Paper Sample: End-of-Life Choices in California: Legal, Ethical, and Practical Considerations

End of life is a condition where a person has a remaining life span of six or fewer months. This is mainly associated with a patient having a terminal illness or having an incurable disease. End-of-life treatment involves patients using some death-inducing medicines as a way to quicken death (Rich, 2012). This being the case, it raises a lot of questions on the right to take a person’s life depending on the views of society.

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The ethicality of the physicians is mostly questioned as their roles of aiding in treatment are reversed in this treatment and instead aid in the death of their patients. However, due to paternalism, the doctor may be more credited to make the decision on the best treatment for the patient due to their experience. According to the Code of Ethics of the American Medical Association, the doctor should objectively relate to the patient. This can be achieved through autonomy and paternalism and therefore no room for conflict of interest (Broody, 2010)

Other contemporary ethical issues include the research fertility. According to Andrew Pollack, there is research on the best embryo to get a baby from; test-tube embryo or the human embryo (Pollack, 2014). The interests of the kind of child parents have is also ethical. Some parents alter their children’s formation before birth to suit their interests by using technology. Based on John A. Robertson (1996), the interests of the parents and that of their unborn baby should be equalized.

In California, the state has permitted its doctors to carry out and uphold the treatment based on the set conditions. It is the fifth state to be allowed to use hospice treatment, the doctors are expected to do good for their patients. According to Kennedy Schwartz, physicians should not inflict harm on their patients but should prevent evil, remove harm, and promote the good, (Kennedy Swartz, 2001). This is a conflicting decision not only for the caregivers but also for the families involved. The drugs commonly used are the ABX2-15 as advised by the doctor.

A case study in an end-of-life situation is of an 80-year-old man diagnosed with pulmonary fibrosis associated with cardiac failure. The chances of him being in his final year are high. He was an active and habitual smoker just recently and had just been cured of tuberculosis four months prior. His kids live miles away with four of his grandchildren. As a retired teacher, he lives alone.

He has been under pain management for a while now. Due to the distance, his family has only seen him twice in three months and as a result, Tim feels neglected. He suffers from depression and though he has accepted his soon-to-be fate, he still wishes he could have more time with his family. He soon after learns about the ABX2-15 and decides the prescription would do to aid a faster death. He opts for home-based care but his health diminishes with time and after three consecutive admissions, he passes on.

Laws Regarding End-of-Life Issues in California

For those who opt to participate in the end-of-life process, it is a requirement by the law to carry out the process in a just manner. There is a procedure that the physicians must take while attending to the affected patients. This may include a diagnosis that is already confirmed and if need be, they can be referred to other specialized physicians. The said doctor must be registered and licensed by the Drug Enforcement Administration. They are entitled to advise their patients of their current situation and where necessary to even make them aware of other options like palliative care instead of end-of-life medicines.

Before administration of the said drugs, the doctor should analyze the mental condition of their patients to determine how they respond to their condition (Mughal, 2014). This is very important as the patient may not be in their full state of mind when agreeing to such terms. Some may be mentally ill or depressed, and thus end up opting to take the drugs. It should be noted that the law does not allow a person to opt into such a decision if they are not of legal age.

The patient must be 18 years and above and very susceptible to the fatal illness with probably a life term of less than six months. According to DeBord (2014), physicians should work towards minimizing their patient’s pain and any symptoms when working towards a decent death for their patients. The process is also helpful to caregivers since they are taught how to care for the patients.

Also, the doctor should try to find out if their patient understands their prognosis and diagnosis prior to opting to take the drugs. The doctors should discuss the beliefs, fears, and possibly even hopes of their patients. They should assess how doubtful or accepting the patients are of their condition. The consultation between the doctor and the patient should also involve ways of managing pain and symptoms for the patients (Kennedy Schwartz, 2001). Patients should learn of the advantages of hospice care and palliative care, should they opt to choose from them. Figure 3 illustrates the differences between palliative and end-of-life (hospice) care.

The patients who opt into taking hospice care are required by law to make requests to their physician twice within the same month orally but with a time interval of 15 days. This should be accompanied by a written request from the patient to the doctor. The presence of a third party is crucial so that the person acts as the witness. The patient should also be able to self-administer the medication in situations where the doctors may not be within reach.

