Aging:%20Change%20and%20Adaptation

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Aging Change and Adaptation

• Death and Dying
• April 8, 2003

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Euthanasia a good death

• Voluntary, active euthanasia at the patients
  request, a physician or someone else causes the
  persons death, for example, by administering a
  lethal injection.

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Euthanasia Attitudes

• When a person has a disease that cannot be
  cured, do you think doctors should be allowed by
  law to end the patients life by some painless
  means if the patient and his family request it?

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Physician-assisted suicide

• The patient causes his/her own death, i.e.,
  commits suicide using means--usually a lethal
  dose of medication--provided by a physician
• Euthanasia someone else causes the death
• PAS the patient causes his/her own death

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Suicide Attitudes

• Do you think a person has the right to end his
  or her own life if this person has an incurable
  disease?

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Autonomy

• A person is autonomous if he/she is
  self-governing, capable of making decisions, and
  fixing a course of action in the absence of
  controlling constraints
• It involves self-determination, freedom,
  independence, liberty of choice and action

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Autonomy

• It refers to human agency free of outside
  intervention and interference.

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Other Perspectives

• Beneficence The ethical obligation to minimize
  pain and suffering, to reduce and remove harms,
  and to bring about benefits to an individual.
• Nonmaleficence Do no harm
• Justice What principles should guide the
  allocation of scarce resources?

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Chronology of Recent Developments

• 1991 Washingtons Initiative 119
• Shall adult patients who are in a medically
  terminal condition be permitted to request and
  receive from a physician aid-in-dying?

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• Aid in dying
• a medical service, provided in person by a
  physician,
• that will end the life of a conscious and
  mentally competent qualified patient...

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• in a dignified, painless, and humane manner,
• when requested voluntarily by the patient through
  a written directive.
• Defeated 54-46

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• 1992 Californias Proposition 161
• Shall adult patients who are in a medically
  terminal condition be permitted to request and
  receive from a physician aid-in dying?

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• Aid in dying
• a medical procedure that will terminate the life
  of the qualified patient
• in a painless, humane, and dignified manner,...

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• whether administered by the physician at the
  patients choice or direction or
• whether the physician provides means to the
  patient for self-administration.

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• Defeated 54-46
• 1994 Oregons Ballot Measure 16 - The Oregon
  Death with Dignity Act

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• Shall law allow terminally ill adult Oregon
  patients voluntary informed choice to obtain a
  physicians prescription for drugs to end life?

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The Oregon Death with Dignity Act

• Requirements
• The patient must be 18, terminally ill (having
  less than 6 months to live), and an Oregon
  resident.
• The patient must voluntarily make an oral
  request...

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• to the attending physician for a prescription for
  medication to end his or her life.
• A 15-day waiting period then begins.

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• The attending physician makes sure the patient
  understands the diagnosis and prognosis.
• The patient is informed of all options, including
  pain control, hospice care, and comfort care.

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• The attending physician also must inform the
  patient of the risks and expected result of
  taking the medication.
• The attending physician

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• determines whether the patient is capable of
  making health care decisions and is acting
  voluntarily
• encourages the patient to notify his or her next
  of kin

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• informs the patient that he or she can withdraw
  the request for medication at any time and in any
  manner

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• refers the patient to a consulting physician who
  is asked to confirm the attending physicians
  diagnosis and prognosis.

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• The consulting physician also decides whether the
  patient is capable of making the decision and is
  acting voluntarily.
• If either or both physicians believe the patient
  is suffering...

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• from a psychiatric or psychological illness or
  depression that causes impaired judgment, the
  patient will be referred for counseling.

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• Once the preceding steps have been satisfied, the
  patient voluntarily signs a written request
  witnessed by two people.
• At least one witness cannot be a relative or an
  heir of the patient.

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• The patient then makes a second oral request to
  the attending physician for medication to end
  his/her life.

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• The attending physician again informs the patient
  that he or she can withdraw the request for
  medication at any time and in any manner.

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• No sooner than 15 days after the first oral
  request and 48 hours after the written request,
  the patient may receive a prescription for
  medication to end his or her life.

