Transcript TERMINAL CONDITION

TERMINAL CONDITION
ADJUSTING THE TIME AND MANNER OF
DYING
TERMINAL ILLNESS/CONDITION
DEFINITION
• A CONDITION, BROUGHT ON BY DISEASE OR
INJURY, WHICH IS PRESENT IN PATIENTS WHEN
THEY EXPERIENCE KEY SYSTEM OR MULTIPLE
SYSTEM FAILURE, WHICH IS PART OF AN
IRREVERSIBLE AND/OR DETERIORATING
PROCESS AND WHICH WILL RESULT IN DEATH
AS AN INEVITABLE AND PREDICTABLE
OUTCOME.
– FINAL PHASE OF AN OTHERWISE CHRONIC
CONDITION
SOME KEY ISSUES
• “TIME” DESIGNATION [ARBITRARY?]
• ROLE OF NATURAL SELECTIVE FACTORS
• DEATH AS FAILURE OF BODY SYSTEMS OR
FAILURE OF TECHNOLOGY
• TECHNOLOGY AS “HASTENING” DEATH OR
“LENGTHENING” LIFE
• QUALITY OF LIFE QUESTIONS AFTER DIAGNOSIS
– PAIN CONTROL
– PLEASURES
– ACTIVITIES
ADJUSTING THE TIME AND MANNER OF DYING:
THE CAUSAL CONNECTIONS IN THE DISEASE/INJURY
NETWORK
•
•
•
•
DISEASE
PROGRESS OF DISEASE
SYMPTOMS
THERAPEUTIC RESPONSES
– INITIATING TREATMENT
– WITHHOLDING/WITHDRAWING TREATMENT
• DECISIONS [INTENTIONS]
– PATIENT [REFUSAL OF TREATMENT]
– SURROGATE
– CAREGIVER
• PHYSICIAN’S DIRECT CAUSAL ACTIVITY ADDRESSING PATHOLOGICAL
CONDITION
• CAUSAL FACTORS EXTERNAL TO THE DISEASE NETWORK
– MEDICATIONS --- ACTIONS --- INTENTIONS
RIGHT TO REFUSE TREATMENT
• RIGHT TO PRIVACY
– 1,4,5,9,14 AMENDMENTS
– QUINLAN (1976] ET AL..
• CRUZAN (1990)
– LIBERTY RIGHT (14TH AMENDMENT]
• ENDORSED BY THE PATIENT SELF-DETERMINATION ACT (1990]
• VACCO V. QUILL (1997)
– LIBERTY RIGHT (14TH AMENDMENT]
– “EVERYONE, REGARDLESS OF PHYSICIAL CONDITION, IS
ENTITLED , IF COMPETENT, TO REFUSE UNWANTED
LIFESAVING MEDICAL TREATMENT; NO ONE IS PERMITTED
TO ASSIST A SUICIDE.”