Group Presentation - The Right to Die

8/2/2019 Group Presentation - The Right to Die

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The Right To Die


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Welcome toWashington General


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Ethical Committee of WashingtonGeneral

Our missionTo look at each case presented to the

committee with out being bias andusing ethically correct tactics to comeup with solutions that would be in the

best interests of parties involved.


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Case 1

Anna Maria, a 49 year old female attorney,has recently suffered a major cerebral

hemorrhage. Her prognosis isconsidered extremely poor by onephysician, but possibly hopeful by

another. Her advance directives found onthe chart very clearly state that if shewas in a comatose condition with no

hope for recovery, she did not want lifesustaining treatment. Her family is calledto make a decision about continuing life-

sustaining treatment.


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Anna Marie


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Advance Directives

are considered a type ofinformed consent, as theclient is made aware of

the advantages anddisadvantages of their

decision, and consent isgiven voluntarily while

the client is in a state ofgood mental and

physical health (Hecht,

RN , 2005)


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Living Wills

is a type of advance directivedocument that an individual can havemade

most commonly provide general orspecific advance directives

a surrogate or healthcare proxy and a

durable power of attorney forhealthcare (DPOA) should beidentified.


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DNR, DNAR, or NFR

is a type of advance directive orderedby a physician that serves to preventover treatment or cardiopulmonary

abuse during cardiopulmonaryresuscitation (CPR).

type of advance directive is commonlyseen in medical conditions involving

the elderly, the terminally ill; i.e. finalstage cancer and acquiredimmunodeficiency disease (AIDS)(Hecht, RN , 2005).


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Pros of AdvanceDirectives/Living Wills and DNR The ability to decide what is the best

care of treatment for you when theinevitable occurs

it relieves the pressure off of family

members, friends and doctors in makingcritical decisions. the ability to choose when and how you

are wish to die providing dignity, even in

death a DNR is sometimes necessary for the

patient or physician to choose due to theextremeness of the case and it relieves

pain from the patient.


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Cons of AdvanceDirectives/Living Wills & DNR

the vague use of terms may often lead tomedical and legal discrepancies.

living wills only become active based on thecondition stipulated, i.e. physically or mentallyincapacitated.

Without the required diagnosis, the individualmay receive treatment that is in contrast tothe advance directives

DNR orders only preclude resuscitative

efforts in the event of cardiopulmonary arrestand should not influence other therapeuticinterventions that may be appropriate for thepatient" (Do-not-resuscitate orders endangerpatients, 2002).


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Frame Word for Ethical

Decision Making

4. Make a Decisionand Test It

3.Evaluate The Pros andthe Cons

2. Get The Fact

1.Recognizing the Ethical issue

5.Act andReflect On It


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Ethical Decision Making1. Recognize the ethical

issue: Ethical issue is the choice

to follow the advancedirective or not; Due to theconflict between

physicians.2. Get the Facts

Patient has suffered majorcerebral hemorrhage

Her prognosis is hopefullyby one physician anddoubtful by another

She has an advancedirective that is clear

Her family is called in to


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Ethical Decision Making

PROS

Respect forautonomy

She will not be inpain any more

She could suffermore extensive

damage e.g. stroke The cost of

sustaining life ifkept alive.

Cons

Physician has todiagnosis you asbeing terminally ill.

Relatives shouldnot be given thechoice due to theclear advancedirective

More money toobtain a thirdopinion.

3. Considering the Pros and the Cons


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Pros Decision

To Follow theAdvance Directive

Outcome of Decision The Patient Dies

Her suffering and

pain is ended.

Cons Decision

To Seek a Thirdopinion

Outcome of Decision Patient may live

Patient may due on

her own.

4. Make a Decision and Test It.


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ETHICAL DECISIONMAKING

5. Act and Reflect on theoutcome.


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CASE 2 Martin Major is 26 years old with stage 4 liver cancer

that has spread to the bone and colon. Martins canceris terminal and the doctors have estimated his lifeexpectancy to be about three months. He states thatthe symptoms are unbearable. He is in constant painand medication offers little relief. The colon cancer hadcaused several bowel obstructions that resulted in him

experiencing severe abdominal distention, shortness ofbreath, nausea, and painful vomiting of fecal matter.Martin is easily fatigued and is at a point where he is nolonger able to care for himself. He has expressedseveral times that he no longer wish to live in constantpain and agony.