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• The attending physician again verifies at this
  time that the patient is making an informed
  decision.
• Safeguards

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• Immunity Physicians who prescribe medication
  for a terminally ill patient to end his or her
  life would be protected from civil or criminal
  liability. Physicians are not obligated to
  participate.

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• Residency requirements Only requests made by
  Oregon residents may be granted. Physicians must
  be licensed in Oregon.

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• Reporting requirements Each year, the Oregon
  Health Division must review a sample of records
  of deaths that occur under this law.

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• Effect on insurance or annuity policies A
  qualified patients act of ingesting medication
  to end his or her life will not have an effect
  upon a life, health, or accident insurance or
  annuity policy.

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• A qualified person who takes medication to end
  his or her own life will not have his/her
  insurance policies affected -- even if those
  policies specify that death by suicide is not
  covered.

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• Liabilities Coercion of a patient, altering or
  forging a request for medication or concealing a
  withdrawal of that request, with the effect of
  causing the patients death, are Class A felonies.

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• Passed 51-49 by a margin of 32,000 votes on Nov.
  4, 1994.
• On Dec. 8, 1994 District Court issues a
  temporary injunction preventing the law from
  going into effect.

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• On Dec. 28, 1994 injunction continued
• Surely, the first assisted suicide law in this
  country deserves a considered thoughtful
  constitutional analysis.

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• Aug. 3, 1995 law ruled unconstitutional
• There is little assurance that only competent
  terminally ill persons will voluntarily die.

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• Some good results cannot outweigh other lives
  lost due to unconstitutional errors and abuses.

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• Ruling overturned in Feb., 1997 by the US Court
  of Appeals and the US Supreme Court on October
  14, 1997.

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• Both courts held that the persons who brought the
  challenge were not in good standing, i.e., were
  not immediately affected or threatened by the
  law.
• Oregon legislature asks voters to vote on the
  proposed law again.

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• In November, 1997 the original law passed again
  by a margin of 60 to 40.

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Oregons Physician-Assisted Suicide LawUpdate
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Legal and LegislativeChallenges
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Pain Relief Promotion Act

• June 1999Introduced in U.S. House by Hyde,
  Stupak, Nickles
• Would prohibit use of federally controlled drugs
  for PAS

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Pain Act, cont.

• Encourages aggressive pain management for dying
• Would impede or stop PAS under Oregons law

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PAS Act, cont.

• October 27, 1999U.S. House votes 271156 to pass
  the Pain Relief Promotion Act
• Pain Relief Promotion Act has since languished in
  the U.S. Senate and has not been reported out of
  the Committee on Health, Education, Labor, and
  Pensions

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Attorney General Ashcroft

• Nov. 6, 2001
• Doctors who prescribe drugs to hasten the death
  of terminally ill patients are in violation of
  the federal Controlled Substances Act.

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Court Ruling

• April 17, 2002
• U.S. District Court Judge Robert Jones
• The 11/6 directive is not entitled to deference
  under any standard and is invalid.

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Court Ruling (cont.)

• The fact that opposition to assisted suicide my
  be fully justified--morally, ethically,
  religiously, or otherwise--does not permit a
  federal statute to be manipulated from its true
  meaning to satisfy even a worthy goal.

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PAS So Far
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Oregon State Statistics

• Patients
• 1998-2001
• 91 received and used lethal prescriptions
• out of 117,896 deaths
• 1/1,296 deaths (.08)

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Statistics, cont.

• Vitals
• 44 Men
• 47 Women
• 97 were white
• Median age69

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Statistics, cont.

• Illness
• Cancer 70
• ALS 7
• COPD 7
• Other 7

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Statistics, cont.

• Educational Level
• Some high school 10
• High school graduate 42
• College graduate 39

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Statistics, cont.

• Reasons identified
• Loss of autonomy 74
• Inability to participate 67
• Loss of bodily control 55
• Burden on others 30
• Inadequate pain control 18

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Statistics, cont.

• Insured
• Private 65
• None 1
• Place of death
• Home 82
• Hospital 1

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Statistics, cont.

• Minutes between ingestion and unconsciousness
  median 5
• Minutes between ingestion and death median 30

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Vermont Death with Dignity Act
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