Death

1
Death Dying
Death Dying
2
The Changing Medical Situation

• Until 1940s, 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.

3
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

4
Stages of Bereavement
Components to think about

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

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

5
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.

6
Euthanasia

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

• means a good death, dying well.
• What is a good death?
• Peaceful
• Painless
• Lucid
• With loved ones gathered around

7
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)
8
States with Wills to Live or Living Wills
Alabama              Alaska                 
 Arizona                Arkansas California
           Colorado               Connecticut
         Delaware District of Columbia     
                   Florida                
 Georgia  Hawaii                 Idaho       
            Illinois                   Indiana
        Iowa                    Kansas
                 Kentucky               Louisiana
Maine                  Maryland              
Massachusetts        Michigan Minnesota         
 Mississippi             Missouri                
Montana Nebraska            Nevada
                 New Hampshire     New
Jersey   New Mexico        New York             
North Carolina      North Dakota Ohio
                  Oklahoma               Oregon
                Pennsylvania  Rhode Island     
 South Carolina        South Dakota       
Tennessee   Texas                 Utah
                      Vermont             
 Virginia Washington        West Virginia       
  Wisconsin             Wyoming 
In what states is euthanasia legal?
9
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)

10
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

11

• 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
  ).

12
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

13
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

14
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
15
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

16
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

17
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/?rn4
9750cl2912713ch334515srcnews
18
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

19
Argument Supporting Euthanasia

• Euthanasia is seen as form of mercy killing,
  dying with dignity, especially for those who are
  suffering from terminally ill disease