Medical ethics ii

1. Medical ethics ii Dying and Death

2. Medical ethicsdeath • What is death?

3. Medical ethicsdeath • In the normal course of life, when people age their cells accumulate toxins that cause their skin and organs to slowly deteriorate over time. • So when people get up in years, to around ninety, their cells stop working properly because they have built up so many toxins that the cell could not function. • But throughout history most people do not die of “old age.” They die “prematurely” as the result of an illness or accident. • There are thus two processes that cause people to die – naturally through aging, or prematurely through accident or disease.

4. Medical ethicsdeath • From a biological point of view, all the different cause of death share a final pathway - a state of medical shock characterized by a lack of oxygen being delivered to the different organs. • So, the medical definition of death is when a person has no heartbeat and no respiration and there are no reflexes in the base of the brain (brain steam).

5. Medical ethicsdeath • Death for a social point of view is the ending of tangible relationships among human beings. • Death for a religious point of view is a “passage” to a different form of life.

6. Medical ethicsdeath • Is death harmful? • Why are we afraid of dying?

7. Medical ethicsdeath Living Will • They are declarations made by a competent adult (designated decision maker) about the health care they would like for themselves if in the future they become seriously ill or incapable of making their wishes known • It relieves family members from making life or death decisions

8. Medical ethicsdeath Hospice • Refers not so much to a place but an approach to being with and caring for dying persons. • Incorporates a variety of services designed for people who are terminally ill. • An intense multi-faceted, spiritually based approach to assisting people through the dying process.

9. Medical ethicsdeath Five Approaches to Dying Practiced by Hospice • Considers death and dying as a normal aspect of life • Advocates family involvement in caring for the dying person, including care within the person’s home for as long as it is beneficial

10. Medical ethicsdeath • Hospice seeks to help those who are dying to be givers as well as receivers of care in a community of mutual support • Actively involves dying persons in decision making • Sees the spiritual dimension as very important for dying persons and fosters spiritual preparation for death

11. Medical ethicsdeath • The term euthanasia comes from the Greek root meaning “good death”; sometimes referred to as “mercy killing” • Euthanasia is the intentional termination of life by another at the explicit request of the person who dies. • The term implies that the person who wishes to die must initiate the act.

12. Medical ethicsdeath Active or Direct Euthanasia taking deliberate steps to end the life of a suffering and incurably ill person Passive or Indirect Euthanasia deliberately not taking steps to prevent a sick person’s death

13. Medical ethicsdeath • Voluntary euthanasia • occurs at the request of the person who dies • Non-voluntary euthanasia • occurs when the person is unconscious or otherwise unable to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf

14. Medical ethicsdeath Ordinary Means of Care • All medicines, treatments, and operations, which offer a reasonable hope of benefit and which can be obtained and used without excessive expense, pain, or other inconveniences.

15. Medical ethicsdeath Extraordinary Means of Care • All medicines, treatments, and operations, which cannot be obtained or used without excessive expense, pain, or other inconveniences, or which, if used, would not offer a reasonable hope of benefit.

16. Medical ethicsdeath • The Catholic ethical tradition holds that one is morally obliged to use the ordinary means of sustaining life, but not obliged to make use of extraordinary means. There are particular circumstances for every case. • The Catholic church acknowledges that what may be ordinary in one situation may not be in another.

17. Medical ethicsdeath • Physician-assisted suicide • a person, who is incurably ill, kills himself or herself with the help of a physician • Dr Jack Kevorkian

18. questions • 1. What is the difference between active and passive euthanasia? • 2. What is the difference between voluntary and involuntary euthanasia? • 3. What two questions determine whether a life-support measure is an ordinary or an extraordinary means? • 4. What is physician-assisted suicide and how is it different from euthanasia? • 5. Determine whether the following decisions fall under the definition of euthanasia in the strict sense. Explain your choice. •  a) A seventy-year-old woman suffers her third stroke in five years, leaving her paralyzed on her left side and unable to raise herself from her bed without assistance. She notices the nursing home staff that if she stops breathing she would like not to be revived. • b) A sixty-five-year-old man discovers that he has a colon cancer. His father died of this disease many years ago, and the man fears undergoing the same suffering. He plans to take a lethal dosage of painkillers before the condition gets much worse. • c) A couple’s daughter is born with severe mental retardation and also with a major blockage (requiring extensive surgery) in her intestines preventing her from taking in regular nourishment. Since the parents do not want their child to live with the degree of retardation that doctors indicate she suffers from, the couple refuses to sign paper allowing doctors to remove the blockage. Without this operation the child will soon die.