim that they are ready to "give up", might well change their tune if they thought they could live with a better quality of life for a few more years free of pain and hopelessness.
My concern is just as Arras mentioned, the possibility for abuse of PAS is extremely high. Also, if pain is the box that needs to be checked for this "procedure" to take place, how can that be measured and who then determines when it's enough pain to prescribe PAS? I don't think we're ready as a society to answer questions like these enough to make them legislatively enforceable.
True, there doesn't seem a more geniune opportunity to be autonomous in ones life considering health care then to decide how/when to die, but to make that choice for others by setting a precedent is dangerous at best. After all, once the decision is made, it's hardly reversible.
What would you do if faced with that decision for yourself or a loved one? It's difficult to for me, as (thankfully) a healthy person to even fathom how I'd answer this question...
As a healthy person there is no better time to fathom this question. If you avoid it the choice will fall on those you love and others you never met. Good luck.
ReplyDeleteI agree with presence saying that it is too early to legalize PAS in social consequences of liberization. "slippery slop" arguments is once if PAS legalization come, then there are some issues that hard to control for these matters to individual patients with unfairness, abuse, neglect and mistake. It will be too late to do anything when we are facing some problems with PAS.
ReplyDeleteJohn D.Arras's arguments with favoring in PAS,
#1 Autonomy- Patient right to decide
#2 Euthanasia is sometimes the best choice.
A.people fear a loss of control when they are very sick. B. People who suffer from severe depression;however, when physician treat their patient with right prescription to treat for depression and pain medications or other medications for other problems, they may not feel wanted to die anymore because these patients are getting more tolerable with their symptoms and pain with prescription drugs.
Arras arguments for the againt PAS are more stronger than favor with these reasons.
#1 violation of moral rule against killing.
#2 Physician should not kill their patients. by PAS would ruin patient and physician's relationships. physician should be helping their patient to cure, but not killing.
#3 social consequences that there are chance to treat patients unfairly even though patient is not terminally ill. Sometime, physician can make a mistake, abuse or neglect their patint to performing pas injusifiably.
Arras beleives that it is wise to legal restraint PAS and aggressive medical intervention unreasonably and inappropriately.
I am favor in Arras arguments. People who are terminally ill as like cancer patients who are staying in hospice facility, no other treatment can not help these patients for cure, any way these patients are getting benefit to receive pain medications without legal restriction a like morphine drip through intravenously at end of their terminal stages who suffer from mostly in pain. So that they will die peacefully with no pain when time come.
Our earthly life, we are getting for only one time. I would like to carefully evaluated for my life by my self and physicians that if I could sustain my life as long as I could live with better quality of my daily life.