The patient must also be a resident of California and able to make sound decisions on their own. This should be certified by their doctor after a mental assessment of the patient. Their decision to opt in to ask for aid-in-dying drugs should also not be a result of being coerced by others. It should be noted that no one is allowed to make the request on behalf of somebody else; only the patient is allowed to make their request known. This means that not even the power of an attorney permits a third party to make such a request on behalf of their client, the patient.

It is also a requirement by the law that the patient must be suffering from a terminal illness with a remaining span of about six or fewer months (Rich, 2012). The diagnosis should be final and incurable according to the doctors and with a reasonable assessment of likely death within a few months. The patient should also be well informed of their condition by the physicians and should they feel like they are being deprived of information, they are at liberty to consult with other doctors or organizations and even use referrals. Figure 2 shows how the laws relate to patients and their physicians at the end of life issues based on the principles and how they are applied to the care.

Consent in End-Of-Life Issues

Consent in end-of-life situations requires prior consideration of matters in depth. Before the physicians can administer the “aid-in-dying” drug, they must first get the approval of the patient. This means that the patient should be in a position where they already know of their state of health, have consciously determined what they want freely without influence, willingly present their wish to start on the medication, and understand the consequences of their actions. The patient’s mental state of mind should be okay so that their decision will not be considered to be void (Mughal, 2014). Otherwise, their request would be nullified.

Consent in matters of life and death can only be considered to be ethical if the patient solely makes the decision. It should be rated based on the expectations of the patient; and how realistic their expectations are. They should understand the nature of the treatment and the impact it would have directly and indirectly on them and their loved ones. The patient should be able to clearly voice out their wishes and rationally discuss the information they receive, as a way of gaining more knowledge on the subject.

They should be fully aware of all the possible scenarios in the course of their treatment or lack of treatment. Based on the info availed, they can decide if they can cope and take each day as it comes or if they would rather put an end to their already not-so-long life. They should also understand the terms for undertaking the treatment as stated by the law. However, it should be noted that the patient equally has the right to refuse to undertake the treatment.

Consent is said to be problematic if the decision to be made by the patient is either unknown, unavailable at the crucial time of need, or if the decision is considered void due to various circumstances. Such circumstances include dealing with minors, patients who suffer from dementia, the mentally ill, the unconscious, and the disoriented old (Brody, 2010). Their decision to partake in treatment is highly questioned and thus may be considered to be unauthentic.

An example of consent is the case of an individual who recently got dementia. His decision to pursue end-of-life medication has a higher chance of being accepted compared to another individual who has lived with the condition for a longer period of time.

Institutional Review Boards and Clinical Research.Institutional Review Boards (IRBs) major in looking out for the welfare of people during the medication. Through clinical research, the body can evaluate and monitor the progress of the study with humans as the subject of the study. They also audit the records and improve on research based on educating the participants (Jacobs, 2010). They have enacted a set of regulations that protect human life and advocate for conducting good trials.

The required essentials include consent, having the necessary documents, and following the set protocols during the trial (DeBord, 2014). The National Advisory Board on Social Welfare and Healthcare Ethics majors on the principles of ethics avails healthcare expertise and submits initiatives for healthcare.

The International Conference on Harmonization in conjunction with the WHO ensures that the given data from patients and the results of the trials are precise and reliable (Jacobs, 2010). They also ensure the utmost confidentiality of their patient’s details. Such bodies are entitled to educate their researchers on ethical issues and avoid misconduct since the trials are done on vulnerable people. The institutions should ensure that the risks of the trials are reduced and constantly monitor the progress of the trial on the patient.

For example, is the study of contraceptives in San Antonio. Its main objective was to identify the side effects of the pills. The Hispanic women who were the subjects were however not informed of the ongoing trial. As a result, a lot of unplanned conceptions took place. This was a result of misconduct which is against the expectations on the review boards. The patients were not fully informed about the trial and as a result ended up expectant.

Role of the Government in the End of Life Issues

The government plays a major role by regulating the processes of reporting clinical data in the necessary healthcare forums. It indulges in purchasing the best treatment quality-wise and gifting the best clinical health workers (American Medical Association, 2014). Public domains are created as a way to disseminate relevant information to the public. It expands on applied research and encourages the spread of the information obtained from the research by use of modern technology.