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Transcript
END-OF-LIFE ISSUES
Ramos, Grace
Ramos, Patrick
Ramos, Ronald
Rangel, Erika
Raymundo, Nikko
Rayos, Karen
SECTION D 2011
HOSPICE CARE
2
What is Hospice Care?
•
•
final stages of life (terminal illness)
progressive stages of a lifethreatening illness
– -patient no longer responds effectively to
treatment
– -has a life expectancy of 6 months or less
– hospice philosophy emphasizes caring, not
curing
– does not speed up death or delay it
– control pain and other symptoms so the patient
can remain as alert and comfortable as possible
3
Maximize the Quality of life,
not the duration of life
Hospice is the model for end-of-life
care.
 compassionate care at the end-of-life
 special training

Anticipate
Assess
Treat
prevent all types of physical symptoms that
cause discomfort and distress.
4

At the center of hospice is the belief that
each of us should be able to die painfree with dignity, and that our families
receive the necessary support to allow us
to do so.
5
Hospice care: Services
Provided
Psychological: spiritual guidance and
helping to cope with dying
 Pain and symptom management
 Short term inpatient services

when pain and symptoms become too great
when family members need respite time
6
 Training
family members how to care for
their loved one
 medical equipment, drugs, and supplies
 bereavement care and counseling to
surviving family members
 spiritual, mental, emotional and physical
comfort
7
Hospice Care Is Given In Many
Settings
1. Patient’s home
 2. Hospital
 3. Independently-owned hospice home
 4. Nursing facility that provides hospice
care

8
Hospice care and the community
 emphasis
on caring for the patient and family
integrates the patient's own personal community
into the community of caring persons more fully
than hospitals normally can.
 extensive
involvement of volunteers in
hospice care than in hospital care.
 heavy emphasis on an interdisciplinary
approach
regular case conferences attended by the hospice
team.
 deepens
the personal relationship of the
persons giving care with both patients and
families.
9
Virtues of a Catholic
Health Care Giver
Virtue
It is moral excellence.
 valued as promoting individual and
collective well-being and thus good by
definition.
 "Virtue", says Augustine, "is a good habit
consonant with our nature."
 Saint Thomas's brief but complete
definition of virtue: "habitus operativus
bonus", an operative habit essentially
good.

11
Three types of Virtues
INTELLECTUAL
• Prudence
• Understanding
• Wisdom
MORAL
• Justice
• Fortitude
• Temperance
• Compassion
THEOLOGICAL
• Faith
• Hope
• Charity
INTELLECTUAL VIRTUES
Prudence
 As defined by St. Thomas, is the right
method of conduct.
 confers a readiness for well-doing, but
causing one to use that readiness rightly.
 directs on in the choice of means most
apt, under existing circumstances, for the
attainment of a due end.
 may be considered a moral virtue, since it
has as its subject matter the acts of the
moral virtues
INTELLECTUAL VIRTUES
Understanding
 apprehending Christ’s public revelation
easily and profoundly
 gives great confidence in the revealed
word of God and leads those who have it
to reach true conclusions from revealed
principles
 one of the seven gifts of the Holy Spirit
INTELLECTUAL VIRTUES
Wisdom
 exceeds the gift of understanding in that it
shows us God’s perspective
 fullness of knowledge through affinity for
the divine
 supplements the virtue of faith
MORAL VIRTUES
Justice
 an essentially moral virtue
 regulates man in relations with his fellowmen
 disposes us to respect the rights of the
patients, to give each man his due
 A sin against justice requires reparation.
 A person is to compensate for the harm
he has inflicted.
Moral Virtues
Fortitude
 firmness of spirit
 steadiness of will in doing good despite
obstacles in the performance of one’s daily
duty
 suppresses inordinate fear and curbs
recklessness
 moderates rashness
 the special virtue of pioneers in any field.
Moral Virtues
Temperance
 moderates the desire for pleasure
 regulates every form of enjoyment that
comes from the exercise of human
volition, and includes all those virtues,
especially humility, that restrains the
inordinate movements of one’s desires or
appetites
Moral Virtues
Compassion
 much like sympathy in that it stems from
the suffering of another
 also includes the need or desire to
alleviate suffering (Eisenberg, 2002).
Theological Virtues
Faith
 “the assurance of things hoped for, the
conviction of things not seen,”
 our firm belief in God and all that He has
revealed to us through the Church.
 We believe because God is all-knowing
and all-good so what He tells us is
infallibly true.
Theological Virtues
Hope
 Virtue by which the will is so perfected,
 commonly defined as a divinely infused
virtue, by which we trust, with an
unshaken confidence grounded on the
Divine assistance, to attain life everlasting
Theological Virtues
Charity
 virtue by which God is loved by reason of His own
intrinsic goodness or amiability and our neighbor
loved on account of God
 It differs from faith, as it regards God not under the
aspect of truth but of good.
 Of the three theological virtues, it is the most
excellent.
 While charity excludes all mortal sin, faith and hope
are compatible with grievous sin; but as such they are
only imperfect virtues; it is only when informed and
clarified by charity that their acts are meritorious of
eternal life.
DIRECT EUTHANASIA
Direct Euthanasia
active euthanasia
 action is taken by which one ends the
life of someone else
 Active interference in the course of
natural events, the taking of steps
through positive action
 puts life and death in the hands of
man

