Kaley Galbreath, Kaila White, Hanane Kandoussi, Berkley Moss, Deidre Bell, Carrie Guinn, Lisa Brown

 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?

 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

 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 physician- assisted 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

 legalized euthanasia in September 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 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.

 The federal government does not have assisted suicide laws.  Those laws are generally handled at the state level

 Death with dignity act was passed in November 1994 by a margin of 51% in favor and 49% opposed.

 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.

 On May 20, 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

 In 2014, New Mexico judge ruled that terminally ill, mentally competent patients have the right to get a doctor to end their lives.

 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:  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.

 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

 Legalizing assisted suicide will have a great impact on society and will affect everyone in one way or another.

 Religious groups  People with disabilities  Policy makers  Insurance companies

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 Live Out Disease

Better pain and symptom management Patient is sedated and made unconscious therefore unaware of the pain Palliative Care/Sedation

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 Treatable Depression

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 Advance Directives

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.) Refusal of Treatment

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 DNR/DNACPR

 Our stance on doctor-assisted suicide? Pro!  Terminally-ill patients. i.e. terminal cancer, end stage renal disease, advanced heart disease, etc.  Typically about 6 months or less to live.

 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:  Patients need (at least) 2 physicians to confirm end stage disease.  Patients must go through a psychological evaluation to determine if they are competent to make the decision.  Patients need (at least) 2 witnesses to confirm that patient wishes to end their life.  Patients must administer (life-ending) drugs themselves.

Possible other qualifying illnesses or disabilities for the future?  Untreatable diseases  Paralyzed patients  Brain trauma

 Body and life in control of patient  Choice may be made during chronic illness due to pain and cost

 Pain and suffering  Pain despite medication  Medication and low quality of life

 State/local government hospitals — $1,625  Non-profit hospitals — $2,025  For-profit hospitals — $1,629  Avg. $1,760

 Who must pay?  Family  Friends  Government Agencies  Hospital  Life support cost $2,000 - $4,000 min.

 Left feeling helpless  Feel like a burden  Embarrassment  Put control back in their hands

 End stage of debilitation illness  Pain and suffering  Financial burden  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 After 14 appeals and numerous motions, the feeding tube was removed and Terry Schievo passed away on March 31, 2005.

 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.

 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.

 Facts About Euthanasia. (n.d.). Retrieved February 18, 2015, from  Schadenberg, A. (2015, February 16). Assisted Suicides in Oregon Jump 44 Percent as Abuses Continue. Retrieved February 27, 2015, from suicides-in-oregon-jump-44-percent-as-abuses-continue/ suicides-in-oregon-jump-44-percent-as-abuses-continue/  83 died from assisted suicide in WA in (2013, June 21). Retrieved March 16, 2015, from  Where Is Euthanasia Legal? (n.d.). Retrieved March 8, 2015, from  Oregon's Death with Dignity Act: First year Experience. (1999, February 18). Retrieved March 17, 2015, from tyAct/Documents/year1.pdf tyAct/Documents/year1.pdf  "Alternatives to Euthanasia." Alternatives to Euthanasia. The Life Resource Charitable Trust, Web. 19 Mar  "Alternatives to Euthanasia and Assisted Suicide." Euthanasia and Assisted Suicide. Web MD UK and Boot UK, Web. 19 Feb  "Ethics Guide- Forms of Euthanasia." BBC News. BBC, Web. 15 Mar  "Euthanasia and Assisted Suicide- End of Life Care." End of Life Care Decisions. NHS Choices, 08 Nov Web. 25 Feb  despite-familys-wishes/2013/12/30/41f122f e3-8def-a df2_story.html  html