Philip C. Brutkiewicz

Dr. Emerson

IDMD 101

29 September 2023

Physician Assisted Death

What is death? When do we truly die? These are the main questions brought to us in the first reading of the day. Many define death as the permanent end of biological functioning of an organism, or organismic death. This is contrasted with the death of a person, which is the irreversible loss of all functions of the brain and consciousness. These trains of thought lead us into questions about abortion, euthanasia, and the withdrawal of life support. Death Dualism combines both of these ideas, stating that death is both organismic and consciousness-based. In the Quill article, Dr. Quill indirectly “helps” his patient, Diane, with terminal cancer commit suicide by providing her with a high dose of sleeping pills which he knows she could use to kill herself. His patient, Diane, has leukemia but decides she doesn’t want treatment as she wants self control and dignity for the remainder of her life. Just as in Chapter 3, the example of Diane brings up the debate of is helping kill another person ethical? Should Quill be punished for assisting in a suicide of an already “dead” person? These are all questions that the article brings to the surface for discussion.

In class that day, after going over the summary of the readings, the class was presented with discussion questions. These included:

Kurt Cobain, the lead member of the band Nirvana, committed suicide at age 27, in the prime of his career. However, Cobain was suffering from depression and a heroin addiction. Was Cobain already dying before he took his own life? Does his situation deserve a different view than that of Diane, since Cobain’s ailment was more mental and Diane’s was physical? (different models of medicine)

Was Dr. Quill right in his decision to supply Diane with sleeping pills he knew she could take her life with (and did), letting Diane go out her own way even if it went against the Hippocratic Oath?

We begin the discussion with the first question, to which the class agrees, to various extents, that Cobain was not already dead. Cobain, even though he was in a horrible mental state, still had the power to get himself out. Switching from Cobain to Diane, Noah has no problem with Diane’s doctor helping take her life, but says that Quill should have justified his situation to law enforcement instead of lying and blaming her death on leukemia.  Diane was going to commit suicide anyway so it was best in a safe and controlled manner. Victoria says that Quill was right in the end as he saved the family from trauma. Too often we associate legality with morality, and covering it up was what the patient wanted. Kaitlin objects, saying that if Quill truly believed that what he died was right he wouldn’t have covered it up. The class agrees that Cobain and Diane’s issues were out of control, but they were only severely hindered, not dead. Nick believes that the medical professionals and patients both cannot really define personhood, only biological death. Dr. Emerson argues that Cobain’s situation has a different stigma because he was young when he died, even though addicts are always in recovery and never “normal” again. It is really difficult to pin down when a situation is medically futile. Micaela believes that one would be dead if they were living like Diane, barely able to function before dying of cancer in weeks. Alejandro is wary of this, as he thinks describing someone “dead” while they are still conscious could lead to a slippery slope where doctors are free to “pull the plug” for faulty reasons. Doctors are supposed to continue life, not end it.

The discussion then shifted to views on death and whether it is good or bad? Is it something to be excited for, with the hope of heaven/paradise? Sophia says that death is not black and white and we should rely on patients’ own opinions for themselves. Kaitlyn agrees, saying that some people religiously think that death is good because of hope for heaven. Nick believes that wanting death is not the same as wanting heaven. Noah believes that medicine needs to be personalized, just as finance portfolios are. Dr. Emerson agrees, saying death can change its value based on the situation.

After this discussion, I realized that the death of an organism is more useful than the death of a person. With the death of an organism, life is officially over, and physicians can act as such. However, personhood is more murky, with different members of society arguing loss of personhood at different stages of suffering. If society was to use the personhood model over the organismic model, it could lead to a slippery slope, which is worrisome. Doctors may abuse their power, and declare someone dead as a person too soon, especially members of society not deemed “useful”, such as the homeless or the extremely poor. These doctors may take these suffering members of society, and instead of helping them get as close to normal functioning, decide that their life does not have value and that they are better off dead. This is pure eugenics, artificially altering the genetic pool of the population, which has been rightly discouraged for almost a century but is starting to come back.

Personalized medicine is needed. As Noah put it, we already personalize finances, so why not personalize our livelihood and our health? Just because one human may be lost as a person does not mean another is in the same boat, even if they have the same health statistics. While Diane may have been “dead” as a person since she was ailing and about to die, another person might be excited to live the rest of their life, no matter the condition or duration. We should not make the same decisions on everyone, we must have diversity-based approaches instead of a one-size-fits-all approach.

This discussion confronts the debate of abortion. America has long been divided over the issue, whether fifty years ago with Roe v. Wade or the recent ruling in favor of state’s rights. Biologically, the unborn fetus is alive, as it has a pulse and is a living organism. However, early on, the fetus has yet to develop consciousness, which supporters of personhood can say proves that an abortion is not murder. In the early stages of pregnancy, I believe that the collection of cells is not yet a person, so an abortion is ok. However, in the latter stages of pregnancy, the child starts to develop some mental abilities. At this stage, I do not support physician-assisted abortions as it starts to become murder.

Through the readings and discussion, the class and I gained a better understanding of how we identify death, as well as when physicians should intervene. Some physicians, such as Quill, even intervene against the Hippocratic Oath if they think that it is the right decision. Doctors are taught to preserve life, not to end it, but if a situation is bound to happen, the doctor may act to make the situation as smooth as possible. Nothing is black and white, and death is no exception.