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 Bereavement

• Denial• Anger• Bargaining• Depression• Acceptance

• Wills• Place of death• Place of burial• Method of burial

Components to think about

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.

• means “a good death,” “dying well.”

• What is a good death?– Peaceful– Painless– Lucid– With loved ones

gathered around

•Definition: painlessly ending life of a being that is suffering from terminal illness or other painful or

incurable condition.

The Euthanasia Society of England (1935)

Oregon Assisted Suicide (1998)only state to do so

Kevorkian Sentenced to Prison(1999)

Netherlands Legalizes Euthanasia(2000)1st country to do so

Belgium Legalizes Euthanasia(2002)

Alabama              Alaska                   Arizona                ArkansasCalifornia            Colorado               Connecticut          DelawareDistrict of Columbia                         Florida                  Georgia 

Hawaii                 Idaho                    Illinois                   Indiana         Iowa                    Kansas                  Kentucky               Louisiana Maine                  Maryland               Massachusetts        MichiganMinnesota           Mississippi             Missouri                 Montana

Nebraska            Nevada                  New Hampshire     New Jersey  New Mexico        New York              North Carolina      North DakotaOhio                   Oklahoma               Oregon                 Pennsylvania Rhode Island       South Carolina        South Dakota        Tennessee  

Texas                 Utah                       Vermont               VirginiaWashington        West Virginia          Wisconsin             Wyoming 

States with Wills to Live or Living Wills

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 AssociationHouse 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

Vacco v. Quill (1997)

• Issue: Active assisted suicide is banned, while passive refusal of treatment is permitted

• Holding: NY law banning assisted suicide does not violate constitutional right of equal protection

• Reasoning: Difference between “letting die” and “making die” is important, logical, rational, well-established.

• Thus, there is no equal protection violation to treat them differently under the law.

1997 USSC

Dr. T. Quill request to actively assist patients with cancer to die with dignity.

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