Download Controversy 7

Controversy 7
Should People Have the Choice
to End Their Lives?
Should People Have the Choice
to End Their Lives?
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More than two-thirds of all deaths in the U.S.
occur among people over age 65
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Medical advances force us to make
decisions unforeseen just a few decades ago
Should People Have the Choice
to End Their Lives? (cont.)
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Euthanasia – from the ancient Greek meaning
simply “good death”
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Active euthanasia – denotes some deliberate
intervention to end the patient’s life, such as giving a fatal
dose of painkilling medication
Passive euthanasia – not doing something, such as
withdrawing life-support therapy
Assisted suicide – a doctor or family member actively
provides the means or carries out the instructions
required for an individual to end his or her life
Depression and Suicide

Several common predictors of suicide include:
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Intolerable psychological pain and frustration
A feeling of hopelessness or helplessness
Communicating the intent to kill oneself
Clinical depression – differs from the “down” state
that is a common response to setbacks and is
temporary

Can be difficult to diagnose because it can manifest with
a variety of symptoms
 Insomnia, fatigue, inability to concentrate, anxiety, and
other physical or emotional comforts
Depression and Suicide (cont.)
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It can be difficult to determine whether an elderly
patient’s rejection of lifesaving treatment is an
informed choice or a sign of depression
 But depressed patients are more likely to refuse
procedures in situations where the medical
prognosis is actually good
Doctors are committed to keeping patients alive at
all costs
 But the attitude of “treatment at all costs” may
not respect someone’s decision to end their life
The “Right to Die”
Widespread public discussion of the ethics of
death and dying began during the late 1960’s
 First major “right-to-die” case involved Karen
Ann Quinlan in 1976
 First important “right-to-die” law passed was
the California Natural Death Act (1976)
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Under common law in the U.S., people have a
basic right to accept or reject medical treatment,
and therefore a right to refuse treatment
The “Right to Die” (cont.)
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Guardian at litem – a designated spokesperson
who represents the interests of an incapacitated
person and reports to the court
Courts rely on two kinds of standards to determine
when to withhold or withdraw treatment
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Standard of substituted judgment – asks “What would
this patient have wanted under these circumstances?”
Best-interest standard – asks “What is the balance of
benefits and burdens that a “reasonable person” might
want under these conditions
The “Right to Die” (cont.)
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Gerontocide – the killing of the old, a practice in some
premodern societies facing conditions of extreme scarcity
Advance directives – legal documents such as a living will
or power of attorney for health care instructions
 In most jurisdictions in the U.S., assisting a suicide is a
crime
Americans lack a clear consensus about exactly how “dying
well” might be defined
 At a minimum, ‘dying well’ typically refers to having the
right to know one’s medical condition, and the choice to
accept or reject life-prolonging treatment
Outlook for the Future
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The Netherlands has gone the furthest in legalizing
euthanasia and physician-assisted suicide
Critics of assisted suicide and euthanasia believe
we should focus more on palliative care – such as
hospice and better pain medication
Patient Self-Determination Act (PSDA) – a 1991
law that requires hospitals, nursing homes, and
other health care facilities to advise all patients at
the point of admission about their right to accept or
refuse medical treatment