1. Physician assisted suicide, euthanasia, “law of double effect’, Palliative Sedation, Withholding or Withdrawing Medical Interventions

2. PHYSICIAN ASSISTED SUICIDE In assisted suicide, the patient swallows a lethal dose of drugs or activates a device to administer the drugs. Physicians assist by: 1.Providing the means for the suicide 2.Provide information on it or referring the patients to where they might get information. e.g. Hemlock society

3. Assisted suicide is not ethical but legal in 5 US states. They are: Washington Vermont Oregon Montana New mexico

4. EUTHANASIA Here, the physician administers a lethal dose of medication, such as Potassium Chloride. The physician both supplies the means of death and is the human agent in the events leading to the patient’s death. It is sometimes called Mercy Killing. It is neither Ethical nor legal.

5. “LAW OF DOUBLE EFFECTS” A terminally ill patient may require high doses of opioids or steroids for severe pain relief. In rare cases, the dose required to relieve suffering may also hasten death. There is a difference between administering a lethal injection and giving pain medications that might inadvertently shorten a patient’s life. The issue is one of intent i.e. to relieve pain and suffering. It is both Ethical and legal

6. Withholding or Withdrawing Medical treatment Ethically and legally, when a competent patient makes an informed decision to refuse life sustaining therapy, this request is upheld. Patients have a right to be free of unwanted medical interventions. Under such circumstances, the underlying illness, not the physician’s action is considered the cause of death.

7. Palliative Sedation This refers to the practice of sedating a terminally ill patient to the point of unconsciousness, due to intractable pain and suffering that has been refractory to pain medications. Such patients are dying; they are hours or days away from death. This is considered Ethical and legal

8. Note: On the exams, you can’t perform Euthanasia, Assisted suicide and The law of Double Effects

9. Case Study Debbie case Brittany Maynard case Dr Jack Kerviokian