Determination of Death / Informed Consent

• UNIFORM DETERMINATION OF DEATH ACT (UDDA):

• DYING -> W/IN CONTEXT OF FAITH

• ORDINARY / EXTRAORDINARY MEANS OF LIFE SUPPORT

• ASSIST / SUBSTITUTE VITAL ORGANS

• DIALYSIS

• VENT

• CPR

• KILLING OR ALLOWING TO DIE?

DETERMINATION OF DEATH

ORDINARY / EXTRAORDINARY MEANS OF LIFE SUPPORT

Uniform Determination of Death Act (UDDA):

• model state law

• approved 1981

• NATIONAL CONFERENCE OF COMMISSIONERS ON UNIFORM STATE LAWS

• AMERICAN MEDICAL ASSOCIATION (AMA)

• AMERICAN BAR ASSOCIATION (ABA)

• PRESIDENT’S COMMISSION FOR THE STUDY OF ETHICAL PROBLEMS IN MEDICINE AND BIOMEDICAL AND BEHAVIORAL RESEARCH

Determination of Death:

(1) irreversible cessation of circulatory and respiratory functions or

(2) irreversible cessation of all functions of the entire brain, including the brain stem

UNIFORM DETERMINATION OF DEATH: 1. STANDARD CRITERIA (CARDIO-PULMONARY):

 NO HEARTBEAT AND NO BREATHING or

2. NEUROLOGICAL CRITERIA; ELECTROENCEPHALOGRAM (EEG) x PARTIAL BRAIN DEATH (NOT ACCEPTABLE)  TOTAL BRAIN DEATH (YES ACCEPTABLE)

MEDULLA OBLONGATA

DYING -> W/IN CONTEXT OF FAITH

HUMAN LIFE: YES FUNDAMENTAL VALUE / NOT ABSOLUTE VALUE

USA LIFE EXPECTANCY:

• WOMEN: 81 YEARS

• MEN: 76 YEARS

• COMBINED: 79 YEARS

MANAGEMENT, RELIEF: PAIN / SUFFERING

ANALYSIS: BENEFIT / BURDEN

DIAGNOSIS -> PROGNOSIS

BIOETHICAL MEANS OF LIFE SUPPORT:

• ORDINARY (PROPORTIONATE) / EXTRAORDINARY (DISPROPORTIONATE)

CLINICAL MEANS OF LIFE SUPPORT:

• STANDARD MEDICAL PRACTICE / EXPERIMENTAL TREATMENT

ERD 56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that, in the judgment of the patient, offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.

ERD 57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that, in the patient's judgment, do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

ETHICAL OBLIGATION RE. VITAL ORGANS: ASSIST / SUBSTITUTE

WHEN TO WITHHOLD OR WITHDRAW LIFE SAVING TREATMENT?

DIALYSIS: SUBSTITUTES KIDNEYS

RESPIRATOR; ASSISTS IN PROVIDING OXYGEN

VENTILATOR; DEPENDS ON THE SETTINGS: ASSIST OR SUBSTITUTE BREATHING

RESPIRATORS: ASSIST BREATHING

(NOT VENTILATOR)

VENTILATOR: PERFUSION

WEANING PROCESS

VENT ~ 2-3 WEEKS BEFORE TRACHEOTOMY

EXTUBATION

TRACHEOTOMY

(TRACHEOSTOMY)

CARDIOPULMONARY RESUSCITATION (CPR):

• ASSISTS / SUBSTITUTES HEART

Defibrillation

• treatment for cardiac dysrhythmias

• Ex. ventricular fibrillation (VF) and ventricular tachycardia (VT)

• delivers a dose of electric current to the heart

KILLING OR ALLOWING TO DIE?