Module 5 Lesson 4: Extraordinary Means, Euthanasia, and Living Wills PDF

EXTRAODINARY MEANS, EUTHANASIA AND THE SIGNIFICANCE OF A LIVING WILL LESSON 4.1 DEFINITION OF TERMS DEFINITION OF TERMS EUTHANASIA: Originally meant “a good death.” A confusing and ambiguous term because it is subject to emotionalism. More recently it...

EXTRAODINARY MEANS, EUTHANASIA AND THE SIGNIFICANCE OF A LIVING WILL LESSON 4.1 DEFINITION OF TERMS DEFINITION OF TERMS EUTHANASIA: Originally meant “a good death.” A confusing and ambiguous term because it is subject to emotionalism. More recently it has come to mean mercy killing. MERCY KILLING: A legal form of murder in most countries. Using the term to stand for both mercy killing and allowing someone to die, blurs a very necessary and important distinction between an act of murder and what is merely good medical practice. i.e. Allowing people to die of natural causes, without DEFINITION OF TERMS ALLOWING SOMEONE TO DIE: Involves both not starting curative treatment when no cure is possible and stopping treatment when it is no longer able to cure a dying patient. Implies an essential recognition that there is some point in any terminal illness when further curative treatment has no purpose. A patient in this situation should be allowed to die a natural death in comfort, peace, and dignity without any interference from medical science and technology. DEFINITION OF TERMS MERCY DEATH: The taking of a direct action in order to terminate a patient’s life because the patient has voluntarily requested it. Mercy death is REALLY an assisted suicide. Chronically or terminally ill patients often are unable to commit suicide and therefore ask someone (often a physician) to “put them out of their misery.” MERCY KILLING: The taking of a direct action to terminate a patient’s life without the patient’s permission. The decision is often made on the assumption that the patient’s life is no longer “meaningful” or DEFINITION OF TERMS BRAIN DEATH: Occurs when a patient has a normal heartbeat and normal respiration but has suffered irreversible and total brain damage. Without brain activity, the patient is reduced to a body with a beating heart and breathing lungs. CRITERIA FOR DETERMINING BRAIN DEATH: 1. Unreceptivity and unresponsiveness 2. No spontaneous movements or breathing 3. No reflexes 4. A flat electroencephalogram (EEG) DEFINITION OF TERMS BRAIN DEATH: Occurs when a patient has a normal heartbeat and normal respiration but has suffered irreversible and total brain damage. When patients are declared “brain dead,” removing life-support equipment or stopping treatment obviously CANNOT be the cause of their death, so this does not constitute allowing someone to die, mercy death, or mercy killing. PROBLEM: What about people who have not suffered brain death but injuries made the brain so badly damaged that patient lives are drastically altered? DEFINITION OF TERMS PERSISTENT VEGETATIVE STATE OR IRREVERSIBLE COMA: Results from damage to the cerebral cortex, or neocortex, which controls the cognitive functions. A PVS patient is NOT BRAIN DEAD but lacks, and will permanently lack, even those minimal functions that make a life human. Might be called cortical or cerebral death. Persons in this state often are awake, but they are not aware of what is going on around them. LESSON 4.2 CURRENT LEGAL STATUS OF MERCY DEATH AND MERCY KILLING CURRENT LEGAL STATUS OF MERCY DEATH AND MERCY KILLING Neither mercy death nor mercy killing is legal in the United States or in most countries throughout the world. U.S. CIRCUIT COURT OF APPEALS IN MANHATTAN: Ruled that New York’s manslaughter statute could not be used to prosecute doctors who prescribe lethal drugs to terminally ill patients who ask for them and then use them to commit suicide. NINTH CIRCUIT COURT OF APPEALS IN CALIFORNIA: Declared physician assisted suicide to be a fundamental constitutional right protected by the LESSON 4.3 ALLOWING SOMEONE TO DIE ALLOWING SOMEONE TO DIE Advancing medical technology has made it possible for more people to live longer than ever before. i.e. A person can be kept alive almost indefinitely by respirators, heart machines, feeding tubes, pacemakers, miracle drugs, organ transplants, kidney dialysis machines, and so on. Such advances have incurred problems as to the quality of the lives we are extending. i.e. People suffering from kidney failure, or cancer. As these patients’ lives are extended by means of advanced medical technology, so too are their pain, ALLOWING SOMEONE TO DIE Therefore, literally thousands upon thousands of people, of various ages and in various stages of dying, face what many would describe as lives of low quality. It seems to many people that what we need to do is to accept as moral, and then legalize, some methods of allowing patients to die, mercy death, or mercy killing. ARGUMENTS AGAINST ALLOWING SOMEONE TO DIE 1. ABANDONMENT OF PATIENTS: Some people argue that not using or discontinuing any means that might keep dying people alive even a little longer is tantamount to refusing them proper medical care. 2. THE POSSIBILITY OF FINDING CURES: If we are too quick to let people die, we may be denying them the opportunity to be cured of their illness. ARGUMENTS AGAINST ALLOWING SOMEONE TO DIE 3. THE IMPOSSIBILITY OF OPTING FOR DEATH: We can never choose death