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					Death & Dying
  The Changing Medical Situation
• Until 1940‟s, medical care was often just
  comfort care, alleviating pain when possible
• During last 50+ years, medicine has become
  increasingly capable of postponing death

Increasingly, we are
forced to choose whether
to allow ourselves to die.
                         Death and Dying
• Dying occurs in 3 phases
   – Agonal phase- gasps
     and muscle spasms
   – Clinical death- short
     interval in which
     heartbeat, circulation,
     breathing and brain
     functioning stop but
     resuscitation is still
     possible
   – Mortality occurs when
     individual passes into
     permanent death
 Stages of          Components to
Bereavement          think about
   •   Denial         •   Wills
   •   Anger          •   Place of death
   •   Bargaining     •   Place of burial
   •   Depression     •   Method of burial
   •   Acceptance
         The Hippocratic Oath

"I will give no deadly
medicine to any one if
asked, nor suggest any
such counsel"

  … Hippocratic Oath by "Father of
            Medicine,
   Greek physician Hippocrates,
         about 400 B.C.
                             •Definition: painlessly
                          ending life of a being that
                          is suffering from terminal
• means “a good            illness or other painful or
  death,” “dying well.”        incurable condition.
• What is a good
  death?
   –   Peaceful
   –   Painless
   –   Lucid
   –   With loved ones
       gathered around
The Euthanasia Society of England
             (1935)
    Oregon Assisted Suicide
        (1998)only state to do so
 Kevorkian Sentenced to Prison
            (1999)
Netherlands Legalizes Euthanasia
         (2000)1 country to do so
               st



  Belgium Legalizes Euthanasia
              (2002)
  States with Wills to Live or Living Wills
   Alabama           Alaska           Arizona       Arkansas
  California        Colorado          Connecticut   Delaware
   District of Columbia                Florida      Georgia
 Hawaii            Idaho           Illinois       Indiana
  Iowa              Kansas           Kentucky       Louisiana
 Maine             Maryland         Massachusetts    Michigan
 Minnesota          Mississippi        Missouri      Montana
Nebraska          Nevada           New Hampshire New Jersey
New Mexico        New York         North Carolina North Dakota
Ohio             Oklahoma          Oregon         Pennsylvania
Rhode Island      South Carolina     South Dakota   Tennessee
    Texas            Utah              Vermont      Virginia
 Washington        West Virginia      Wisconsin      Wyoming



 In what states is euthanasia legal?
    Euthanasia vs. Assisted Suicide
•   Who is „agent‟? Who
    does killing? Who
    terminates life?

•   Euthanasia: second
    person is agent

•   Assisted suicide: person
     whose life is ending is
     agent (with some help from
     another who provides means)
         American Medical Association
             House of Delegates
•   Active euthanasia: Mercy
    killing: intentional termination of
    life of one human being by
    another = contrary to policy of
    AMA

•   Passive: cessation of
    employment of extraordinary
    means to prolong life when
    irrefutable evidence that
    biological death is imminent:
    decision of patient, family, with
    advice of physician
• Most euthanasia
  cases involve
  elderly, right-to-die
  campaign has
  cases of brain-
  damaged young
  women: Karen Ann
  Quinlan (1975-
  1985), Nancy
  Cruzan (1983-
  1990), and Terri
  Schiavo (1990-
  2005 ).
             Karen Ann Quinlan
• Age 21, home from party
  lapsed into coma
• PVS
• Removed from active life
  support 1976
• Died of pneumonia in
  1985
• 1st significant precendent
              Nancy Cruzan
• Injuries from auto
  accident left her in
  PVS
• State is bearing costs
• Decided by USSC
  1990
• Request feeding tube
  removed
• Died 11 days later
• Issue: Active assisted suicide     Vacco v.
  is banned, while passive
  refusal of treatment is           Quill (1997)
  permitted
• Holding: NY law banning           1997 USSC
  assisted suicide does not
  violate constitutional right of   Dr. T. Quill
  equal protection
• Reasoning: Difference             request to
  between “letting die” and         actively assist
  “making die” is important,        patients with
  logical, rational, well-
  established.                      cancer to die
• Thus, there is no equal           with dignity.
  protection violation to treat
  them differently under the law.   USSC = NO
   Governor Bush v. Michael Schiavo
            (Florida, 2004)
• Previous decisions: voluntary euthanasia
  request by Terri Schiavo
• Issue: constitutionality of law passed by FL
  legislature giving governor authority to reinsert
  feed tubes
• Holding: law violates
  separation of powers
• Reasoning: basis of our
  system of government
             Terri Schiavo
• collapsed in home on
  1990
• 20 m without oxygen
• PVS
• March 18, 2005 court
  cases between
  parents & husband
  ended – husband won
• Died March 31, 2005
      Dr.Kevorkian Sentenced to Prison
                   (1999)
      Pathologist Dr. Jack
      Kevorkian was
      sentenced to 10-25
      year prison term for
      giving lethal injection
      to Thomas Youk
      whose death was
      shown on 60 Minutes


http://cosmos.bcst.yahoo.com/up/player/popup/?rn=49750&cl=2912713&ch=334515&src=news
       Arguments Against Euthanasia

• Euthanasia would not only be
  for people who are "terminally
  ill"

• Euthanasia can become
  means of health care cost-
  containment

• Euthanasia will become non-
  voluntary

• Euthanasia is rejection of
  importance /value of human
  life
 Argument Supporting Euthanasia
• Euthanasia is seen
  as form of mercy
  killing, dying with
  dignity, especially
  for those who are
  suffering from
  terminally ill
  disease

				
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