TERMINAL CONDITION

ADJUSTING THE TIME AND MANNER OF DYING

TERMINAL ILLNESS/CONDITIONDEFINITION• A CONDITION, BROUGHT ON BY DISEASE

OR INJURY, WHICH IS PRESENT IN PATIENTS WHEN THEY EXPERIENCE KEY SYSTEM OR MULTIPLE SYSTEM FAILURE, WHICH IS PART OF AN IRREVERSIBLE AND/OR DETERIORATING PROCESS AND WHICH WILL RESULT IN DEATH AS AN INEVITABLE AND PREDICTABLE OUTCOME.– FINAL PHASE OF AN OTHERWISE CHRONIC

CONDITION

SOME KEY ISSUES• “TIME” DESIGNATION [ARBITRARY?]• ROLE OF NATURAL SELECTIVE FACTORS• DEATH AS FAILURE OF BODY SYSTEMS OR

FAILURE OF TECHNOLOGY• TECHNOLOGY AS “HASTENING” DEATH OR

“LENGTHENING” LIFE• QUALITY OF LIFE QUESTIONS AFTER

DIAGNOSIS– PAIN CONTROL– PLEASURES– ACTIVITIES

ADJUSTING THE TIME AND MANNER OF DYING:THE CAUSAL CONNECTIONS IN THE DISEASE/INJURY NETWORK• DISEASE• PROGRESS OF DISEASE• SYMPTOMS• THERAPEUTIC RESPONSES

– INITIATING TREATMENT– WITHHOLDING/WITHDRAWING TREATMENT

• DECISIONS [INTENTIONS]– PATIENT [REFUSAL OF TREATMENT]– SURROGATE– CAREGIVER

• PHYSICIAN’S DIRECT CAUSAL ACTIVITY ADDRESSING PATHOLOGICAL CONDITION

• CAUSAL FACTORS EXTERNAL TO THE DISEASE NETWORK– MEDICATIONS --- ACTIONS --- INTENTIONS

RIGHT TO REFUSE TREATMENT• RIGHT TO PRIVACY

– 1,4,5,9,14 AMENDMENTS– QUINLAN (1976] ET AL..

• CRUZAN (1990)– LIBERTY RIGHT (14TH AMENDMENT]

• ENDORSED BY THE PATIENT SELF-DETERMINATION ACT (1990]

• VACCO V. QUILL (1997)– LIBERTY RIGHT (14TH AMENDMENT]

– “EVERYONE, REGARDLESS OF PHYSICIAL CONDITION, IS ENTITLED , IF COMPETENT, TO REFUSE UNWANTED LIFESAVING MEDICAL TREATMENT; NO ONE IS PERMITTED TO ASSIST A SUICIDE.”