Physician Assisted Death

&Euthanasia

Lisa Cabrera&

Kathryn Pugh

Ethical Question???

Should terminally ill patients, with less than 6 month to live, have the right to end their life via Euthanasia or PAD?

Definitions

There are active and passive forms of euthanasia:

Passive: withdrawal of life-sustaining interventions, which facilitates patient death

Active: the administration of an intervention that causes death (all interventions below)

Physician Assisted Death (PAD)--MD prescribes lethal Rx, but pt self-administers Rx

● Generally viewed as a form of suicide (legal in 4 states)

Euthanasia--MD prescribes Rx and MD administers Rx ...think Dr. Kevorkian!!

● Generally viewed as a form of mercy killing (illegal in all 50 states)

Terminal Sedation:--Two-stage process. First, patient is deprived of food and fluids; second, patient is infused with continuous sedative in a palliative effort to relieve pain

● may result in death, but this is not the intention

Recent History of PAD 1945: Post WWII sentiments regarding medical paternalism and the German Eugenics movement, led to the suppression of pro PAD sentiments in America. 1974: Society For The Right to Die was founded. This marked a renewed interest in pursuing the legalization of PAD.1980s: Hemlock Society (HS) established by PAD proponent Derek Humphrey. HS offered support and resources to terminally ill pts seeking PAD. Humphrey’s wife with terminal cancer took her life by self-administering a lethal dose of morphine. 1990: Jack Kevorkian facilitated the death of his first terminally ill patient. 1991: Humphrey wrote NY Times bestselling book, Final Exit, which advocated for the legalization of PAD.1994: Oregon becomes the first state to legalize PAD via the Death with Dignity Act.1998: Kevorkian airs video on 60 Minutes of himself injecting a terminally ill patient with a lethal drug. Patient passes away.

History of PAD Continued1999: Kevorkian is tried and convicted of second-degree murder in the state of Michigan. He is sentenced to 15-25 years in prison.2000s: Numerous pro PAD organizations spring up all over the country. 2003: Attorney-General John Aschroft challenges the Oregon Death with Dignity Act in the 9th Circuit Court of Appeals. Supreme court rules against Ashcroft and Oregon’s DWDA is upheld.2008: Washington becomes the second state to legalize PAD, with provisions nearly identical to OR’s.2009: Vermont becomes the third state to legalize the practice of PAD. Provisions are similar to OR’s and WA’s. 2013: Montana becomes the fourth state to legalize PAD, with the least restrictive eligibility requirements.Current: Brittany Maynard case hits the news. Several states are actively being pursued by pro PAD activists in hopes of changing public opinion, and state laws regarding PAD.

History of Euthanasia

Ancient� World History● The Romans and the Greeks did not have very strong moral objections to

euthanasia.● Their moral compass revolved around whether it was wrong to allow a human to

suffer in prolonged agony rather than to provide a timely end to suffering.

�Nazi Germany● Adolf Hitler wanted to create a perfect state, free of undesirables.

● The Reich Health Ministry administered a questionnaire that allowed physicians to decide whether someone met the criteria outlined by the Nazi state as deserving a quick termination of life .

History of Euthanasia Continued

Dr. Jack Kevorkian- “Dr. Death”● Notorious public figure that made headlines. “Dr. Death” was coined after his

unorthodox proposals of providing that convicts could volunteer for a painless medical death in 1958.

● Set up his own “death” clinic near Detroit,Created his “Thanatron” for $45. This consisted of 3 bottles of fluids: saline followed by painkiller, and then fatal dose of potassium chloride.

● 1990: assisted a 45 year old woman with Alzheimers in a public park.

● 1991: Michigan barred his practice and use of hes machine.

● Then assembled his Mercitron, Co2 through a mask.

● Prosecuted 4 times, acquitted in 3 cases and mistrial for the 4th in state of Michigan.

● 1999: charged of second-degree murder and illegal delivery of a controlled substance.

● Sentenced to 25 years in prison, released after 8, and died in 2011.

Patient Impetus For Seeking PAD/Euthanasia

Terminally ill patients seek out PAD and Euthanasia as a means of avoiding these devastating progressive effects: ● Intractable pain that does not respond to drug-based palliative

care interventions.● Trauma of being cognizant while mental and physical faculties

are slowly stripped away.● The psychological anguish (anxiety, fear, depression) that

terminally ill patient endure while facing death.● Feeling a complete loss of self-efficacy, power, control, and

autonomy. ● Inability to experience most forms of pleasure.● The emotional toll it takes on the family to watch their loved one

slowly lose their physical and mental faculties along with their independence.

