Dying and Suicide



EUTHANASIA and PHYSICIAN ASSISTED SUICIDE

 

CASES:

1. Karen Ann Quinlan:  The right to refuse treatment

2. Oregon 1994 Law (in effect 1998) - Physicians prescribe Medications in Lethal Dosage

     Doctors only (MD's) Protected-1998 only 15 in 29,000 deaths in Oregon

3. Federal Patient Self Determination Act-

      Requires Notice of State Laws for refusal of treatment including Advanced Directives

      Obstacles Preventing the Observance of the Act and Respect for Self Determination

4. The Cruzan Case(1983): a 25 year old with PVS

      1990 US Supreme Court (5-4) Decision- a LIBERTY INTEREST

5. Dr. Jack Kevorkian:  Dr. DEATH! Physician Assisted Suicide

     Michigan Law vs Assisted Suicide; 1998 case, taped for  CBS "Sixty(60) Minutes"

6. Elizabeth Bouvia(1983): Demand for Self Determination and Assistance while starving

7. A Canadian Tragedy:   12 year old girl with cerebral Palsy-carbon monoxide poisoning

 

EUTHANASIA

Meaning of the term:  A good Death! An easy death?

Types of Euthanasia?

Active / Passive Distinction

 Killing vs Letting Die

Voluntary vs Involuntary

Self Administered -  Active Self Administered - Passive

Other Administered Active and Voluntary     Passive and Voluntary

                                 Active and Involuntary   Passive and Involuntary

                                Active non- voluntary        Passive non-voluntary

 

DEFINING DEATH

Traditional Heart Lung Criteria

Whole Brain Criteria- No Consciousness, No Brain Stem Activity, IRREVERSIBLE COMA

         Uniform Determination of Death Act - Adopted by > 35 states  not by New York

Higher Brain - Coma with brain stem activity

Personhood- neo cortex- loss of what is essential and characteristic

 

Dutch Experience- 1993 Rules to allow physicians to assist or to kill people at their request

  28 point check list

   1990  2300 deaths that were voluntary and 400 assisted suicides

    1. Patient-initiated request

    2. Patient Competence

     3. Informed about alternatives

     4. Enduring Decision

     5. Unbearable Suffering

     6. Professional Consultation

      7. Government Report

      8. Signed and Witnessed Authorization

Advanced Directives:

    Do Not Resuscitate Orders- DNR's

    Living Wills

    Proxy Appointments-Legal Agents

 

The Right of Self Determination:

1. Children- guardians make decisions and may not refuse imperative (life saving) procedures

2. Adults

   A. Incompetent - court appointed guardian makes decisions and may not refuse imperative 9life saving) procedures

   B. Competent- may refuse any and all treatments:

           Exceptions: prisoners and those with dependents may not refuse imperative treatments

   C. Formerly Competent and now incapacitated

OPTIONS:

•         Doctor Decides

•         Committee of Doctors

•          Advanced Directives

•                Document: Living Will

•                Surrogate: Durable power of Attorney: PROXY

•          Next of Kin

•           Court

 

ETHICAL THEORIES

 

Natural Law:

No direct termination of a life.  Indirect is allowed.  Pain relief even unto respiratory failure is permitted.  No moral obligation to treat the hopeless cases. Allowing to die is permitted allowing nature or God's Will to take their courses.

UTILITARIAN:

Action or inaction that leads to death is correct when it alleviates suffering and promotes the general welfare and better feelings (utility).

Kant:

Rational agents have the duty to preserve their lives if possible.  No deliberate suicide.  When agent is no longer capable of rational thought then there is no longer a duty to preserve that life.  Allowing to die is thus permitted and compatible with Kant's principle even if not required as a perfect duty.

 

Ross:

Duty to fulfill promise and a duty to act in a person's best interests.

 

Rawls:

Maximize Liberty and allow for self-determination. Minimizing the disadvantages allows for terminating treatments and hastening the death of the hopelessly ill and suffering.

 

 

 

ARTICLES:

James Rachels: Active and Passive Euthanasia

• No real Distinction

• Crucial Element is Intention

Dan W. Brock: Voluntary Active Euthanasia; a Utilitarian justification

J. Gay-Williams: The Wrongfulness of Euthanasia

   1. it is against Nature

  2. It is against Self Interest

• mistaken diagnosis

• chance of cure

• pessimism- self defeating

3. Practical Effects

    a. Dr's and RN's are committed to saving lives.  They would be corrupted to think that there are occasions when the person (Patient) is better off dead.

   b. Slippery Slope!!- 

•        from Self Administered to Other Administered

•        from Voluntary to non-voluntary

•        from for the benefit of the person to the benefit of others, society, humankind

 

Daniel Callahan: When Self Determination Runs Amok

US Supreme Court: Karen Quinlan

Rebecca Dressen and John A. Robertson: Quality of Life and Non Treatment Decisions

Bernard Gert, James L. Bernat, R. Peter Mogielnicki: Distinguishing Between Patients' Refusalas and Requests

Sandol Stoddard: Terminal But Not Hopeless

 

DECISION SCENARIOS:

1. Pneumonia and 92 year old male

2. Brain hemorrhage and 81 year old male

3.Five (5) Fatal Diseases in 70 year old male with a Living Will

4. Four deaths of elderly without higher brain functions

5. Shot dead

herlands Law 1993

7. Female 45 years old with leukemia and an overdose of prescribed medication

8. Flash Fire Victim and surrogate decision making

 

 

 

 

 

 

SUICIDE

 What is suicide?

 What is required for an act of suicide?

actions or omissions

actions or intentions

outcome or intention

Attempted Suicide

Committed Suicide

  

How are these to be described? Suicide? Something else?

Situations:

1 Socrates

2 Jews at Masada

3 Christians in Coliseum

4 Irish in British Prisons

5 Buddhists in Indochina

6 Woman taken by would- be rapist

7 POW's

8 Spies

9 Slaves in the hold of a slave ship

10 Persons in intractable pain

11 persons with an incurable, life threatening, debilitating  disease

12 Persons with an emotional problem in emotional pain

Would you act to prevent any of the acts above if you could?

Should family members be permitted to assist in suicides?

What conditions or safeguards should exist, if any?

Should health care personnel be permitted to assist in suicides?

Should doctors, nurses, others?

What conditions or safeguards should exist, if any?

 

State Intervention to Prevent Suicide

State Intervention to Compel Life Saving Treatment

Acts of Paternalism!

Issues: Self Determination, Autonomy, Individual Liberty, Competency

with Dependents and Incompetents, the guardian must decide in favor of treatment if there are such possible that will relieve , rectify or cure.

Only Life Saving Medical Treatment can be imposed on another

 

ETHICAL THEORIES:

Kant- No

St. Augustine- NO

Hume-Yes

St. Thomas Aquinas- No but maybe yes

RATIONAL SUICIDE - When Death is preferable both NOW and in the FUTURE.

 

The Role of others? A.  To refrain from interference

                                 B. To Assist

 

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download