Download Right to Die

Kaley Galbreath, Kaila White, Hanane Kandoussi, Berkley
Moss, Deidre Bell, Carrie Guinn, Lisa Brown
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Ethical decision making must balance the rights of an individual to
decide for themselves, the views of society as a whole, and the desires
and whishes of a family and others close to the individual.
Should a patient have the right to choose to die?
What are the circumstances that a patient would want and have the
right to choose to end their life?
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Euthanasia Active is when the physician takes direct action
Passive is when simply withholding or withdrawing the treatment to
sustain life
Physician assisted suicide (PAS) is when usually medication is given to a
patient that wants to end his or her life and they take it on their own
and would also have the choice not to take it
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Most terminally ill patients want the right to exercise the option of
assisted suicide or euthanasia
Pain and suffering
Not being able to function or make choices themselves, being so
debilitated that they are being given care by doctors or family
members
Netherlands :
In 1990:
 About 9% of all deaths were a result of physicianassisted suicide or euthanasia.
 96.6% deaths were actively caused by physicians .
 Only 3.4% were passive euthanasia
 61% of patients received lethal dose, even though
27% of them were
fully competent
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legalized euthanasia in September 2002. Both a
physician and a psychologist must be involved in the
process if the patient’s competency is in doubt.
Colombia
Euthanasia was authorized in 2010. The court
defined terminally ill as a person with condition
such as AIDS, kidney failure, liver failure, cancer and
other terminal conditions with extreme suffering.
India, Ireland, and Mexico
Active euthanasia is illegal. However, it is not illegal
to withdraw life support or other treatments if the
patient or family request it.
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The federal government does not have assisted suicide laws.
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Those laws are generally handled at the state level
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Death with dignity act was passed in November
1994 by a margin of 51% in favor and 49% opposed.
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On December 31, 2009, the Montana Supreme
Court's ruling legalized the doctor-prescribed
suicide in the state.
The law requires that physicians assist patients by
providing lethal prescription drugs but the patient
have to them take on their own.
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On May 20, 2013. Vermont became the fourth state in the country that
allows physician assisted suicide.
Since then physician reporting forms have been completed for two
people, according to the Department of Health
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In 2014, New Mexico judge ruled that terminally ill, mentally
competent patients have the right to get a doctor to end their lives.
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The terminally ill individual who has made the decision that they want to
end their life on their own terms.
The reasons patients gave when requesting PAS in Oregon:
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86% reported a decreasing ability to participate in activities that made life enjoyable
100% reported loss of autonomy, and
86% reported loss of dignity
Of those patients in Oregon that request PAS, roughly 62% of them actually
complete it.
90% of those patients died at home.
88% of them were on hospice.
Physician assisted suicide accounts for 15.6 per 10,000 deaths in Oregon.
The decision of a loved one to end their own life can have varied affects
on family members.
In the normal course of an illness, loved ones, friends and family are all going to be
involved in the dying process.
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Physician-assisted suicide is fundamentally incompatible with the
physician’s role as healer.
Physicians have to be prepared to deal with patient requests to end their own
life.
 They have to assess and reassess their treatment plans for effectiveness.
 They should explore the reason for the request.
 Use community-based services and hospice care to decrease the typically
enormous financial and emotional burdens on the patient’s home life and
caregivers
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Legalizing assisted suicide will have a great impact on society and will
affect everyone in one way or another.
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Religious groups
People with disabilities
Policy makers
Insurance companies
Live Out Disease
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Hospice Care emphasizes
palliative care not curative and
focuses on extending the quality
of life.
Includes not only the patient but
the family in the course of care
and provides emotional, physical,
and spiritual support.
Hospice neither hastens not
postpones death
Allows patients to die in a
comfortable, homely environment
Palliative
Care/Sedation
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Better pain and symptom
management
Patient is sedated and made
unconscious therefore
unaware of the pain
Treatable
Depression
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The desperate need for relief
against their physical suffering
can cause psychological
distresses such as depression and
feelings of hopelessness, making
suicide/euthanasia an option to
hasten death
By treating the depression, the
thoughts of suicide could be
lessen and perhaps prevented
Advance
Directives
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Instructions for end-of-life care and
what life-saving measures you want
or do not want to be taken such as
dialysis, ventilators, feeding tubes,
etc., as well as dictate a durable
power of attorney. These forms allow
you to dictate your terms of care and
you must be specific about what you
want and don’t want and under what
circumstances
Must be no doubt of mental capacity
Are not permanent and can be
revoked at any time
Refusal of
Treatment
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Refuse any type of life-saving
treatment and receive care under
your own terms, as long as there is
sufficient mental capacity
Mental Capacity Act 2005: Every
person is considered mentally
capable unless they have brain
damage or is impaired and cannot
make a decision at the current time
(head trauma, alzheimers, etc.)
DNR/DNACPR
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Do not resuscitate or do not attempt
CPR is used in the cases of cardiac or
pulmonary arrest; this form signifies
that you do not want to receive CPR
or be resuscitated
Another way to dictate life saving
measures
Is not permanent and can be revoked
or changed at any time
Can be completed in paper form or
worn as bracelet or necklace
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Our stance on doctor-assisted suicide? Pro!
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Terminally-ill patients. i.e. terminal cancer, end stage renal disease,
advanced heart disease, etc.
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Typically about 6 months or less to live.
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Doctor-assisted suicide is currently legal in 5 states and New York has introduced the “death with
dignity” bill which is still in progress .
In order to be eligible for doctor-assisted suicide:
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Patients need (at least) 2 physicians to confirm end stage disease.