The Bioethics of PAD/EuthanasiaRespect For Autonomy: ensures that all patients are treated as self-governed beings that are imbued with the capacity to make informed decisions, that are free from coercion.

● PAD proponents use the bioethical tenet of respect for autonomy as a platform for the legalization of PAD. Patient’s right to die on their own terms and their choices should be respected.

Non-maleficence: the concept of doing no harm to patients. If harm is necessary, it is for a greater end benefit.

● From a medical standpoint PAD and euthanasia are only offered to terminally ill patients. This population is already in a state of extreme trauma and suffering in all aspect of their being. PAD would might constitute harm,be to end their suffering and allow them to die with dignity.

Beneficence: the concept of acting in the best interest of the patient by ensuring that all procedures and interventions intend to bring the patient into a greater state of health and well-being.

● Terminally ill patients have a limited amount of time left on this earth. This population is no longer seeking medical interventions that improve health therefore. The only beneficent medical act that a healthcare provider can offer this population, is relief of suffering. Voluntary PAD and euthanasia accomplished this objective.

Justice: the concept that all patients should be treated with liberty, fairness, equality and not subjected to social, cultural, psychological, or financial prejudices.

● Allowing food and fluids to be withdrawn from terminally ill patients causes death. PAD and euthanasia bring about the same outcome, therefore they should be treated as equivalent medical interventions. By not doing so, one medical act is being unjustly favored over another.

Social, Legal/Political, and Spiritual Arguments

For and Against PAD/EuthanasiaSpiritual:Religious-thou shalt not kill (self or others), therefore ending a life is wrong.Atheist-decision to end your life, due to the ravages of a terminal illness, is a personal choice that should be honored.

Social:Pro-will be an uplifting aspect of society illustrating compassion and mercy for those that are suffering. Con-will slowly eat away at the social/moral fabric of society. If this becomes legal, what’s next?

Legal/political:Pro-constitution ensures that all Americans are born with inalienable rights. It is unethical and an abuse to power for a governing body to have greater control over a person’s body than they themselves do. Con-intentionally taking a life is against federal law, even if the person gives consent.

PAD/Euthanasia Global Trends

i dont know how to fn copy the maps

Nursing Implications for PAD/Euthanasia ● Justification for euthanasia is based on respect for autonomy and

beneficence.● Opponents, base their arguments on the principle of non-

maleficence. As a nurse, regardless of our own beliefs and morals, we must advocate for our patients and their wishes.

● If a patient made an autonomous decision to end their life with the aid of a physician, as nurses, we would be bound to respect and honor this.

● This would imply that we should do all we can to be clinically available to meet the needs of our patients. Even if this includes the delivery of death-hastening palliative interventions.

● Justice would mean that each patient receives what he or she need according to what his or her condition is .

● As nurses, we take away our personal views, emotions and ideals when it comes to each and every patient in order to provide them justice.

Cultural Considerations for PAD/Euthanasia

Attitudes toward life and death are socio-culturally based:● The Buddhist believe that death is a new beginning to a new life,

reincarnation. They welcome death. ● The Catholic church: “Everyone has the duty to lead his life in

accordance with God's plan.” (Pope John Paul II declaration on death, 1980)

● Chinese culture: The current legal system regards it as a form of criminal homicide, however, 68% polled were “open minded” about PAD/euthanasia.

● South Africa belief system: the soul of the departed person passes to the world of their ancestral spirits where it continues to live. Suicide in any form is not favored.

Kat’s Personal Views on PADI believe that life is a gift that we are only given once, therefore we should cherish every breath. However, when a terminal illness causes a human soul to experience great pain and suffering, and deprives them of the opportunity to experience life-giving moments, then we should honor a patient’s decision to end their life--this would be one of the truest acts of compassion and mercy.

“The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time”.-Mark Twain

Lisa’s Personal Views on Euthanasia

I am not losing sight of the precious and irreplaceable value of human life. I am affirming that life is precious, and having received the divine blessing of life, it then becomes the inherent right of every human being to decide when, in terminal cases, life is no longer worth living, and that the pain involved in staying alive outweighs the benefits of ending that life so that the suffering endured not only by the patient, but by the family and friends may end as well.

