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from our blog: living with dying |
Physician-Assisted Death and Behavioral Economics
Posted by Guest Blogger on May 9, 2011
This article was written by by Arjun Khanna and originally published on Dan Ariely's Blog.
As the American population ages, the debate about the ethics of physician-assisted suicide for terminal patients becomes more important.
Proponents of legalizing of physician-assisted suicide argue the practice is ethically justifiable because it can alleviate prolonged physical and emotional suffering associated with debilitating terminal illness. Opponents claim that legally sanctioned lethal prescriptions might destroy any remaining desire to continue living – a sign of society having "given up" on the patient.
Ultimately, these arguments rest on differing opinions regarding the effect of this policy on the patient's wellbeing. The challenge, then, is to determine how legalization of physician-assisted suicide would affect the wellbeing of terminally ill patients and their medical decision-making. Outside of philosophical arguments, examination of an interesting finding regarding physician-assisted suicide – know as "The Oregon Paradox" – can add an interesting dimension to the debate. The paradox is the finding that when terminal patients in Oregon receive lethal medication (under Oregon's Death with Dignity Act), they often feel a sense of greater wellbeing and a desire to live longer. In 2010, of 96 patients requested lethal medication, only 61 actually took it. Even more interesting are the many anecdotal accounts of terminal patients, upon receiving lethal medication, that feel a surge of wellbeing and a desire to persevere through their illness.
Why is this this the case? Looking at this question from an expected-utility perspective suggests that given the option to terminate their own life, terminal patients will decide how long they want to live by comparing the value they expect to gain from the rest of their lives to the expected intensity of their suffering. At the point where future utility is expected to be negative—that is, when the patient's condition becomes so intolerable that living any longer is not worth the cost—the patient would choose to end life if the option were available. The critical point from this perspective is that patients choose the amount of time they are willing to continue living with their illness, which will depend how quickly they deteriorate. If the rate of deterioration is slower than expected, then patients should delay terminating their lives; if the rate of deterioration is faster than expected, patients should desire to end their lives quicker.
But now let us say that patients have been prescribed lethal medication and have the option of ending their lives at any point of their choosing. As before, patients don't want to choose a time too soon or too distant, but with the power to control the end of their lives they no longer have a reason to err on the side of haste! The patients can now wake up every day with the comfort of knowing that they do not have to suffer through pain or stress they might find intolerable.
Being given the option to determine the time of our own death can transform patients from powerless victims of their illness to willing survivors of it. Together, the importance of feeling in control and the ability to reduce (but not eliminate) uncertainty about rate of deterioration adds an interesting new dimension to the underlying ethical debate and seems to provide credence to the benefits of legalized physician-assisted suicide.
It is clear is that we need a greater understanding of the decision-making of patients at the end of their lives, and that with this improved understanding we can construct policy to better protect their wellbeing (for an interesting recent movie on this topic see "How to Die in Oregon").
Defend dignity. Take action.
You are the key to ensuring well-crafted Death with Dignity laws for all Americans. With your financial and volunteer help, the Death with Dignity National Center, a 501(c)(3), non-partisan, non-profit organization, has been the leading advocate in the death with dignity movement. Member contributions helped us pass a new Death with Dignity law in Washington, defend the Oregon law, and provide education and outreach programs for the vitality of the death with dignity movement.









Comments
Kudo's to the sensitive "How to Die in Oregon" film maker! I have long thought we should all be assigned a "boodle-bag" available, upon request, to determine when and how we choose to end this experience we call LIFE when we choose.
I am an 80 year old woman, former breast cancer patient, who has also had two strokes from which I worked very hard with a physical therapist to regain strength and get my body back in shape. I live alone, love my life ... moved from Hawai'i to Santa Monica in 2003 to begin my "last hurrah" as a character actor. My family (there) could not believe I would leave the comfort of the islands to embark on a new experience, knowing no one in the industry or, any neighborhood! Now they are happy and rather proud of me. I miss watching great grandchildren grow up but it is my life and I have never regretted the decision. Each month I scramble to keep above water financially but each day I hop a bus because my agent has called and I am fortunate enough to be booked for a job or called for an audition I feel a JOY that can't be replaced. I know how fortunate I am as I look around and watch friends struggling w/boredom or alcoholism or alzheimers!
Just as I control my life now, I want to be able to control my death. What is the status of California on "death w/dignity?' What can I do politically to insure an individual's wishes to control their destiny can be determined?
About the Oregon Paradox discussion: very interesting and worthwhile except for one thing. It's perhaps better to say: "have access to lethal medication" instead of "receive" or "being given." "Being given" and "receive" are passive in tone; the element of free choice is underplayed or lost. In addition, the words can suggest to a hurried reader that the patient had already taken the medication (and then regretted it, wished to live longer).