1 Study Guide Module Four End of Life Decisions Extending life indefinitely End of Life Decisions I am not afraid of death I just don t want to be there when it happens Woody Allen comedian actor Picture courtesy http manhattman com wp content uploads loveandeath3 e1357958765734 jpg What are the legal and ethical considered in end of life decisions As medicine s technical limits have become increasingly clear Americans seem more willing to address end of life decision making 1 Physician Assisted Suicide Legal and ethical considerations http www healthlawyers org Publications Journal Documents Vol 2040 20Issue 201 Physician Assisted 20Suicide 20Legal 20and 20Ethical 20Considerations pdf 1 This evolution toward recognizing the appropriateness of assistance in dying raises legal and ethical issues for physicians and healthcare institutions such as nursing facilities and acute care hospitals What three ethical issues are raised in this article 2 The Hippocratic tradition prohibits physicians from what The Hippocratic tradition prohibits physicians from administering a deadly drug and considers it unethical for physicians to deliberately cause death whether requested by the patient or for the noble purpose of pain relief 3 As a matter of constitutional law in the United States what is the state required to do when the patient cannot communicate their desire the state may act to protect and further life when persons cannot communicate and it is unclear what they would want were they able to communicate 2 4 Why did the Michigan Court of Appeals acquit Kevorkian The Michigan Court of Appeals ruled that the ban on assisted suicides was passed illegally 64 Judges dismissed charges against Kevorkian ruling that assisted suicide is a constitutional right and juries acquitted him 5 Of the 130 patients that dies with Kevorkian s assistance what percentage were known to be terminally ill Only 40 had been diagnosed as terminally ill 6 Why was Kevorkian criticized on professional and ethical grounds he did not know his patients was unqualified to diagnose or understand illnesses because he was a pathologist had a conflict of interest because of his desire to publicize himself and initially his suicide machine assisted persons who did not have terminal illnesses and made little effort and was not even qualified to judge the mental competence of the persons he assisted in suicide 7 Kevorkian hoped to establish an obitorium a clinicwhere terminally ill persons wanting to commit suicide could be assisted to die True or false True 8 What was Kevorkian s primary defense and how was this similar to similar to that of Roe vs Wade Which found a constitutional right to privacy protected a woman s decision to abort her pregnancy in the first trimester free from state interference Dr Jack Kevorkian with his defense attorney Jeffery Fieger and his euthenasia device Picture courtesy of http img timeinc net time photoessays 2011 jack kevorkian 0603 kevorkian 01 jpg 9 In the state of Oregon what are the 6 threshold requirements in order for a physician to prescribe medications used to end one s life 1 is an adult 2 is capable 3 is a resident of Oregon 4 has been determined by the attending physician and consulting physician to be suffering from a terminal disease 5 has voluntarily expressed his or her wish to die and 6 make s a written request for medication for the purpose of ending his or her life in a humane and dignified manner in accordance with Oregon Revised Statutes Sections 127 800 to 127 897 3 10 Once the threshold requirements have been established obtaining a prescription requires what steps 1 The patient must make two oral requests to his or her physician separated by at least 15 days 2 The patient must provide a written request to his or her physician signed in the presence of two witnesses 3 The prescribing physician and a consulting physician must confirm the diagnosis and prognosis 4 The prescribing physician and a consulting physician must determine whether the patient is capable 5 If either physician believes the patient s judgment is impaired by a psychiatric or psychological disorder the patient must be referred for a psychological examination 6 The prescribing physician must inform the patient of feasible alternatives to assisted suicide including comfort care hospice care and pain control 7 The prescribing physician must request but may not require the patient to notify his or her next of kin of the prescription request 11 Assisted suicide has been available in Switzerland since what year 1942 12 Given that Dutch physicians historically have been willing to actively euthanize persons without their consent persons at risk are justified in fearing that their lives will be ended without their consent This fear has caused many of the most vulnerable Dutch the disabled or elderly to do what to carry cards specifying their desire to continue living 13 According to the article what is the most important reason for traditional health care organizations to decline to assist in suicide The public may find it fearsome and inconsistent that providers they are asked to trust to help them regain and maintain their health also assist in suicide 14 A California Public opinion poll after Jack Kevorkian s second degree murder conviction showed that public support of PAS increased or decreased public support of PAS increased from seventy percent to seventy five percent 15 Data from a survey of Oregon Physicians not opposed to PAS illustrate that these physicians share what concerns Half feared the attempt might fail and result in harm half were not confident they could predict when a patient had less than six months to live half were unsure what drug to prescribe one third feared someone other than the patient would take the medication one third were not confident they could recognize depression and some did not want to become known as suicide doctors 16 In the conclusion section of this article what is described as autonomy As framed the debate on decisions at the end of life focuses on negative rights Freedom from unwanted health services is a negative legal and ethical right grounded in the liberty right to be free from unwanted interference Simply stated this is autonomy Continued attention to the implications of technology for patient autonomy and the principle of nonmaleficence do no harm are necessary if an organization is to fulfill its mission in the context of its philosophy 17 What is
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