carla staton and heather mutchie. questions? how old is old? when have you lived a full life? what...
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Ethical Issues on Aging & Dying
Carla Staton and Heather Mutchie
Questions?How old is old?When have you lived a full life?What is bioethics and why has it become so
important?What is the difference between active and
passive euthanasia?How does having the option of euthanasia effect
people?How hard should we work to keep an old person
alive? Vs. keeping a young adult or child alive?
BioethicsBecause of increased medical technology,
Bioethics has become more prominent Bioethics is the study of the interface
between human values and technological advances in health and life sciencesWhich means, balancing between respecting a
person’s freedoms and wishes and recognizing that it is impossible to to establish one solid version of the moral decision
Example: the decision to turn off life support for a family member.
EuthanasiaEuthanasia is the practice of ending life
based on mercyEuthanasia is arguably the most important
issue in bioethics today and very controversial
The considerations that must be made when considering euthanasia are the value and quality of a human life
Most common situations where this arises are terminal illnesses and when life is sustained only by a medical machine
Euthanasia
Active vs. Passive EuthanasiaEuthanasia can be practiced either actively
or passivelyActive euthanasia is deliberately and
intentionally ending a person’s lifeIf the patient is unresponsive the wishes of
their proxy or surrogate are considered in this matter.
Passive euthanasia is the type of euthanasia that involves letting someone dieExample: not preforming a surgical procedure
Active EuthanasiaActive Euthanasia is also commonly referred
to as assisted suicideExamples are administering a drug overdose
or disconnecting life supportThough most Americans support actions like
disconnecting life support, there is still strong moral opposition for many reasons, commonly religion
Many studies have been conducted in European countries as well on this issue and found that mixed feelings are widespread
Cont.A Swedish study (Valverius, Nilstun, &
Nilsson, 2000) showed that increasing the education on pain relief methods decreased the amount of requests for assisted suicide
Cultural InfluencesA person’s culture has a tremendous effect on
how they view suicideCatholics view suicide as the ultimate sin Japanese believe that suicide is an honorable
way to dieAsian Americans have the highest rate of
suicide in America and generally feel that being a burden on their families is justification
Less than a third of Americans in most Ethnic groups oppose physician-assisted suicide
Cultural Influences
CriteriaMany people accept physician-assisted suicide if a
certain number of criteria are metThe Oregon law makes it legal to request a lethal dose of
medicine, however there are strict guidelines The Dutch Supreme Court ruled that physicians cannot
be prosecuted for assisted suicide if criteria are metOregon law is more restrictive but fundamentally similar.
It requires that patient be informed that they terminally ill and of all the alternatives, the patient must be mentally competent and make a total of 2 oral requests and a written request with 15 days in between each request
Impacts of Oregon Law341 deaths in the first 10 yearsPsychological benefits for the patients
Knowing the option is available for them to use is comforting
Passive EuthanasiaWithholding treatment from an already dying
person is generally acceptedTreating cancer in a dementia patientThe moral justification is that treatment would only
prolong death and extend the pain of the patientWithholding nourishment, such as food, is
generally opposed by most people, even when the patient is terminally ill.U.S. Supreme Court ruled in the Nancy Cruzan case
that a living will or health care power of attorney must indicate the desire to stop nourishment and that no third party has the right to do so.
Passive EuthanasiaTerri Schiavo Case also dealt with the form of
passive euthanasia that ended nourishment through forced feeding.This case illuminated all of the moral, medical,
and legal issues surrounding the topic of passive euthanasia
The argument between her parents and husband showed how emotional passive euthanasia and the belief in “death with dignity” can be.
End-of-Life IntentionsSome of the controversy and argument around euthanasia
can be avoided by making one’s intentions clearly knownEnd-of-life intentions are generally made known through a
living will. In the living will, feelings about certain treatments, diseases and life support are written down and a durable power of attorney for health care is appointed.
Living wills come into importance when the person is not competent or unconscious.
Living wills bring up issues that many people do not want to think about or deal with so many people avoid taking this step, making the ethics surrounding euthanasia more and more complex
Passive EuthanasiaPassive Euthanasia has become a controversy
in more ways that oneEuthanasia itself is highly debated but
passive euthanasia seems to be contradictory The argument is any form of euthanasia still
ends a life, which is an active processPassive Euthanasia can be accomplished two
ways: withholding treatment and withholding nourishment; However, these two methods are met with differing levels of approval
How old is old?Life Expectancy: age at which 50% of the
population dies as of this Century: 85 years old
Lifespan: maximum potential; longest lived of a population
As of this Century: 120 years old
Arking, R, Biology of Aging
All of these are great for caring for sweet old ladies BUT…Callahan’s “On Setting Limits” 1968What is the social role of the old that we are
keeping around? Being used for the effects that come with aging
rather than for the unique quality of being aged Social responsibilities
Theories of Aging: Disengagement and ActiveTHEREFORE: Is it right to use public funds to prolong
their lives?
Public funding for the AgedACTIVE - The Advanced Cognitive Training for Independent and Vital
Elderly
REACH-Resources for Enhancing Alzheimer’s Caregiver Health
Medicare – gov’t funding for medical expenses
Hospice – end of life care (not exclusive to elderly)
Graph from Dr. Rodney Guttmann
Cont’d
Resource Allocation-Society as a Cell
When have you lived a ‘full’ life?Measurements of quality of life
How to quantify? How could we declare a cut-off point? When can we say a life is ‘worth’ living?