1. Death & Dying
Death & Dying

2. The Changing Medical Situation
Until 1940’s, medical care was often just comfort care, alleviating pain when possible
During last 50+ years, medicine has become increasingly capable of postponing death
Increasingly, we are
forced to choose whether
to allow ourselves to die.

3. Death and Dying Agonal phase- gasps and muscle spasms
Dying occurs in 3 phases
Agonal phase- gasps and muscle spasms
Clinical death- short interval in which heartbeat, circulation, breathing and brain functioning stop but resuscitation is still possible
Mortality occurs when individual passes into permanent death

4. Components to think about
Stages of Bereavement
Components to think about
Wills
Place of death
Place of burial
Method of burial
Denial
Anger
Bargaining
Depression
Acceptance

5. The Hippocratic Oath
"I will give no deadly medicine to any one if asked, nor suggest any such counsel"
… Hippocratic Oath by "Father of Medicine, Greek physician Hippocrates, about 400 B.C.

6. means “a good death,” “dying well.” What is a good death?
Euthanasia
Definition: painlessly ending life of a being that is suffering from terminal illness or other painful or incurable condition.
means “a good death,” “dying well.”
What is a good death?
Peaceful
Painless
Lucid
With loved ones gathered around

7. The Euthanasia Society of England (1935)
Oregon Assisted Suicide (1998)only state to do so
Kevorkian Sentenced to Prison (1999)
Netherlands Legalizes Euthanasia (2000)1st country to do so
Belgium Legalizes Euthanasia (2002)

8. Washington West Virginia Wisconsin Wyoming
States with Wills to Live or Living Wills
Alabama              Alaska                   Arizona                Arkansas
California            Colorado               Connecticut          Delaware
District of Columbia                         Florida                  Georgia 
Hawaii                 Idaho                    Illinois                   Indiana        
Iowa                    Kansas                  Kentucky               Louisiana
Maine                  Maryland               Massachusetts        Michigan
Minnesota           Mississippi             Missouri                 Montana
Nebraska            Nevada                  New Hampshire     New Jersey  
New Mexico        New York              North Carolina      North Dakota
Ohio                   Oklahoma               Oregon                 Pennsylvania 
Rhode Island       South Carolina        South Dakota        Tennessee  
Texas                 Utah                       Vermont               Virginia
Washington        West Virginia          Wisconsin             Wyoming 
In what states is euthanasia legal?

9. Euthanasia vs. Assisted Suicide
Who is ‘agent’? Who does killing? Who terminates life?
Euthanasia: second person is agent
Assisted suicide: person whose life is ending is agent (with some help from another who provides means)

10. American Medical Association House of Delegates
Active euthanasia: Mercy killing: intentional termination of life of one human being by another = contrary to policy of AMA
Passive: cessation of employment of extraordinary means to prolong life when irrefutable evidence that biological death is imminent: decision of patient, family, with advice of physician

11. Most euthanasia cases involve elderly, right-to-die campaign has cases of brain-damaged young women: Karen Ann Quinlan ( ), Nancy Cruzan ( ), and Terri Schiavo ( ).

12. Karen Ann Quinlan Age 21, home from party lapsed into coma PVS
Removed from active life support 1976
Died of pneumonia in 1985
1st significant precendent

13. Nancy Cruzan Injuries from auto accident left her in PVS
State is bearing costs
Decided by USSC 1990
Request feeding tube removed
Died 11 days later

14. Issue: Active assisted suicide is banned, while passive refusal of treatment is permitted
Holding: NY law banning assisted suicide does not violate constitutional right of equal protection
Reasoning: Difference between “letting die” and “making die” is important, logical, rational, well-established.
Thus, there is no equal protection violation to treat them differently under the law.
Vacco v. Quill (1997)
1997 USSC
Dr. T. Quill request to actively assist patients with cancer to die with dignity.
USSC = NO

15. Governor Bush v. Michael Schiavo (Florida, 2004)
Previous decisions: voluntary euthanasia request by Terri Schiavo
Issue: constitutionality of law passed by FL legislature giving governor authority to reinsert feed tubes
Holding: law violates separation of powers
Reasoning: basis of our system of government

16. Terri Schiavo collapsed in home on 1990 20 m without oxygen PVS
March 18, 2005 court cases between parents & husband ended – husband won
Died March 31, 2005

17. Dr.Kevorkian Sentenced to Prison (1999)
Pathologist Dr. Jack Kevorkian was sentenced to year prison term for giving lethal injection to Thomas Youk whose death was shown on 60 Minutes

18. Arguments Against Euthanasia
Euthanasia would not only be for people who are "terminally ill"
Euthanasia can become means of health care cost-containment
Euthanasia will become non-voluntary
Euthanasia is rejection of importance /value of human life

19. Argument Supporting Euthanasia
Euthanasia is seen as form of mercy killing, dying with dignity, especially for those who are suffering from terminally ill disease