Death and Dying

TOPIC:

DEATH & DYING

CASE: PHYSICIAN ASSISTED DYING(Jack Kevorkian)

CONTENTS:

1. HISTORICAL BACKGROUND1. HISTORICAL BACKGROUND

2. ETHICAL ISSUES2. ETHICAL ISSUES– Principles InvolvedPrinciples Involved– Arguments for and againstArguments for and against

3. DEVELOPMENTS3. DEVELOPMENTS– Updates, regulations or lawsUpdates, regulations or laws

4. CASE IN THE PHILIPPINES4. CASE IN THE PHILIPPINES

1. HISTORICAL 1. HISTORICAL BACKGROUNDBACKGROUND

• words eu and thanatos which combined means good death


400BC

• "I will give no deadly medicine to any one if asked, nor suggest any such counsel." Hippocrates mentioned and opposed euthanasia in the Hippocratic Oath

• Hence the Greeks and Romans still allowed voluntary euthanasia


1828• first known anti-euthanasia law in the

United States was passed in the state of New York, with many other localities and states following suit over a period of several years.

• After the civil war, voluntary euthanasia was promoted by advocates, including some doctors.


Prior to World War II • In 1939, non-voluntary euthanasia was

practiced for the first time by German physicians, to eliminate the diseased and disabled among the German people in closed gas chambers.

• The Nazis used the same gas chambers to exterminate captured Russians, gypsies and Jews.

• 300,000 Germans

http://www.buzzle.com/articles/nazism/


Oregon Assisted Suicide (1998)

The U.S. state of Oregon legalizes assisted suicide in 1998.


Kevorkian Sentenced to Prison(1999)

In 1999, pathologist Dr. Jack Kevorkian was sentenced to a 10-25 year prison term for giving a lethal injection to Thomas Youk who was in the final stage of ALS (amyotrophic lateral sclerosis)


Netherlands Legalizes Euthanasia(2000)

In 2000, the Netherlands became the first country in the world to legalize euthanasia.


Belgium Legalizes Euthanasia(2002)

In 2002, Belgium became the second country in the world to legalize euthanasia.


Netherlands Legalizes Euthanasia(2000)

In 2000, the Netherlands became the first country in the world to legalize euthanasia.

CONTENTS:





EUTHANASIA?The practice of ending the life of a terminally illperson in a painless or minimally painful way,

for the purpose of limiting suffering.

ETHICAL ISSUES

Classification of euthanasia:– Physician assisted suicide– Voluntary– Nonvoluntary

• Procedural decision– Passive euthanasia– Active euthanasia

What is physician-assisted suicide (PAS)? Is physician-assisted suicide ethical? What are the arguments in favor of PAS? What are the arguments against PAS?

http://depts.washington.edu/bioethx/topics/pas.html#ques2



What is phyasician-assisted suicide (PAS)?• Physician-assisted suicide (PAS)

generally refers to a practice in which the physician provides a patient with a lethal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life.

Some other practices that should be distinguished from PAS are:

• Terminal sedation: This refers to the practice of sedating a terminally ill competent patient to the point of unconsciousness, then allowing the patient to die of her disease, starvation, or dehydration.

• Withholding / withdrawing life-sustaining treatment: When a competent patient makes an informed decision to refuse life-sustaining treatment, there is virtual unanimity in state law and in the medical profession that this wish should be respected.

• Pain medication that may hasten death: Often a terminally ill, suffering patient may require dosages of pain medication that impair respiration or have other effects that may hasten death. It is generally held by most professional societies, and supported in court decisions, that this is justifiable so long as the primary intent is to relieve suffering.

Is physician-assisted suicide ethical?• The ethics of PAS continue to be debated. • Often this is argued on the grounds that PAS

may be a rational choice for a person who is choosing to die to escape unbearable suffering.

• Furthermore, the physician's duty to alleviate suffering may, at times, justify the act of providing assistance with suicide.

• Arguments rely a great deal on the notion of individual autonomy.– recognizing the right of competent people

to chose for themselves the course of their life, including how it will end.

• Opponents argue that PAS runs directly counter to the traditional duty of the physician to preserve life.

What are the arguments in favor of PAS?

