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TERMINAL CONDITION ADJUSTING THE TIME AND MANNER OF DYING TERMINAL ILLNESS/CONDITION DEFINITION • A CONDITION, BROUGHT ON BY DISEASE OR INJURY, WHICH IS PRESENT IN PATIENTS WHEN THEY EXPERIENCE KEY SYSTEM OR MULTIPLE SYSTEM FAILURE, WHICH IS PART OF AN IRREVERSIBLE AND/OR DETERIORATING PROCESS AND WHICH WILL RESULT IN DEATH AS AN INEVITABLE AND PREDICTABLE OUTCOME. – FINAL PHASE OF AN OTHERWISE CHRONIC CONDITION SOME KEY ISSUES • “TIME” DESIGNATION [ARBITRARY?] • ROLE OF NATURAL SELECTIVE FACTORS • DEATH AS FAILURE OF BODY SYSTEMS OR FAILURE OF TECHNOLOGY • TECHNOLOGY AS “HASTENING” DEATH OR “LENGTHENING” LIFE • QUALITY OF LIFE QUESTIONS AFTER DIAGNOSIS – PAIN CONTROL – PLEASURES – ACTIVITIES ADJUSTING THE TIME AND MANNER OF DYING: THE CAUSAL CONNECTIONS IN THE DISEASE/INJURY NETWORK • • • • DISEASE PROGRESS OF DISEASE SYMPTOMS THERAPEUTIC RESPONSES – INITIATING TREATMENT – WITHHOLDING/WITHDRAWING TREATMENT • DECISIONS [INTENTIONS] – PATIENT [REFUSAL OF TREATMENT] – SURROGATE – CAREGIVER • PHYSICIAN’S DIRECT CAUSAL ACTIVITY ADDRESSING PATHOLOGICAL CONDITION • CAUSAL FACTORS EXTERNAL TO THE DISEASE NETWORK – MEDICATIONS --- ACTIONS --- INTENTIONS RIGHT TO REFUSE TREATMENT • RIGHT TO PRIVACY – 1,4,5,9,14 AMENDMENTS – QUINLAN (1976] ET AL.. • CRUZAN (1990) – LIBERTY RIGHT (14TH AMENDMENT] • ENDORSED BY THE PATIENT SELF-DETERMINATION ACT (1990] • VACCO V. QUILL (1997) – LIBERTY RIGHT (14TH AMENDMENT] – “EVERYONE, REGARDLESS OF PHYSICIAL CONDITION, IS ENTITLED , IF COMPETENT, TO REFUSE UNWANTED LIFESAVING MEDICAL TREATMENT; NO ONE IS PERMITTED TO ASSIST A SUICIDE.”