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.

Philip Brutkiewicz

Dr. Emerson 

IDMD 101 

10 October 2023 

Short Paper

Written by Harriet Pilpel, The Right of Abortion advocates for the ability to get an abortion in the United States. The article first explores the issue of population control. The U.S. is experiencing overpopulation, and while few argue for compulsory sterilization to combat this, little is done to make birth control easily available for those who want it. This is particularly a problem for the poor and underprivileged, such as racial minorities. Part of this is due to strict anti-abortion laws in many states. These laws limit healthy abortions in these areas to those who can afford an out of hospital abortion, which are usually middle and upper class white women. Society should see that in order to slow population growth rate without compulsion, abortion must be made easily and legally available. 

This article connects to the issues regarding death in Care and Cure by Jacob Stegenga. In Chapter 3, the death of an organism is contrasted with the death of a person. While most define death as the permanent end of biological functioning in an organism, many believe biological functioning alone does not make us alive. While to be an organism one only needs a heartbeat, to be a person one must have consciousness and a soul. This question of what makes us dead has in turn asked us to question what makes us alive. In the context of abortion, a young unborn fetus is organismically alive. This is the view which many lawmakers in our country have taken, such as the Supreme Court when overturning Roe v. Wade and removing the constitutional right to abortion (“Roe v. Wade”). On the other hand, the unborn child has not yet achieved consciousness, thereby not a “person” in the model that the book presents. This issue is significant as depending on which criteria decision-makers in our country take, access to healthy abortions can either be easily available or scarce like in many states today. Lawmakers, such as the Supreme Court, are ignorant of the fact that abortions, like it or not, are going to happen. This is seen in a quote from the article, saying, “Abortion is still the most widespread…method of fertility control in the modern world.” If abortions are vitally important to reduce unwanted births and are going to happen regardless, we should legalize them and promote healthy abortions in hospitals. Lawmakers should be more worried about a person’s livelihood and those already born than the lives of the unborn. 

This piece on the right to abortion also highlights the issue presented in Care and Cure of physician-assisted death. The Hippocratic Oath states that physicians must cause no harm and only give beneficial treatments, but if the child is not wanted and cannot be taken care of, is harm truly being inflicted or really just avoided? Physicians should answer to the mother’s decision, as the parent can decide for themself if the procedure will benefit them more than harm in an abortion. As seen in Care and Cure, patient autonomy has been an ideal of American law since the 1950s. Physicians must seek their patients’ consent, and there is no greater scenario to abide by this rule than in the decision to receive an abortion. By physicians assisting in abortions, it not only gives a higher rate of success and safety, but also mental comfort to mothers who can trust a physician more than someone unqualified. According to the Atlantic, there are 8000-1000 abortions in hospitals compared to 1 million outside hospitals annually. We need to support physician-assisted abortions in hospitals so that less people are attempting home abortions that are much more dangerous for the child and the mother. As the article states, we must not compel the “unwilling to bear the unwanted”. 

Not only does our nation have a problem with general access to abortions, but there are major inequalities in abortion access based on race, color, and socioeconomic status. This is in large part due to the fact that white women tend to be able to better afford out of hospital abortion care, whether it be in their area or traveling to a different state. As Pilpel reveals in her article, “women whose deaths were associated with abortion in New York City in a typical year were 56 percent black, 23 percent Puerto Rican, and 21 percent white”. This sort of statistic is the focus of Hausman’s article What’s Wrong with Health Inequalities?. The article evaluates whether health inequalities involve injustice and compares these inequalities to the standards of the World Health Organization. The World Health Organization, or WHO, generally defines an injustice as a lack of the ability “to be given an opportunity to have equal health status insofar as possible”. In the statistic of New York City abortion deaths, this is a clear injustice as black women and women of color in the city are at a much higher risk of dying than white women. City officials and hospitals must focus on offering easier access to abortions in areas where these women are statistically underserved, such as predominantly black or Puerto Rican neighborhoods. These officials and hospitals can do this by building more hospitals in these areas, setting up clinics, and building trust between the physician and patient. If the patient does not trust the physician, as seen in Care and Cure, the patient is much less likely to tell a physician the entire story or even see the physician again. Take the example of Anne Dodge, a patient who had to go to many different primary care doctors as no doctor truly listened to her situation. Eventually Dodge received a proper diagnosis after going to a doctor that gave her a proper evaluation (Introduction-How Doctors Think). Just as with Dodge, physicians should listen to the mother’s demands when performing an abortion to prevent physical and mental trauma. The end of a possible life is sure to give these women feelings of regret and depression, and physicians must coordinate check-ups after the procedure to ensure well-being. This is why it is important in the fight against abortion injustice to not just have clinics in these areas, but to also have qualified physicians to serve these women. 

Abortion access is a right that all women should have, regardless of where they live. Though some argue for the organismic model of living, an unborn fetus should not be considered living as it has not yet attained consciousness. Lawmakers should use this model to guide their decisions and make abortions easier to obtain. Physicians should be the guiding hand in these abortions, not only performing them but also guiding the mother mentally. We must also try to eliminate injustice in inequalities the best way possible through a reallocation of resources. Abortions have been happening since the advent of humanity. They always will, so we should make them as safe and available as possible.

Works Cited

Hausman, Daniel  M. “What’s Wrong with Health Inequalities .” Journal of Political Philosophy: Volume 15, Number 1, University of Wisconsin-Madison , 2007. 

Introduction- How Doctors Think , 10 Oct. 2023. 

Pilpel, Harriet. “The Right of Abortion.” The Atlantic, Atlantic Media Company, 16 Aug. 2018, www.theatlantic.com/magazine/archive/1969/06/the-right-of-abortion/303366/. 

“Roe v. Wade.” Oyez.Org , www.oyez.org/cases/1971/70-18. Accessed 8 Oct. 2023. 

Stegenga, Jacob. Care and Cure an Introduction to Philosophy of Medicine. The University of Chicago Press, 2018.