Martin signed living will (when he was diagnosed) thatstated that if he should stop breathing no extraordinarymeasures are to be attempted to prolong his life. Henow wishes a peaceful death rather than continuinguntil he reaches an undignified end.


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Martin Major
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is the common term foractions by which anindividual helps another

person voluntarily bringabout their own death."Assistance" may mean

providing one with themeans (drugs orequipment) to end their

own lives, but may extend

Assisted Suicide
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Euthanasia

Comes from the Greek words, eumeaning good and thanatosmeaning death

Is the act or practice of killing orpermitting the death of hopelessly sickor injured individuals in a relativelypainless way for reasons of mercy

The killing, by act or omission, of adependent human being for theiralleged benefit
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Pros of Assisted Suicide andEuthanasia

Tremendous pain and suffering of patients can be saved.

The right to die should be a fundamental freedom of eachperson.

Patients can die with dignity rather than have the illnessreduce them to a shell of their former selves.

Health care costs can be reduced, which would save estatesand lower insurance premiums.

Nurse and doctor time can be freed up to work on savablepatients.

Prevention of suicide is a violation of religious freedom.

Pain and anguish of the patient's family and friends can belessened, and they can say their final goodbyes.

Reasonable laws can be constructed which prevent abuseand still protect the value of human life.

Vital organs can be saved, allowing doctors to save the livesof others.

Without physician assistance, people may commit suicide in amessy, horrifying, and traumatic way.
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Cons of Assisted Suicide andEuthanasia

It would violate doctors' Hippocratic oath.

It demeans the value of human life.

It could open the floodgates to non-critical patientsuicides and other abuses.

Many religions prohibit suicide and the intentional

killing of others. Doctors and families may be prompted to give up on

recovery much too early.

Government and insurance companies may put

undue pressure on doctors to avoid heroic measuresor recommend the assisted-suicide procedure.

Miracle cures or recoveries can occur.

Doctors are given too much power, and can be wrongor unethical.
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Ethical Decision Making1. Recognize the ethical issue:

Ethical issue is the choice to whether ornot to follow the living will or assist himto die with dignity.

2. Get the Facts

Patient has terminal cancer with a lifeexpectancy of three months

He states that his symptoms areunbearable because he is in constant

pain and agony He can no longer care for himself and

does not want to be a burden on others

The patient has signed a living will but

expresses several times that he nolon er wishes to live
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In Oregon and Washington the safeguard criteriamust be meet to ensure there is no chancepatients are coerced to hasten their deaths

The patient must verbally request the medication from thephysician twice, and each request is separated by 15 days.

In addition, the patient must make a written request to theattending physician, which is witnessed by two individuals

who are not primary care givers or family members.

The patient is notified and is able to rescind the verbal andwritten requests at any timeeven right before the patientingests the medication.

The patient must be able to self-administer and ingest theprescribed medication.

The attending physician must be Oregon or Washington-licensed
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The physician's diagnosis must include terminal illness, with sixmonths or less to live.

The diagnosis must be certified by a consulting physician, who must

also certify the patient is mentally competent to make andcommunicate health care decisions.

If either physician determines the patient's judgment is impaired, thepatient must be referred for a psychological examination.

The attending physician must inform the patient of alternatives,including palliative care, hospice and pain management options.

The attending physician must request the patient notify their next-of-

kin of the prescription request.

A person who coerces or exerts undue influence on a patient torequest medication for the purpose of ending the patient's life shallbe guilty of a Class A felony.

t ca ec s on a ng
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t ca ec s on a ng3. Considering the Pros andCons

Pros Respect for

autonomy, he should

be allowed to decide He will no longer be

in pain and agony

He can die with

dignity and in peace

Cons It violate doctors'

Hippocratic oathcausing death is causing

harm It goes against the

request of his Living will

It demeans the value of

human life Euthanizing him It could

open the floodgates tonon-critical patient

suicides and other

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Ethical Decision Making4. Make a Decision and Test It.

Pros Decision To allow Euthanasia

Outcome of Decision

The Patient Dies with

dignity His suffering and pain is

ended

ConsDecision

To follow the

living will
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Documents

Group Presentation - The Right to Die