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.”