Reaction paper 2

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Controversy7.ppt

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Controversy 7

Should People Have the Choice

to End Their Lives?

Should People Have the Choice to End Their Lives?

More than two-thirds of all deaths in the United States occur among people over age 65

Medical advances force us to make decisions unforeseen just a few decades ago

Should People Have the Choice to End Their Lives? (cont.)

Euthanasia—from the ancient Greek meaning simply “good death”
Active euthanasia—denotes some deliberate intervention to end the patient’s life, such as giving a fatal dose of painkilling medication
Passive euthanasia—not doing something, such as withdrawing life-support therapy
Assisted suicide—a doctor or family member actively provides the means or carries out the instructions required for an individual to end his or her life

Depression and Suicide

Several common predictors of suicide include the following:
Intolerable psychological pain and frustration
A feeling of hopelessness or helplessness
Communicating the intent to kill oneself
Clinical depression—differs from the “down” state that is a common response to setbacks and is temporary
Can be difficult to diagnose because it can manifest with a variety of symptoms
Insomnia, fatigue, inability to concentrate, anxiety, and other physical or emotional discomforts

Depression and Suicide (cont.)

It can be difficult to determine whether an older adult’s rejection of lifesaving treatment is an informed choice or a sign of depression
But depressed patients are more likely to refuse procedures in situations where the medical prognosis is actually good
Doctors are committed to keeping patients alive at all costs
But the attitude of “treatment at all costs” may not respect someone’s decision to end his or her life

The “Right to Die”

Widespread public discussion of the ethics of death and dying began during the late 1960s
First major “right-to-die” case involved Karen Ann Quinlan in 1976
First important “right-to-die” law passed was the California Natural Death Act (1976)

The “Right to Die” (cont.)

Under common law in the United States, people have a basic right to accept or reject medical treatment, and therefore a right to refuse treatment

The “Right to Die” (cont.)

Guardian at litem—a designated spokesperson who represents the interests of an incapacitated person and reports to the court
Courts rely on two kinds of standards to determine when to withhold or withdraw treatment
Standard of substituted judgment—asks “What would this patient have wanted under these circumstances?”
Best-interest standard—asks “What is the balance of benefits and burdens that a ‘reasonable person’ might want under these conditions?”

The “Right to Die” (cont.)

Advance directives—legal documents such as a living will or power of attorney for health care instructions
In most jurisdictions in the United States, assisting a suicide is a crime

Americans lack a clear consensus about exactly how “dying well” might be defined
At a minimum, “dying well” typically refers to having the right to know one’s medical condition, and the choice to accept or reject life-prolonging treatment

Outlook for the Future

The Netherlands has gone the furthest in legalizing euthanasia and physician-assisted suicide
Critics of assisted suicide and euthanasia believe we should focus more on palliative care—such as hospice and better pain medication
Patient Self-Determination Act (PSDA)—a 1991 law that requires hospitals, nursing homes, and other health care facilities to advise all patients at the point of admission about their right to accept or refuse medical treatment

Reading 30: Why Do People Seek Physician-Assisted Death?

What are some of the insights Pearlman and Starks gained from conducting their longitudinal study of patients who seriously pursued assisted death?

Reading 31: A Time to Die

McKhann states, “Quality of life to the last and control over the circumstances of dying are issues that touch everyone, and assisted dying will become legal and accepted when the public wants it to be.”

Discuss your reactions to this quote. Do you agree or disagree that assisted dying will become legal with the public wants it to be?

Reading 32: Last Rights—
Aunty’s Story

What are the major impressions you took away from Last Rights: Aunty’s Story, by Woodman?

Reading 33:
Neither for Love Nor Money

Kass begins his essay with the question: “May or ought one kill people who ask to be killed?”

Discuss your thoughts in response to this question from various standpoints—caregiver, physician, spouse.