1. Respect for autonomy: • In some situations the choice of the patient

takes priority over other considerations.

• Suppose that person says after all alternatives have been thoroughly considered , "My life is no longer worth living; I cannot stand it any longer; I want to end it now to avoid further pain, indignity, torment, and despair."


2. The role of the physician is to do what is best for the patient, and in some extreme situations this may include hastening death upon the voluntary request of the dying.


3. Compassion:

• Suffering means more than pain; there are other physical and psychological burdens.

• It is not always possible to relieve suffering.

• Thus PAS may be a compassionate response to unbearable suffering.


4. Individual liberty vs. state interest:

• Though society has strong interest in preserving life, that interest lessens when person is terminally ill and has strong desire to end life.

• A complete prohibition on assisted death excessively limits personal liberty.

• Therefore PAS should be allowed in certain cases.


5. Openness of discussion: • Some would argue that assisted death

already occurs, albeit in secret. • For example, morphine drips ostensibly

used for pain relief may be a covert form of assisted death or euthanasia.

• That PAS is illegal prevents open discussion, in which patients and physicians could engage. Legalization of PAS would promote open discussion.

What are the arguments against PAS?

1. Sanctity of life: This argument points out strong religious and secular traditions against taking human life. It is argued that assisted suicide is morally wrong because it contradicts these beliefs.


2. Passive vs. Active distinction:

• The argument here holds that there is an important difference between passively "letting die" and actively "killing."

• It is argued that treatment refusal or withholding treatment equates to letting die (passive) and is justifiable, whereas PAS equates to killing (active) and is not justifiable.


3. Potential for abuse: • Here the argument is that certain groups of

people, lacking access to care and support, may be pushed into assisted death.

• Furthermore, assisted death may become a cost-containment strategy.

• Burdened family members and health care providers may encourage option of assisted death. To protect against these abuses, it is argued, PAS should remain illegal.


4. Professional integrity: • Here opponents point to the historical ethical

traditions of medicine, strongly opposed to taking life.

• For instance, the Hippocratic oath states, "I will not administer poison to anyone where asked," and "Be of benefit, or at least do no harm."

• Furthermore, major professional groups (AMA, AGS) oppose assisted death. The overall concern is that linking PAS to the practice of medicine could harm the public's image of the profession.


5. Fallibility of the profession: • The concern raised here is that

physicians will make mistakes. • For instance there may be uncertainty in

diagnosis and prognosis. • There may be errors in diagnosis and

treatment of depression, or inadequate treatment of pain. Thus the State has an obligation to protect lives from these inevitable mistakes.

SUMMARY

REASONS AGAINST• People might commit euthanasia against a person’s wishes. • People might recover from an illness against all odds. • Doctor’s diagnosis might be wrong. • Christians believe in the Sanctity of Life. Against

Commandment ‘Do not kill’. • Jesus suffered on the cross – he didn’t cut short his suffering

therefore not down to us to end our life. • Doctors are against euthanasia it is their job to try and save

& protect life. • Some people think accepting suffering may have a spiritual

value for your soul. • Jesus cared for the sick, he never talks about any type of

euthanasia • Christians have Hospices – hospitals where the terminally ill

are cared for, without losing their dignity.

SUMMARY

REASONS FOR• People have a right to decide when they

want to die. • Wrong to keep people alive beyond their

natural life span (e.g. life support machine).

• Gives people the ability to die with dignity.

• Relatives spared the agony of watching their loved ones suffer a slow and painful death.

CONTENTS:





The Case of Dr. Kevorkian

• Beginning of 1999

• Kevorkian served eight years of a 10-to-25-year prison sentence for second-degree murder.

• June 1, 2007

• He was released on condition that he would not offer suicide advice to any other person.

• January 15, 2008

• Kevorkian gave his largest public lecture since his release from prison, speaking to a crowd of 4,867 people at the University of Florida.

• The Gainesville Sun reported that Kevorkian expressed a desire for assisted suicide to be"a medical service" for willing patients.

• "My aim in helping the patient was not to cause death“

• "My aim was to end suffering. It's got to be decriminalized."

• February 5, 2009

• Kevorkian lectured to students and faculty at Nova Southeastern University in Davie, Florida. Over 2,500 people heard him discuss tyranny, the criminal justice system and politics.

