Transcript Power Point Presentation

 The
concept of death
 Criteria of death: refers to the
evidence that indicates that
someone is dead
◦ Cardiopulmonary criterion:
irreversible cessation of
cardiopulmonary functions
◦ Brain-death criterion
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Physician-assisted suicide: when a patient
ingests a lethal substance provided by the
physician for that purpose
Voluntary euthanasia: the physician
administering the lethal substance
Is there a moral difference between the two?
Does, in the former case, the physician kill
the patient, while in the latter, the patient
kills herself?
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Has its origins in Roman Catholic moral
theology, where it is employed to distinguish
between obligatory care—ordinary— and care
that may be permissibly forgone—
extraordinary.
has been criticized as being unclear and
resulting in confusion and controversy about
how it should be applied (U.S. President's
Commission).
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The distinction used to mark the difference
between statistically usual and statistically
unusual care, between noninvasive and highly
invasive treatments, and between treatments that
employ low- and high-technology interventions
The correct understanding of the traditional
distinction is the difference between treatment
that is beneficial and treatment that is unduly
burdensome (or without benefit) to a patient.
 Public
opinion
 Medicine: American Medical
Association’s ethical guidelines
◦ “the physician should not
intentionally cause death.”
 Religion
 Law
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Four Kinds of End-of-Life Treatment
Pain and suffering
Pain management
Competency
Persistent Vegetative State
Whole-Brain-Death
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Four forms of treatment of patients near
death that have received special attention are:
resuscitation,
artificial nutrition and hydration,
terminal sedation,
futile treatment
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70-90% of advanced cancer patients have
sever pain that requires the use of opioid
drugs
90 - 95% of patients can have their pain
controlled
5% have excruciating and intractable pain at
the end of life
Options:
◦ Continue to offer morphine (ineffective)
◦ Kill patient (illegal and immoral)
◦ Offer palliative sedation
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The larger question in many of these
situations is: how do we respond to suffering?
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Hospice and palliative care
Aggressive pain-killing medications
Sitting with the dying
Euthanasia
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Brain death is defined as the irreversible cessation
of all the functions of the entire brain, including
the brainstem. If the brain can be viewed
simplistically as consisting of two parts—the
cerebral hemispheres (higher centers) and the
brainstem (lower centers)—brain death is defined
as the destruction of the entire brain, both the
cerebral hemispheres and the brainstem.
In contrast, in the permanent vegetative state (PVS)
the cerebral hemispheres are damaged extensively
and permanently but the brainstem is relatively
intact
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The vegetative state is characterized by the
loss of all higher brain functions, with relative
sparing of brainstem functions. Because
brainstem functions are still present, the
arousal mechanisms contained in the
brainstem are relatively intact and the patient
therefore is not in a coma. The patient has
sleep/wake cycles but at no time manifests
any signs of consciousness, awareness,
voluntary interaction with the environment, or
purposeful movements. Thus, the patient can
be awake but is always unaware: a mindless
wakefulness.
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The vegetative state is considered
persistent when it is present longer than
one month in the acute form and
permanent when the condition becomes
irreversible.
The exact prevalence is unknown, but it is
estimated that in the United States there are
approximately 10,000 to 25,000 adults and
4,000 to 10,000 children in a vegetative
state (Multi-Society Task Force on PVS).
The Terri
Schiavo case
is, so far, the
most famous
and notorious
end-of-life
case of the
twenty-first
century.
Lawrence M. Hinman
http://ethics.sandiego.edu
3/27/2016
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The Schiavo autopsy, released June 15 2005,
showed severe and irreversible brain damage
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Brain half its usual size
Damaged in almost all regions, including that
region which controls vision
Lawrence M. Hinman
http://ethics.sandiego.edu
3/27/2016
15
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ethical and legal doctrine of informed consent
The doctrine of informed consent
◦ requires that treatment not be administered without
the informed and voluntary consent of a competent
patient
◦ promotes the well-being of patients while
respecting their self-determination or autonomy
◦ provides especially strong support for patients
deciding about life-sustaining treatment
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another person must decide for them about
life support treatment
turning to a close family member of the
patient, when one is available
How should a surrogate make lifesustaining-treatment decisions for an
incompetent patient?
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There are three standards for a surrogate's
decisions:
advance directive (e.g., a "living will" or a
"durable power of attorney for healthcare")
the "substituted judgment" standard
the "best-interest" standard
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Physician gives a lethal injection to the patient
Physician assists a patient with suicide
Physician gives a dying patient medication
needed for pain relief although the drugs will
hasten death
Physician withdraws nutrition and hydration
through tubes or lines
Physician withdraws needed life-sustaining
treatment
Physician withholds nutrition or life-suistaining
treatment
 Various
degrees of causing death:
◦ Active euthanasia
◦ Assisted suicide
◦ Pain medication so heavy it shortens
life
◦ Withdrawal of needed life-sustaining
treatment
◦ Withdrawal of medical nutrition and
hydration
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Moral conceptions regarding taking life and
killing may be divided into:
goal-based,
duty-based, and
rights-based
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A goal-based position (utilitarianism)
prohibits taking life when doing so fails to
maximize the goals or consequences the
position holds to be valuable, for example,
human happiness or the satisfaction of
people's desires
This position not only permits but requires
taking an innocent person's life when doing
so will produce the greatest balance of
benefits over harms
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Taking life is wrong because it violates a
fundamental moral duty not to take innocent
human life intentionally.
This view looks not to the consequences
produced by a particular killing but to the
action itself, which is prohibited by the duty
not to kill.
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Taking human life is morally wrong because it
violates a basic moral right not to be killed.
killing harms its victims because it denies
them their future, together with all that they
wanted to pursue or achieve in that future.
It wrongs its victims by taking from them
without their consent what is rightfully
theirs—their lives.
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the distinction is central to the Roman
Catholic doctrine of double effect
Double effect refers to actions that may have
two effects, one that is directly intended and
the other one only indirectly intended or
foreseen.
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In treating a dying cancer patient's pain, it
may seem clear that the physician's primary
or direct intention is to treat the pain
The earlier death from respiratory depression
caused by the morphine the physician
prescribes to treat the pain is, at most, a
secondary or indirect intention, or more
accurately, a fore-seen but unintended
consequence.
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Killing is usually distinguished from allowing to die by
establishing whether something was done, or not done,
that resulted in death.
A person who kills performs an action that causes a
person to die in a way and at a time that the person would
not otherwise have died.
The claim is that the mere fact that one doing is a killing,
while the other is an allowing to die, does not make one
morally better or worse than the other, or make one
morally justified or permissible when the other is not. This
is compatible with saying that a particular killing, all
things considered, is morally worse than, or not as bad as,
a particular allowing to die because of other differences
between the two, such as the motives of the agents or the
presence or absence of the consent of the victim.
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When a decision is made not to initiate some form of lifesustaining treatment, such as kidney dialysis or support,
and the patient dies as a result, this is commonly
understood to be an omission and so an allowing to die
But what of stopping life support—for example, stopping
respirator support at the persistent, voluntary request of a
clearly competent and respirator-dependent patient who is
terminally ill and undergoing suffering that cannot be
adequately relieved? If such action is taken by the
physician with the intent of respecting the patient's right
to decide about his or her treatment, most people would
consider it a morally justified instance of allowing the
patient to die. If only killing, but not allowing to die, is
prohibited, then stopping life support and not starting it
are both allowing to die and morally permitted.