1. PLA4522 Health Care Law Amanda Woods November 22, 2013 Santa Fe College

2.  5 th Century B.C.  Ancient Greeks and Roman attitude (ProCon.org, 2013)  1800’s  Forbidden physician-assisted suicide ( ProCon.org, 2013)  Early 1900’s  Bill defeated (ProCon.org, 2013)  1930’s  Critical point in history (ProCon.org, 2013)

3.  October 1, 1976  Withdrawal of life-sustaining medical treatment (ProCon.org, 2013)  1977  Eight states sign right-to-die- bills (ProCon.org, 2013)  June 25, 1990  Cruzan v. Director, Missouri Department of Health (Fremgen, 2012)  1994  The Oregon Death with Dignity Act passed (ProCon.org, 2013)

4.  November 4, 2008  Washington signed bill (ProCon.org, 2013).  December 4, 2008  Montana legalized physician-assisted suicide (ProCon.org, 2013).  May 20, 2013  “End of Life Choices”(ProCon.org, 2013).

5.  Illegal states use palliative care (Quill, 2012)  Hospice care centers  30% of dying patients (Quill, 2012)

6.  Federal Laws (Salladay 2004)  State Laws (Shariff 2012)  Montana  Oregon  Washington  Vermont  Patient’s rights to end life (Shariff 2012)

7.  Montana’s Law (ProCon.org, 2013)  Court system  Oregon, Washington, and Vermont Laws (Darr 2007)  Age of 18 or older  Terminally ill  Competent  Requests  Patient Request timeline

8.  Physician Guidelines (ProCon.org, 2013)  Licensed  Consulting physician  If patient is impaired  The next of kin must be notified  Alternative choices

9.  Japan (Humphrey 2005)  Largest group in the world  80% of citizens die in hospitals  European nations (Marker 2006)  No specific laws or penalties  Relaxed laws  Survey of 34 European Nations (Humphrey 2005)

10.  Category (Fremgen, 2012):  Active  Passive  Subcategory (Perry, n.d.):  Voluntary  Nonvoluntary  Involuntary

11.  Illegal in the United States (Darr, 2007)  Except for 4 states:  Montana  Oregon  Vermont  Washington  National associations highly oppose (Hosseini, 2012):  American Medical Association  American Nursing Association  General public approves (Gardner, 2012):  60-70% advocate

12.  “Slippery Slope Theory”  Medical Profession Violation  Patient Pain and Suffering  Patient Rationality  Financial and Family Burden

13.  Opponents fear abuse (Seay, 2001).  Forego treatment  Establish end-of life-means  Devalues life (Diamond, 2013)  Reduces desire to prolong life  Purposeful death – unreasonable (Kovner & Lusk, 2012)

14.  Hippocratic Oath (Hosseini, 2012)  “Do no harm”  Preservation of life  Promotion of health  Other Healthcare Professional Duties (Varelius, 2006):  Patient autonomy  Justice  Nonmalfeasance  Relief from pain and suffering  Promotion of well-being

15.  Opponents (Varelius, 2006):  Cure or treatment possibility  Alternative methods  Advocates (Morar & Dura, 2013):  Affects the patient’s life  Work  School  Personal  Treatments may not work or too far in the future

16.  Opponents (Menzel & Steinbock, 2013):  Different patient  Fear clouds judgment  Advocates (Gill, 2005):  Mentally competent  Right to die with dignity  Right to decide

17.  Unable to work (Fremgen, 2012)  Unable to care for themselves (Fremgen, 2012)  Medical costs continuously accrue (Kovner & Lusk, 2012)  Medicare paid $55 billion in 2011

18.  Slippery slope  Proper management/authority  Governing bodies  Personal beliefs of staff members  The right to live = the right to die  Other, illegal, alternative and outcomes  Abuse of the system  Respect individuals’ rights (Ersek, 2005)

19.  Too many requirements/barriers to eligibility  Poor access  Only legal in four states (2013)  No state or federal oversight  At the discretion of two physicians to determine eligibility (Ersek, 2005)

20.  More attention to developing policies and legislation  Widespread adoption  Less barriers to entry  Utmost professionalism and respect

21.  More oversight and regulation  Transfer of authority  Specialty purpose-built facilities – first mentioned by Dr. Kevorkian (Darr, 2007)  Family input suggested, but not required

22.  Darr, K. (2007). Assistance in dying: Part II. Assisted suicide in the United States. Hospital Topics, 85 (2), 31-36  Diamond, E. F. (2013). The right to pain control. National Catholics Bioethics Quarterly, 13(2), 237-242.  Ersek, M. (2005). Assisted suicide: Unraveling a complex issue.. Nursing, 35 (4), 48-52.  Fremgen, B. F. (2012). Medical Law and Ethics (4 th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.  Gardner, D. B. (2012). Quality of life and death: Can we have the conversations?. Nursing Economics, 30(4), 224-232.  Gill, M. B. (2005). A moral defense of Oregon's physician-assisted suicide law. Morality, 10(1), 53-67. http://dx.doi.org/10.1080/13576270500031055  Hosseini, H. M. (2012). Ethics, the illegality of physician assisted suicide in the United States, and the role and ordeal of Dr. Jack Kevorkian before his death. Review of European Studies, 4(5), 203-208. http://dx.doi.org/10.5539/res.v4n5p203  Humphrey, D. (2005). Trend carefully when you help to die. Retrieved from http://www.assistedsuicide.org/suicide_laws.html  Menzel, P. T. & Steinbock, B. (2013). Advance directives, dementia, and physician-assisted death. Journal of Law, Medicine, & Ethics, 41(2), 484-500.  Morar, S. & Dura, H. (2013). Points of view about the moral-ethical approach of terminal states. Acta Medica Transilvanica, 2(1), 199-201.  Perry, C. (n.d.). Euthanasia & assisted suicide. Retrieved from http://www.pages.drexel.edu/~cp28/euth1.htm  Procon.org. (2013). History of euthanasia and physician-assisted suicide. Retrieved from http://euthanasia.procon.org/view.timeline.php?timelineID=000022  ProCon.org. (2013). State-by-state guide to physician-assisted suicide. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=000132  Quill, T. E. (2012). Physicians should 'assist in suicide' when it is appropriate. Journal of Law, Medicine & Ethics, 40(1), 57-65. http://dx.doi.org/10.1111/j.1748-720X.2012.00646.x  Seay, G. (2001). Do physicians have an inviolable duty not to kill?. Journal of Medicine and Philosophy, 26(1), 75-91.  Varelius, J. (2006). Voluntary euthanasia, physician-assisted suicide, and the goals of medicine. Journal of Medicine and Philosophy, 31(2), 121-137. http://dx.doi.org/10.1080/03605310600588665