Direct Euthanasia
deliberate killing of a terminally ill
person for the purpose of ending the
suffering of that person
 Illegal in the Philippines, United States
and most countries

◦ Legal in Netherlands and Belgium
Arguments for Active
Euthanasia
1) The justification for passive euthanasia
is that it eliminates pointless suffering.
2) But active euthanasia eliminates more
suffering more than passive euthanasia
(because it’s quicker).
3) Therefore, if passive euthanasia is
justified, then active euthanasia is more
justified.
Arguments for Active
Euthanasia

Rule Utilitarianism
◦ only thing in life that is good as an end in
itself is pleasure
◦ “kill all those who suffer a terminal illness
with no chance of recovery”
 positives outweigh the negatives
Arguments for Active
Euthanasia

The Natural Law Theory
◦ impermissible to natural law theory
because it violates the natural inclination
to preserve life which is the basis of the
ethical theory
◦ Immoral act
Ethics on Direct Euthanasia
firm and constant ethical
condemnation of all forms of direct
euthanasia
 classified as a mortal sin
 God has supreme dominion of His
creation and there is a purpose for
human suffering
 “Thou shalt not kill” (Matthew 5:21,
19:18, Mark 10:19, Luke 18:20,
Romans 13:9)

INDIRECT EUTHANASIA
Indirect euthanasia

Providing treatment (usually to reduce
pain) that has the foreseeable side
effect of causing the patient to die
sooner
◦ patient dies sooner as a side effect of
giving a medical treatment given to relieve
pain or improve end-of-life symptoms
Direct vs. indirect euthanasia

Catechism of the Catholic Church
differentiates between direct and
indirect euthanasia, also called active
and passive euthanasia
difference between the two is
the action taken

DIRECT
EUTHANASIA
◦ action is taken by
which one ends the
life of someone else

INDIRECT
EUTHANASIA
◦ consists of
"discontinuing medical
procedures that are
burdensome,
dangerous,
extraordinary, or
disproportionate to
the expected outcome
(Catechism 2278)

At first glance, the two might seem
similar when considered in light of
Thomistic philosophy
◦ aimed toward the same end – death

Each is thought to be done out of
compassion, though direct
euthanasia, is a result of "misplaced
compassion”
(Evangelium Vitae Ch. 15)

To differentiate between the two, we
might refer to Aquinas’ discussion of
homicide in which he says, "we ought
to love the nature which God has
made" and "God is Lord of death and
life" (ST II-II Q. 64, Art. 6).
Direct vs. indirect euthanasia

DIRECT
EUTHANASIA
◦ puts life and death
in the hands of man

INDIRECT
EUTHANASIA
◦ allowing someone to
die by not taking
extraordinary
measures – respects
the nature God has
made and recognizes
his authority regarding
life and death
"Those whose lives are diminished or
weakened deserve special respect.
Sick or handicapped persons should
be helped to lead lives as normal as
possible.
• "Whatever its motives and means,
direct euthanasia consists in putting
an end to the lives of handicapped,
sick, or dying persons. It is morally
unacceptable."
Catechism 2276-77
•
OTHER CLASSIFICATIONS OF
EUTHANASIA
Four Types of Euthanasia
Voluntary and Direct
 Voluntary but Indirect
 Direct but Involuntary
 Indirect and Involuntary

