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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