• Poor sound and a long lecture caused many people to leave within 45 minutes. For those who remained, he discussed euthanasia during a question and answer period.

• September 2, 2009

• He appeared on Fox News Channel's Your World with Neil Cavuto in his first live national television interview to discuss health care reform.

• September 20, 2009

• He appeared at Kutztown University of Pennsylvania to speak to a sold-out audience. Sellers of tickets claimed that all tickets were sold out within 5 minutes of the office opening.

REGULATIONS/ LAWS OR

ANYTHING THAT DEVELOPED OUT

OF THE CASE

Michigan Governor Signs Bill Making Assisted Suicide a Felony

• Causing a person by force to commit suicide is murder. Causing, by force or coercion, a person to attempt suicide is attempted murder. Doing any of the following with the intent to assist someone in a suicide is a felony punishable by up to 4 years in prison and/or a fine of $2000:

• 1. Provide the means by which an individual attempts or commits suicide

2. Participate in an act by which an individual attempts or commits suicide

3. Help an individual plan to attempt or commit suicide

• This does not apply to providing pain medications with the intent to relieve pain and not to cause death.

STAND OF OTHER RELIGION AND LEGAL STATUS IN DIFFERENT

COUNTRIES

RELIGIOUS STANDPOINT

Roman Catholic Church

• Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person.

• The Roman Catholic Church regards euthanasia as morally wrong. It has always taught the absolute and unchanging value of the commandment "You shall not kill".

Buddhism

• Buddhists are not unanimous in their view of euthanasia, and the teachings of the Buddha don't explicitly deal with it.

• The most common position is that voluntary euthanasia is wrong, because it demonstrates that one's mind is in a bad state and that one has allowed physical suffering to cause mental suffering.

Hinduism

• According to the Doctrine of Karma, a person cannot escape from his/her Karma by committing suicide.

• Whatever has to be faced has to be faced. If one tries to escape from a problem in this birth, it will have to be faced in a higher proportion in a subsequent birth. Also, committing suicide adds a big Karmic burden on the individual.

Islam

• Muslims are against euthanasia.

• They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this.

Judaism

• The Jewish tradition regards the preservation of human life as one of its supreme moral values and forbids doing anything that might shorten life. However, it does not require doctors to make dying last longer than it naturally would.

• If someone's life is ending and they are in serious pain, doctors have no duty to make that person suffer more by artificially extending their dying moments

LEGAL STANDPOINT

Philippines• Committing and attempting suicide is not

punishable by law but assisting someone in their suicide is.

• It can't be concluded as legal in the Philippines but at the same time, it is not illegal. For the moment, there are no specific laws dealing with the issue of Euthanasia yet.

• Active euthanasia (basically means that it’s the physician’s prerogative) is not legal anywhere.

Albania

• Euthanasia was legalized in Albania in 1999.

• Passive euthanasia is considered legal should three or more family members consent to the decision.

Belgium

• The Belgian parliament legalized euthanasia in late September 2002. Proponents of euthanasia state that prior to the law, several thousand illegal acts of euthanasia were carried out in Belgium each year.

• According to proponents, the legislation incorporated a complicated process, which has been criticized as an attempt to establish a "bureaucracy of death".

•

Netherlands

• In 2002, The Netherlands legalized euthanasia including physician assisted suicide.

• The Ministry of Public Health, Wellbeing and Sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care."

Luxembourg

• On March 18, 2009 Luxembourg has enacted legislation to legalize euthanasia, thereby becoming the third European country, after the Netherlands and Belgium, to permit the intentional killing of dying or otherwise vulnerable people.

• According to the bill, euthanasia will be regulated by a living will or advance directive. Doctors will also be required to consult with a colleague to ensure that the patient has a terminal illness and is in a "grave and incurable condition" before killing him.

•

• The United States

• Euthanasia is illegal in most of the United States. It is legal in the states of Washington, Oregon, Montana and to a limited extent in Texas.

CONTENTS:





Euthanasia in the Philippines

• Euthanasia is illegal in the Philippines and is punishable by law

• The controversial Reproductive Health Bill (family planning, contraceptives, and abortion)

END… Thank You!

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Death and Dying