HAS 4400. Chapter 4 End of Life Issues. Definitions of Death. Medical Cessation of respiration, heartbeat and CNS activity. Brain based: irreversible cessation of all brain activity Legal Uniform Determination of Death Act (UDDA) Brain criteria
End of Life Issues
Non-heart-beating organ donation: A defense of the required determination of deathThe Journal of Law, Medicine & Ethics; Boston; Summer 1999; James M DuBois;
In China, doctors are taking organs and tissue from dead bodies without permission, and Chinese authorities are selling organs taken from executed prisoners. The government so far has failed to curb such abuses.
A report of the ghoulish malpractice and gross mismanagement at Alder Hey children's hospital in Liverpool revealed that, between 1988 and 1995, all the organs of all the children who had post-mortems at the hospital were systematically stripped, on the instructions of Dick van Velzen, a pathologist. Van Velzen failed to obtain parents' consent for these procedures, and lied to them and his own colleagues, who in turn failed to stop him. In response to these revelations, the government has promised to update the murky law governing the consent doctors need from relatives before a post-mortem. And a commission has been established to oversee the return of organs stored across the country to relatives who care to claim them
Ethical Responses to End of Life Issues
The Hemlock Society
Hemlock believes that people should be able to have choice and dignity at the end of life.
"The right to die should
include...the ability to enlist
assistance from...the medical
profession in making death as
quick and painless as possible...If
there is ever a time when we ought
to be able to get the government off
our backs it is when we face death"
Justice Lynn Compton, Bouvla
1. A person sustains a head injury and is conscious but incoherent or in a coma from which they may or may not recover.
2. A person is in an irreversible coma or persistent vegetative state with no possibility of recovery.
3. A person suffers irreversible brain damage but otherwise is healthy.
4. A person has a degenerative brain disease and develops a terminal disease such as cancer or blockage of a coronary artery.
1. Cardiopulmonary Resuscitation (CPR)
2. Mechanical Breathing--Being on a Respirator or Ventilator
3. Tube Feeding
4. Kidney Dialysis or Hemodialysis.
5. Diagnostic Tests
10. Pain Medication within a Regimen of Palliative Care
God had dominion over life’s end. Humans should not intrude into this area.
God’s dominion is not relevant to nonbeliever’s. In addition, some people who believe in God believe in a God who would not want dying prolonged.
There is a tradition in Western civilization against taking innocent life by overt means. It would be a mistake to abandon that tradition.
Western civilization is just one civilization among many. The test of any culture is its ability to adjust and adapt to the issues of its time.
The humane response to the suffering person is to tend to her needs, not to kill her. Suffering can be lessened with out killing the patient. Killing someone represents an inhumane experience for both the person who carries out the deed and the person who is killed.
Ending suffering is a lesser evil than prolonging suffering. We need to respond to the sick and dying who request deliverance with compassion and assistance.
All people have a duty not to commit suicide. There is value and dignity to human life, even in dying.
The life of a suffering person may become useless, at which time the person may choose to have his life ended.
It is hard to impossible to ascertain whether or not the decision for euthanasia is sane, sound, and rational. Most very sick people are also depressed. Additionally, oftentimes such people can be subject to coercion for those who could benefit from their deaths.
Let a person implement his own choices. Depressed people can make rational choices and so can people whose relatives would be relieved by their demise.
Involving physicians and nurses in direct, active euthanasia erodes the ethical foundations of medicine and nursing.
Physicians and nurses are in the best position to aid the terminally ill in dying. Those who hold no ethical scruples about practicing euthanasia should not be prohibited from so doing by professional codes or civil laws.
By implementing direct active euthanasia, we would arrange gruesome, dehumanizing scenarios.
To set the time, place, and scenario for death would not be inhumane. It would be stressful, but there is no denying that death is a stressful event. To be sure, it is easier to deal with the end of a loved one’s suffering than it is to watch the loved one’s suffering continue.
Legalized euthanasia would add to the fears of the sick and dying who would be afraid of being victims of involuntary positive euthanasia.
Sick people would be better off if they thought they could manage their dying.