After studying the course materials located on Module 8: Lecture Materials & Resources page, answer the following: Euthanasia Medical / Generic definition Bioethical def

Euthanasia

Physician Assisted Suicide / Death (PAS, PAD)

Hospice

Palliative care

Terminal sedation

Killing vs allowing to die

Case studies

EUTHANASIA: ORIGINALLY; EU – THANATOS (Gk) “TRUE, GOOD – DEATH”

• HISTORICALLY: ACTIVE / PASSIVE EUTHANASIA

• TODAY: “CAUSING DEATH SO AS TO ALLEVIATE SUFFERING” (ERD 60, 61)

Medical definitions of active and passive euthanasia The practice of intentionally ending a life in order to relieve pain and suffering (MedicineNet)

Generic Definition The act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy (Merriam-Webster Dictionary)

Medical Dictionary (online) deliberate ending of life of a person suffering from an incurable disease Today: include withholding extraordinary means or “heroic measures,” and thus allowing the patient to die Traditionally: positive or active euthanasia (deliberate ending of life and an action is taken to cause death in a person) negative or passive euthanasia (withholding of life-preserving procedures and treatments that would prolong the life of one who is incurably and terminally ill and could not survive without them) Today all euthanasia is generally understood to be active; forgoing life-sustaining treatment is replacing passive euthanasia.

BIOETHICAL DEFINITION OF EUTHANASIA (ERD 60, 61)

60. Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering. Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.

61. Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person's life so long as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.

PAIN / SUFFERING; W/IN CONTEXT OF FAITH -> REDEMPTIVE VALUE

(JUDEO-CHRISTIAN TRADITION)

DECLARATION ON EUTHANASIA (1980):

http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html

Vicarious reparation

Euthanasia vs physician-assisted suicide / death (PAS, PAD)

AID IN DYING (AID)

MEDICAL AID IN DYING (MAID)

PHYSICIAN AID IN DYING (PAID)

Healthy alternative to euthanasia / PAS:

• HOSPICE • PALLIATIVE CARE

Hospice vs Palliative care In common: patient care

Differences (generally):

Place • Hospice; home • Palliative Care; hospital

Timing • Hospice; 6 months (terminal) • Palliative Care; no specified time (terminal or chronic)

Payment • Hospice; not covered by all insurance (yes Medicare) • Palliative Care; hospital billing

Treatment • Hospice; comfort care (few meds and treatments) • Palliative Care; maybe life-prolonging therapies / meds

Palliative / Terminal Sedation

Relieving distress in a terminally ill person in the last hours or days of a dying patient's life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ongoing medications via the rectal route.

• Last resort

• Intractable pain

• If to manage pain only (titration), then not euthanasia

• If to sedate patient into unconsciousness –without N / H-, then euthanasia

Analgesic (pain relief): opioids (morphine, hydrocodone, oxycodone, fentanyl)

Sedative (sleeping): benzodiazepines (midazolam, haloperidol, chlorpromazine, pentobarbital, propofol)

Critical bioethical distinction:

KILLING vs ALLOWING TO DIE

Hemlock Society (1980 – 2003):

American right-to-die and assisted suicide advocacy organization

motto: "Good Life, Good Death"

founded (Santa Monica, CA):

Derek and Ann Humphry, Gerald A. Larue, and Faye Girsh

relocated to Oregon in 1988

2003, renamed: End of Life Choices

2004, Derek Humphry and Faye Girsh founded: Final Exit Network

2007, merged: Compassion in Dying Federation -> Compassion & Choices

Jacob "Jack" Kevorkian (1928 – 2011; 83 y/o) "Dr. Death" American pathologist and euthanasia proponent Right to die via physician-assisted suicide assisted at least 130 patients to PAS 1999: arrested and tried for his direct role in a case of voluntary euthanasia convicted of second degree murder served 8 years of a 10-to-25-year prison sentence released on parole 2007: on condition he would not offer advice nor participate nor be present in the act of any type of suicide involving euthanasia to any other person; as well as neither promote nor talk about the procedure of assisted suicide assisted by attaching the individual to a euthanasia device that he had devised and constructed The individual then pushed a button which released the drugs or chemicals that would end his or her own life Studies of those who sought out Dr. Kevorkian, however, suggest that though many had a worsening illness … it was not usually terminal. Autopsies showed five people had no disease at all. … Little over a third were in pain. Some presumably suffered from no more than hypochondria or depression 2011: diagnosed with liver cancer (hepatitis C) hospitalized with kidney problems and pneumonia died from a thrombosis June 3, 2011 (83 y/o)

CASE OF BRITTANY MAYNARD (1984-2014; 29 Y/0):

2012 MARRIED Daniel Diaz, NO CHILDREN, LIVED IN CALIFORNIA JANUARY 2014; DIAGNOSED WITH GRADE 2 ASTROCYTOMA () = TERMINAL BRAIN CANCER Partial craniotomy and a partial resection of her temporal lobe (understanding speech) APRIL 2014; GRADE 4 GLIOCYTOMA; prognosis of six months to live common symptom is headache — affecting about half of all people with a brain tumor. Other symptoms can include seizures, memory loss, physical weakness, loss of muscle control, visual symptoms, language problems, cognitive decline, and personality changes. partnered with Compassion and Choices to create the Brittany Maynard Fund, which seeks to legalize aid in dying in states where it is now illegal MOVED TO OREGON (PAS LEGAL) -> PAS NOVEMBER 2014 September 2015, California lawmakers gave final PAS approval

NATIONAL AND INTERNATIONAL RIPPLE EFFECT

STATES LEGALIZED PAS:

• CALIFORNIA

• COLORADO

• DC

• HAWAII (2018)

• MONTANA

• OREGON (1994)

• WASHINGTON

• VERMONT

“Life is not a problem to be solved, but a mystery to be lived.”

Friedrich Nietsche / Soren Kierkegaard

BENEVOLENCE = TO WILL THE GOOD

BENEFICENCE = DOING THE GOOD