Quotes“Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever”. ~Elisabeth Kübler-Ross

“Death may be the greatest of all human blessings”. ~Socrates

Headline News Case Study Link: �https://www.youtube.com/watch?v=yPfe3rCcUeQBrittany Maynard 29 yo female from California ● Dx with aggressive terminal brain cancer● Pt decides that she wants to die on her own terms● Seeks out closest state with legalized PAD (Oregon)● Uproots self and husband and moves to OR in order to gain

residency● Fulfills steps necessary to meet OR requirements for PAD● Successfully obtains lethal drug prescription from MD ● BM plans her departure and makes peace with her death● BM self-administers lethal drug--passes away shortly after● Prior to her death, BM became an activist for Compassion and

Choices, the leading pro PAD organization in the US.

Class Discussion

….don’t be shy!

References

�Baily, M. A. (2011). Futility, Autonomy, and Cost in End-of-Life Care. Journal Of Law, Medicine & Ethics, 39(2), 172-182. doi:10.1111/j.1748-720X.2011.00586.x

�Bever, L. (November 2, 2014). Brittany Maynard, as promised, ends her life at 29.

�The Washington Post. Retrieved from

http://www.washingtonpost.com/news/morning-mix/wp/2014/11/02/brittany-maynard-as-promised-ends-her-life-at-29/ . Accessed December 7, 2014.

�Biondo C, Silva M, Secco L. Dysthanasia, euthanasia, orthotanasia: the perceptions of nurses working in intensive care units and care implications. Revista Latino-Americana De Enfermagem (RLAE) [serial online]. September 2009; 17(5):613-619. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed December 5, 2014.

�Birchley G, Cejer B. Nurses as withdrawers of life sustaining treatment in paediatric intensive care. Nursing In Critical Care [serial online]. 2013 Jan-Feb 2013; 18(1):43-51. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed December 5, 2014.

�Darr, K. (2007). Nexus: ethics, law, and management. Assistance in dying: part II. Assisted suicide in the United States. Hospital Topics, 85(2), 31-36.

�Duke, G., Yarbrough, S., & Pang, K. (2009). The Patient Self-Determination Act: 20 years revisited. Journal Of Nursing Law, 13(4), 114-123. doi:10.1891/1073-7472.13.4.114

�Fenigsen, R. (2010). Other People's Lives: Reflections on Medicine, Ethics, and Euthanasia. Issues In Law & Medicine, 26(1), 33-76.

�Friend, M. L. (2013). Physician-Assisted Suicide: Death With Dignity?. Journal Of Nursing Law, 14(3-4), 110-116. doi:10.1891/1073-7472.14.3.4.110

�Garity, J. (2004). Euthanasia -- nursing education and research implications. Journal Of Advanced Nursing, 47(6), 601-602. doi:10.1111/j.1365-2648.2004.003174

�Hoedeman P,(2013) Hitler or Hippocrates: Medical Experiments and Euthanasia in the Third Reich. New England Journal of Medicine, 1993; 328:1429May 13, 2013DOI: 10.1056/NEJM199305133281921

�https://www.youtube.com/watch?v=yPfe3rCcUeQ

�Jack Kevorkian. (2014). The Biography.com website. Retrieved 08:57, Dec 03, 2014, from http://www.biography.com/people/jack-kevorkian-9364141.

�Paris, J. (2010). Autonomy does not confer sovereignty on the patient: a commentary on the Golubchuk case. American Journal Of Bioethics, 10(3), 54-56. doi:10.1080/15265160903581916

�Quaghebeur, T., Dierckx de Casterlé, B., & Gastmans, C. (2009). Nursing and euthanasia: a review of argument-based ethics literature. Nursing Ethics, 16(4), 466-486. doi:10.1177/0969733009104610

�Rose, T. (2007). Physician-assisted suicide: development, status, and nursing perspectives. Journal Of Nursing Law, 11(3), 141-151.

�Swetz, K. M., Burkle, C. M., Berge, K. H., & Lanier, W. L. (2014). Ten common questions (and their answers) on medical futility. Mayo Clinic Proceedings, 89(7), 943-959. doi:10.1016/j.mayocp.