Voluntary and Direct

“chosen and carried out by the
patient”
Voluntary but Indirect

chosen in advance
Direct but Involountary

done for the patient without his or her
request
Indirect and Involuntary

hospital decides that it is time to
remove life support
Physician Assisted Suicide (PAS)
• Refers to the physician providing the means
for the patient’s death, most often with a
prescription.
• Ex. Upon the patient’s request, the physician
provides a patient with a lethal dose of
medication, in which the patient ultimately
administers the medication to end his own
life.
• Voluntary euthanasia.
Ethics of PAS
Ethical
VS
• May be a rational choice for
a person who is choosing to
die to escape unbearable
suffering.
• The physician’s duty to
alleviate suffering may, at
times, justify the act of
providing assistance with
suicide.
Unethical
• Directly counters the
traditional duty of the
physician to preserve life.
• May be abused, if it
becomes legal.
• Patients may become
pressured to choose PAS to
escape expensive and more
complex care options.
Ethical Principles
•
•
•
•
•
•
•
Justice
Autonomy
Compassion
Individual Liberty VS State Interest
Sanctity of Life
Potential for Abuse
Professional Integrity
Justice
• Treating the patient equally and fairly.
• “Treat like cases alike.”
• Terminally ill, competent patients should be
allowed to hasten death by treatment refusal.
• If treatment refusal will not suffice to hasten
death for some patients, suicide should be
given as an option.
Autonomy
• Respecting the choices and wishes of persons
who have the capacity to decide and
protecting those who lack this capacity.
• Right to choose or refuse treatment.
• Competent person should have the right to
choose death.
Compassion
• Understanding of the emotional state of
another, often combined with a desire to
alleviate or reduce the suffering of another.
• Suffering means more pain, including other
physical and psychological burdens.
• Not all suffering cases can be relieved, thus
PAS may be a passion responsible to
unbearable suffering.
Individual liberty VS State interest
• The society has a stronger interest in
preserving life, however that interest lessens
when a person is terminally ill and has a
strong desire to end life.
• Since a complete prohibition on assisted death
excessively limits personal liberty, PAS should
be allowed in certain cases.
Sanctity of Life
• Some strong religious and secular traditions
are against taking human life, therefore
assisted suicide is morally wrong.
Potential for Abuse
• There is potential for abuse, if PAS becomes
legal.
• Certain groups of people, such as those who
are poor or are undergoing complex care, may
be pressured into PAS option.
• Burdened family members and health care
providers may encourage option of PAS.
• Protection against these abuses would be lost
if PAS becomes legal.
Professional Integrity
• As stated in the Hippocratic oath, “I will not
administer poison to anyone where” and “Be
of benefit, or at least do no harm.”
• The association of PAS with the practice of
medicine is contradicting and undermines the
integrity of the profession.
Should an incurably-ill patient
be able to commit PAS? YES





Tremendous pain and suffering
of patients can be saved.
The right to die should be a
fundamental freedom of each
person.
Patients can die with dignity
rather than have the illness
reduce them to a shell of their
former selves.
Health care costs can be
reduced, which would save
estates and lower insurance
premiums.
Nurse and doctor time can be
freed up to work on savable
patients.





Reasonable laws can be
constructed which prevent
abuse and still protect the
value of human life.
Vital organs can be saved,
allowing doctors to save the
lives of others.
Without physician assistance,
people may commit suicide in a
messy, horrifying, and
traumatic way.
Prevention of suicide is a
violation of religious freedom.
Pain and anguish of the
patient's family and friends can
be lessened, and they can say
their final goodbyes.
Should an incurably-ill patient
be able to commit PAS? NO





It would violate doctors'

Hippocratic oath.
It demeans the value of human
life.

It could open the floodgates to
non-critical patient suicides and
other abuses.
Many religions prohibit suicide and
the intentional killing of others. 
Doctors are given too much power,
and can be wrong or unethical.
Doctors and families may be
prompted to give up on
recovery much too early.
Insurance companies may
put undue pressure on
doctors to avoid heroic
measures or recommend
the assisted procedure.
Miracle cures or recoveries
can occur.
•
Sources:
– Goring B. Euthanasia. http://www.kccofc.org/39th/IBS/Tracts/euthanas.htm. 4 February
2009.
– Nguyen CQ. Biomedical Ethics.
– Walton D. Active and Passive Euthanasia. Ethics. Vol. 86,
No. 4 (July, 1976) pp. 343-349.
– Pope Strongly Condemns all Forms of Euthanasia.
Vatican Information Service. 25 February 2008.
– The 60-Second Aquinas Lesson: Brief Title.
http://www.catholicforum.com/churches/luxver/AquinasLessons/aq102798.h
tm. 4 February 2009.
– The Controversy Over Euthanasia.
http://www.angelfire.com/al/jefspage/. 4 February 2009.
– The Ethics of Euthanasia/ Assisted Suicide.
http://www.csus.edu/indiv/g/gaskilld/ethics/Euthanasia.
htm. 4 February 2009.




http://www.newadvent.org/cathen/15472a.htm
http://en.wikipedia.org/wiki/Virtue
http://www.secondexodus.com/html/catholicdefinitions/jus
tice.htm
http://greatergood.berkeley.edu/goodwiki/index.php/Comp
assion_&_Empathy