Right to DieRight to Die

Right to DieRight to Die

Choices for dying patients and Choices for dying patients and their families due to technologytheir families due to technology

What constitutes a “good death”What constitutes a “good death” Most people die in hospitals Most people die in hospitals

with staff trying to keep patient with staff trying to keep patient alive until no chance of recoveryalive until no chance of recovery

Most people want total effort to Most people want total effort to fight off deathfight off death

Some are facing a terminal illnessSome are facing a terminal illness There may come a point when the There may come a point when the

fight no longer seems worth itfight no longer seems worth it Those patients may find their Those patients may find their

wishes and those of their families wishes and those of their families overlooked as physicians juggle overlooked as physicians juggle medical, legal and moral medical, legal and moral considerationsconsiderations

Patients undergoing minor Patients undergoing minor surgical procedures are surgical procedures are routinely asked if they would routinely asked if they would like to fill out a document, like to fill out a document, known as an “advance known as an “advance directive” or “living will”directive” or “living will”

Living WillLiving Will

Every state now allows people Every state now allows people to issue form of directiveto issue form of directive

Specifies what course of action Specifies what course of action they want if they are unable to they want if they are unable to communicatecommunicate

Only 40% of people have living Only 40% of people have living willswills

Not always bindingNot always binding

Court rulings have firmly Court rulings have firmly established a patient’s legal right established a patient’s legal right to discontinue life sustaining to discontinue life sustaining treatment, such as respirators or treatment, such as respirators or artificial nutritionartificial nutrition

Debate over these decisions is Debate over these decisions is far from settled- Terri Schiavo’s far from settled- Terri Schiavo’s case went on for 12 yearscase went on for 12 years

Another issue is whether Another issue is whether individuals should be able to individuals should be able to ask physicians to hasten their ask physicians to hasten their deaths- in effect, help them deaths- in effect, help them end their lives- and whether end their lives- and whether it is morally acceptable for it is morally acceptable for physicians to do sophysicians to do so

Right to DieRight to Die

Should individuals be able to Should individuals be able to ask doctors to hasten their ask doctors to hasten their deaths?deaths?

Who decides whether life is Who decides whether life is worth living or not?worth living or not?

Should others (families, Should others (families, doctors, government) be able doctors, government) be able to decide for them?to decide for them?

Many people say they would Many people say they would rather die than suffer in rather die than suffer in great pain or endure life great pain or endure life trapped in a vegetative statetrapped in a vegetative state

Should individuals have the Should individuals have the right to decide when and how right to decide when and how they will die?they will die?

What is considered What is considered unbearable?unbearable?

Terminal illness?Terminal illness? Chronic physical pain?Chronic physical pain? Debilitating, although not Debilitating, although not

fatal, illness?fatal, illness?

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Euthanasia: hastening the Euthanasia: hastening the death of a terminally ill death of a terminally ill patient- patient-

Is it mercy and respect?Is it mercy and respect? Or is it murder?Or is it murder?

Right to DieRight to Die

Euthanasia: Euthanasia: Is it a measure of control Is it a measure of control

over timing, or is it a slippery over timing, or is it a slippery slope of neglect of old, poor, slope of neglect of old, poor, disabled, emotionally disabled, emotionally distraught, seriously ill?distraught, seriously ill?

Right to DieRight to Die

Religious and moral Religious and moral questions:questions:

Life and death should be left Life and death should be left for God, not human beingsfor God, not human beings

Life is to be cherished, not Life is to be cherished, not abandonedabandoned

Right to DieRight to Die Netherlands, Belgium, Netherlands, Belgium,

Switzerland, Luxembourg- Switzerland, Luxembourg- physician assisted suicide is legalphysician assisted suicide is legal

United States: Oregon and United States: Oregon and Washington permit physician Washington permit physician assisted suicide- Montana and assisted suicide- Montana and Massachusetts have tried to make Massachusetts have tried to make it legal but so far it has failedit legal but so far it has failed

““Death with Dignity Act”Death with Dignity Act”

19941994 OregonOregon Doctors can prescribe lethal Doctors can prescribe lethal

dose but not give itdose but not give it Ensure patients seeking this Ensure patients seeking this

to be mentally competent, in to be mentally competent, in great pain, intent on ending great pain, intent on ending their lifetheir life

60% say doctor assisted 60% say doctor assisted suicide not murdersuicide not murder

Dr. Jack KevorkianDr. Jack Kevorkian

MichiganMichigan Helped 130 people commit Helped 130 people commit

suicidesuicide Sentenced to prison for 10-25 Sentenced to prison for 10-25

yearsyears Served 8 years in a Michigan Served 8 years in a Michigan

prison for administering a fatal prison for administering a fatal injection to a terminally ill maninjection to a terminally ill man

Should Kevorkian have Should Kevorkian have been convicted of murder?been convicted of murder?

