1. END OF LİFE ETHICAL DILEMMA
Assist.Prof.Dr. Mehmet KARATAS
Dept. of History of Medicine & Ethics

2. Euthanasia
CPR (Cardiopulmonary Resuscitation)
DNR (Do Not Resuscitate)
Futility Treatment

3. Definition of Death
Irreversible loss of consciousness, loss of spontaneous breathing with the loss of heartbeat
The death or loss of brain cells are necessary for the determination of death in medical terms
Brain death occurs in every death

4. Possible Reasons for Brain Death
Acute myocardial infarction, bradycardia, tachyarrhythmia, hypothermia, hyperthermia, anaphylaxis, cerebral attacks, anesthesia, trauma, electric shock, lightning strike, drowning in water, electrolyte disturbances, renal failure, toxic causes
Elderness
Chronic Diseases etc.

5. Determination of Brain Death
EEG (Electro Encephalogram)
Angiography

6. Determination of Brain Death
Cornea
Pupils
Oculo-vestibular reflex

7. Brain Death
Cortex (upper brain) death: There are light reflexes, no awareness, and eyes can follow objects when open, can live more than ten years
The brain stem (lower brain) death: Light reflex, unconsciousness and no feelings, eyes closed, no spontaneous breathing

8. Determination of Death
Anaesthetist
Neurologist or Brain Surgeon

9. Ethical Dilemma Experienced Cases
Cancer patients
Terminally ill chronic patients
Psychiatry patients
Elders
Congenital Anomalies

10. Case 1: Mr A Lung Cancer Diabetic Hypertensive Hemothorax
Bleeding in head
Fracture in extremeties
Unconscious

11. CPR: Cardiopulmonary Resuscitation
Basic Life Support
Advanced Life Support

13. DNR: Do Not Resuscitate
Should not be under 18
Should not be pregnant
Have to have chronical disease in terminal period
Two witnesses must consent

14. EUTHANASIA
Painless death in Greek

15. World Euthanasia Application
In , the Dutch government decided to allow physicians to overdose of morphine to terminate babies who develop fatal diseases in order to relief the suffering.
Sunday Times

16. CASE 2: Dr. Chabot (Dutsch Psychiatrist) Lawsuit
Patient B. is 50 years old
Has 2 sons and a problematic marriage
Her oldest son committed suicide in 1986
She had psychiatric treatment
Lost her father in 1988
She left her husband and took her younger son with her
After a car accident in 1990, her son was diagnosed with cancer.
Her son died in 1991

17. Dr. CHABOT lawsuit
Patient B. attempted suicide, but failed. She searched other methods to end her life, but she was afraid that another unsuccessful suicide trial would end her up in a mental hospital.
Patient B. has applied for Voluntary Euthanasia Union and mentioned her desire for death.

18. Dr. CHABOT lawsuit
Dr. Chabot was reprimanded by Medical Disciplinary Court for disturbing the confidence on medical profession
The Supreme Court allowed physicians to help end the lives of the patients with non-fatal diseases and who has not somatic originated pain.

19. CASE 3: Trisomy 18 (Edwards syndrome) (1\6000)
Premature birth
Apnea
Cardiac (VSD), GİS, renal anomalies
Microcephaly, micrognathia, ear malformations, deformed hands, small size, facial asymmetry
30% of them will die in a month, 90% of them will die in a year.

20. Edwards syndrome

21. Opodyme

22. Legal Basis
International Documents
The Law on the Practice of Medicine and Medical Sciences
Medical Ethics Charter
Patients' Rights Directive
Turkish Penal Code
Turkish Medical Association Code of Professional Ethics in Medicine

23. Basic Ethic Principles
Respect for Autonomy
Beneficience
Non-maleficence
Justice

24. References
F. Başak ÇAKMAK/Bilal GÜNENÇ, İnönü Üniversitesi Tıp Fakültesi, translation
Tolga GÜVEN, Marmara Üniversitesi Tıp Tarihi ve Etik AD ders notları
Gürkan SERT, Hasta Hakları
Robert M VEATCH, Medical Ethics
Emine ATABEK, Mebrure DEĞER, Tıbbi Deontoloji Konuları
Hasta Hakları Yönetmeliği, 1998
Klinik Araştırmalar Hakkında Yönetmelik, 2011
Çağlar Boyu Tıp, Roche Yayınları