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Another Voice: Patient autonomy demands respect at the end of life

By Michael Mezzadri

I write this article in response to the Another Voice column in which the author condemns physician-assisted suicide because it has “never been an ethical part of medicine.”

I ask the author two questions: According to whose ethics? And, are we serious about patient autonomy? As an associate professor in philosophy, I would expect the author to see that he is interested in imposing a particular set of narrow ethical principles on the physician-patient relationship, principles that may not be shared within the confines of this sacrosanct relationship, and that limit both patient autonomy and the physician’s duty to minimize suffering.

The set of ethical principles the author espouses puts “life at all costs” on a pedestal, but does not offer solutions to serious questions. It’s an easy way out, one where there are no shades of gray, an un-nuanced philosophy applied to situations that demand nuance.

In terminal illness where pain can be intractable, suffering immeasurable, is the author willing to say that patients under these circumstances must continue to live contrary to their wishes if they are indeed voiced?

By doing so, we make a conscious choice to not only impose and prolong suffering, but to say that their values are secondary.

Having autonomy removed at the end of life is precisely what those approaching end of life fear. Perhaps when patients at the end of life voice fear of losing autonomy and dignity we should take them seriously. Perhaps we should respect them enough to not say “you must continue to live despite your suffering. I know what is best, and it is life.”

Is prolonging life for the sake of life itself a worthy goal? For the healthy and young, it may seem so, yet when we approach death in sickness, values may change, opinions may shift. The response should not be to restrict options for competent patients at the end of life, to impose upon them a particular hierarchy of ethics, but to say, “I take your autonomy seriously.”

Some may not wish to prolong their life; the suffering may be too great. Who are we to say otherwise? We can pretend we are “protecting” people by doing so, but these people do not need protection, they need to have their autonomy respected and their fears of having this autonomy removed ameliorated.

The “aid in dying” movement simply wishes to remove the medical paternalism associated with end-of-life options, to respect the autonomy of the terminally ill, and to remove the pretentious notion that terminally ill patients need protection from the consequences of competently made decisions.

Michael Mezzadri is a student at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.