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Patients must go through a psychological evaluation to determine if they are competent to make the
decision.
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Patients need (at least) 2 witnesses to confirm that patient wishes to end their life.
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Patients must administer (life-ending) drugs themselves.
Possible other qualifying illnesses or disabilities for the future?
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Untreatable diseases
Paralyzed patients
Brain trauma
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Body and life in control of patient
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Choice may be made during chronic illness due to pain and cost
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Pain and suffering
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Pain despite medication
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Medication and low quality of life
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• State/local government hospitals — $1,625
• Non-profit hospitals — $2,025
• For-profit hospitals — $1,629
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Avg. $1,760
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Who must pay?
Family
 Friends
 Government Agencies
 Hospital
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Life support cost $2,000 - $4,000 min.
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Left feeling helpless
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Feel like a burden
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Embarrassment
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Put control back in their hands
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End stage of debilitation illness
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Pain and suffering
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Financial burden
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Right to die
Currently, there are only 5 states in the United States where the legal right to die
law is in effect. These states are Washington, Oregon, Vermont, Montana, and
New Mexico.
Terminally ill patients are now moving to these states to have their wishes
regarding assisted suicide granted.
The Death with Dignity Act allows medically competent, terminally ill (six months
or less) patients to request and receive prescription medications to end their lives.
Florida needs to implement legislation and provide Advance Directive Education
to its population.
A recent, very public example is the Brittany Maynard case. She was a 29
year old married female patient with a rare brain tumor. She was given six
months to live by her doctors. They determined that she would be in a
vegetative state as the tumor grew. While competent, Brittany made the
choice to have assisted suicide after establishing her residence in Oregon.
Her husband and family were at peace with her decision and this heavy
burden was released.
It is important for Advance directives education to be given to Florida’s
population in combination with clear definitions/guidelines concerning
Right To Die laws, in order to prevent political maneuvering by government
representatives.
An example is found in the Terry Schiavo case – a complete debacle! Terry collapsed at
her home in February 1990 and went into cardiac arrest. She was transported to the
hospital and placed on life support and a feeding tube as she did not have a living will.
She remained on life support for 15 years. During this time, her husband, after six years,
once told that she would remain in a vegetative state, petitioned for the removal of her
life support. At that time, her parents challenged the petition.
The courts granted permission for the hospital to remove the feeding tube at a later date,
but Governor Jeb Bush petitioned to let the feeding tube remain in 2003.
After 14 appeals and numerous motions, the feeding tube was removed and Terry
Schievo passed away on March 31, 2005.
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Clear legislation would prevent unscrupulous doctors from developing
and administering their layperson concoctions to, in some cases,
psychologically unsound, depressed and vegetative patients.
Jack Kervorkian was a doctor of Armenian heritage, born in Michigan. He
was fascinated with death throughout his career. He studied and researched
the subject in many countries and became controversial when he suggested
that death row inmates should give back to their country by being used as
human medical experiments. In later years, he discovered the practice of
assisted suicide in the Netherlands.
Dr. Kervorkian concocted “The Thanatron” WHICH consisted of three
bottles that delivered successive doses of fluids: first a saline solution,
followed by a painkiller and, finally, a fatal dose of the poison potassium
chloride.”
He was prosecuted several times after the Janet Adkins assisted suicide
case. She was a 45-year-old Alzheimer's patient from Michigan who found
about Dr. Kervorkian via media and sought his help to end her life.
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These and other cases have provided the opportunity for Florida’s
legislators and healthcare professionals to develop sound policies on
the rising ill and aging population with devastating diagnoses, thus
reducing the exponential financial burden now borne by its tax payers.
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Facts About Euthanasia. (n.d.). Retrieved February 18, 2015, from
http://www.terrisfight.org/facts-about-euthanasia/
Schadenberg, A. (2015, February 16). Assisted Suicides in Oregon Jump 44 Percent as Abuses
Continue. Retrieved February 27, 2015, from http://www.lifenews.com/2015/02/16/assistedsuicides-in-oregon-jump-44-percent-as-abuses-continue/
83 died from assisted suicide in WA in 2012. (2013, June 21). Retrieved March 16, 2015, from
http://www.kgw.com/story/local/2015/03/16/12539886/
Where Is Euthanasia Legal? (n.d.). Retrieved March 8, 2015, from
http://www.newhealthguide.org/Where-Is-Euthanasia-Legal.html
Oregon's Death with Dignity Act: First year Experience. (1999, February 18). Retrieved March 17,
2015, from
https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDigni
tyAct/Documents/year1.pdf
"Alternatives to Euthanasia." Alternatives to Euthanasia. The Life Resource Charitable Trust,
2011. Web. 19 Mar. 2015.
"Alternatives to Euthanasia and Assisted Suicide." Euthanasia and Assisted Suicide. Web MD UK
and Boot UK, 2012. Web. 19 Feb. 2015.
"Ethics Guide- Forms of Euthanasia." BBC News. BBC, 2014. Web. 15 Mar. 2015.
"Euthanasia and Assisted Suicide- End of Life Care." End of Life Care Decisions. NHS Choices, 08
Nov. 2014. Web. 25 Feb. 2015.
http://www.washingtonpost.com/national/jahi-mcmath-could-be-removed-from-life-supportdespite-familys-wishes/2013/12/30/41f122f4-7191-11e3-8def-a33011492df2_story.html
http://www.beckershospitalreview.com/lists/average-cost-per-inpatient-day-across-50-states-in2010.html