(Dr. Leonard Bernstein, MD, MPH is a retired orthodontist and former Professor of Orthodontics at Boston University. After retiring, he returned to school and obtained an MPH from Boston University. He is a prolific author and lecturer on both professional and non-professional subjects. He and his wife live in Brookline, Massachusetts, and in Port of Spain, Trinidad.)
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A society can develop many different cultures and codes, whether moral, ethical, or legal, based upon its needs and experiences. This is especially so for the way societies have evolved and changed attitudes toward death and dying – and whether to aid a person in their dying process.
Early conceptual attitudes
Societies consist of people and the cultures they form, and the decisions they make result in a community. A society can develop many different cultures and codes – moral, ethical, or legal – based upon its needs and experiences. However, societies are not static, but are subject to changing forces and circumstances not only from within, but also from without, imposed by the surrounding world. Such changes can lead to shifts in moral, ethical, and legal standards based on society’s needs as it evolves.
Changing needs in our modern society are causing significant changes in society’s attitudes toward death and dying. One change is the issue of not only providing the means for a person to end their own life, but also of allowing someone else to aid in their dying process.
Many shifts in attitude have, over time, become law, though initially opposed by many individuals and groups. There is still opposition, especially by religious organizations like the Catholic Church. It considers aid in dying to be a grave sin against the Sixth Commandment, which forbids direct and intentional killing.
Their interpretation is, “Thou shalt not kill.” This is not, however, the only interpretation. Under the Philonic division of the Commandments – followed by Hellenistic Jews, Greek orthodox believers, and Protestants (except Lutherans), as well as by the Talmudic division according to the third-century Jewish Talmudic – the proscription is, “Thou shalt not murder.”
The evolution of physician control
A great amount of power over living and dying evolved during a long process from folk healers to Shamans, to barber surgeons, and eventually to the physicians we recognize today. Such power developed by elected legislative bodies recognizing them, licensing them, and granting them control to dispense medications, particularly those able to cause death.
Physicians are trained to present wonderful healing gifts to us. However, in the process, they also evolved a mindset that all diseases must be treated as much and as long as possible to keep the patient alive. For many centuries, the rise of this mindset persisted to the extent that the doctor was culturally imbued with a sense of power. All too often, this belief evolved to authoritarianism. This segued to a code of belief that treatment must go on regardless of the patient’s and family’s wishes. It took years of litigation to wrest this power away.
Patient autonomy
A key concept in the evolution of a patient taking control of their own bodies and treatment is the philosophical idea of autonomy. It can be defined as the capacity and ability to make an informed, un-coerced decision, and the right of the people to make their own decisions. This faith in autonomy is the central premise of the concept of informed consent and shared decision-making.
After much conflict and litigation, autonomy – but only to some degree – was given back to the individual the patient.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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Patient autonomy versus physician authoritarianism . I am completely ready to return to the time of folk healers or Shamans or even Barber Surgeons. Leave it up to the person seeking healing to decide the who, what, where and duration of care. As so well outlined as to patient autonomy – …It can be defined as the capacity and ability to make an informed, un-coerced decision, and the right of the people to make their own decisions”. Hard for me to find any fault with that approach. I have not been to a physician since 1992…could be interesting if I ever meet up with one of them.