Karen Ann QuinlanKaren Ann Quinlan

21 yrs old21 yrs old April 15, 1975, took alcohol April 15, 1975, took alcohol

and drugsand drugs Full blown comaFull blown coma Doctors pronounced her Doctors pronounced her

condition a “persistent condition a “persistent vegetative state”vegetative state”

Karen Ann QuinlanKaren Ann Quinlan

Doctors said most basic life Doctors said most basic life processes could be kept going, but processes could be kept going, but she had ceased to be a human beingshe had ceased to be a human being

Or had she?Or had she? EEG detected traces of electrical EEG detected traces of electrical

activity in her brainactivity in her brain Machine said she was not “brain Machine said she was not “brain

dead”dead”

Karen Ann QuinlanKaren Ann Quinlan

Her parents were deeply religiousHer parents were deeply religious Felt that she had the right to “die Felt that she had the right to “die

with dignity”with dignity” Tried to get respirator turned offTried to get respirator turned off New Jersey Superior Court New Jersey Superior Court

rejected plea after 7 months on rejected plea after 7 months on respiratorrespirator

Karen Ann QuinlanKaren Ann Quinlan

““This is not a court of love, of This is not a court of love, of compassion, but a court of law. compassion, but a court of law. You can’t just extinguish life You can’t just extinguish life because it is an eyesore.” said because it is an eyesore.” said her court appointed guardianher court appointed guardian

New Jersey Supreme Court New Jersey Supreme Court overturned decision March 31, overturned decision March 31, 19761976

Karen Ann QuinlanKaren Ann Quinlan

Everyone thought she would Everyone thought she would die very soon from brain die very soon from brain deathdeath

She lived for 10 years She lived for 10 years without a respiratorwithout a respirator

Died in 1986 from pneumoniaDied in 1986 from pneumonia

60% say spouse should 60% say spouse should make decision for coma-make decision for coma-

like patientlike patient

Terry SchiavoTerry Schiavo

Brain damaged patientBrain damaged patient No living willNo living will Family was dividedFamily was divided Years of litigationYears of litigation Husband eventually won to Husband eventually won to

have feeding tube removedhave feeding tube removed

Terry SchiavoTerry Schiavo

Increased public interest in Increased public interest in living willsliving wills

20 states have issued bills to 20 states have issued bills to clarify laws about living willsclarify laws about living wills

Right to DieRight to Die Perspective 1Perspective 1

Recognize the right to die with Recognize the right to die with dignity, with a physicians dignity, with a physicians assistanceassistance

Permit people to have a “humane” Permit people to have a “humane” deathdeath

Individuals have the right to Individuals have the right to determine the time and determine the time and circumstances of their deathcircumstances of their death

Right to DieRight to Die

Perspective 2Perspective 2 Focus on giving comfort and Focus on giving comfort and

recognizing the patient’s recognizing the patient’s preferencespreferences

Recognize patient’s right to control Recognize patient’s right to control the treatment they receive- relieve the treatment they receive- relieve pain and ease the depression the pain and ease the depression the patient is experiencingpatient is experiencing

Improve the quality of life for the Improve the quality of life for the patientpatient

Allow patient to issue directives, Allow patient to issue directives, not just preferences, about end of not just preferences, about end of life care and treatmentlife care and treatment

Expand hospice careExpand hospice care Remove barriers to effective pain Remove barriers to effective pain

management- such as overly management- such as overly restrictive regulation of narcoticsrestrictive regulation of narcotics

Right to DieRight to Die

Perspective 3Perspective 3 Reaffirm the commitment to Reaffirm the commitment to

preserve lifepreserve life Condemn practice of physician Condemn practice of physician

assisted suicideassisted suicide It should be illegalIt should be illegal Unconditional value of human Unconditional value of human

lifelife

Except when patients explicitly Except when patients explicitly decline further treatment, decline further treatment, physicians must make every effort to physicians must make every effort to sustain lifesustain life

Any compromise in the commitment Any compromise in the commitment of medical professionals to protect of medical professionals to protect and extend life would undermine the and extend life would undermine the public’s faith in the medical public’s faith in the medical professionprofession