over life—we can never opt for death. Medicine must save lives, not end them. There is a difference, however, between accepting death as inevitable and choosing it. 4. INTERFERENCE WITH GOD’S DIVINE PLAN: Some argue that allowing someone to die interferes with God’s divine plan. However, which constitutes interference with God’s plan? ARGUMENTS FOR ALLOWING SOMEONE TO DIE RIGHTS OVER BODIES AND LIVES: 1. INDVIDUAL Individuals have rights over their own bodies, lives, and deaths. Offers patients the option of simply letting the disease follow its course rather than being subjected to the sometimes horrible effects of the various treatments offered to them. CRITICISM: No one has absolute rights over his or her own life and death. Reflected in the phrase “to the extent permitted by law” in the Patient’s Bill of Rights ARGUMENTS FOR ALLOWING SOMEONE TO DIE OF THE PERIOD OF SUFFERING: 2. SHORTENING Patients have the right to refuse treatment, and we should not overrule this right. Treatment often will not cure a particular patient, and sometimes it is worse than the disease. PROBLEM: Allowing someone to die will shorten suffering; however, it also will shorten the person’s life. 3. THE RIGHT TO DIE WITH DIGNITY: Patients have the right to die with dignity. PROBLEM: The phrase “dying with dignity” can ORDINARY AND EXTRAORDINARY MEANS An important distinction to be made has to do with exactly what means doctors are justified in using to keep people alive. TWO (2) TYPES OF MEANS THAT MAY BE APPLIED IN MEDICINE TO KEEP PEOPLE ALIVE: 1. EXTRAORDINARY (OR HEORIC) MEANS: Those that involve a grave burden for oneself or another. May vary according to circumstances involving persons, places, times, and cultures. Radical surgery, radiation therapy, respirators, and heart machines probably fall into this category when they are used merely to prolong dying. ORDINARY AND EXTRAORDINARY MEANS An important distinction to be made has to do with exactly what means doctors are justified in using to keep people alive. TWO (2) TYPES OF MEANS THAT MAY BE APPLIED IN MEDICINE TO KEEP PEOPLE ALIVE: 2. ORDINARY MEANS: Would include controlling pain and other symptoms as opposed to performing radical surgery or using respirators or heart machines. TERMINATION OF ‘EXTRAORDINARY MEANS’: The removal of life support to allow death to occur at a ADVANCE DIRECTIVES ADVANCE DIRECTIVES: Certain documents that have been created to inform others of the kind of treatment one wishes to receive if and when they become seriously ill. Also known as the living will. DOES NOT authorize either mercy death or mercy killing – focuses only in allowing someone to die. SIGNIFICANCE: 1. Ensure that they individuals will receive the kind of treatment they want even if they become too ill later on to communicate effectively to others how they wish to be treated. 2. Provide further evidence that people wish to have a strong LESSON 4.4 MERCY DEATH MERCY DEATH MERCY DEATH (VOLUNTARY DYING OR ASSISTED SUICIDE): The arguments against mercy death are much like those used AGAINST suicide except that in the case of mercy death the issue is further complicated by the fact that someone else has to do the killing. ARGUMENTS AGAINST MERCY DEATH 1. THE IRRATIONALITY OF MERCY DEATH: The argument of irrationality has less force here than in the case of suicide because of the patients’ pain and suffering and because they are going to die soon anyway. One can legitimately ask whether patients in extreme pain and suffering can ever be rational in choosing death. 2. THE RELIGIOUS ARGUMENT: The religious argument remains the same except that the situation is further complicated by the fact that someone else has to do the killing; the mercy motive, it is argued, ARGUMENTS AGAINST MERCY DEATH 3. THE DOMINO ARGUMENT: If mercy death is allowed, mercy killing may soon follow. 4. THE JUSTICE ARGUMENT: involves the guilt and other negative feelings of the person who has to do the killing. Also involves the burden of guilt placed on family members because they couldn’t do anything to prevent their loved one from wanting to die. 5. THE POSSIBILITY OF FINDING CURES ARGUMENTS AGAINST MERCY DEATH 6. THE HOSPICE ALTERNATIVE: Reveres, preserves, and protects human life. It promotes goodness by giving pleasure and avoiding pain, by creating harmony, by making lives as excellent as they can be, and by allowing and encouraging creativity at whatever level is possible. CRITICISM: Some patients may not want any treatment, hospice treatment included, and therefore it can be argued that they should be allowed to choose death. ARGUMENTS FOR MERCY DEATH 1. INDVIDUAL FREEDOM AND RIGHTS: Patients should have the freedom to decide about their own deaths, and the person who performs the act merely carries out the patient’s wishes. 2. HUMAN RIGHTS VERSUS ANIMAL RIGHTS: Just as we are generally willing to put animals out of their misery when they suffer so we should accord our fellow humans the same consideration and mercy. CRITICISM: The rights of human beings to live or die are not in any way the same as those of animals. COUNTERARGUMENT: Humans have free will and therefore should be able to decide for themselves LESSON 4.5 MERCY KILLING MERCY KILLING MERCY KILLING: The termination of someone’s life without that person’s explicit consent by a direct means out of a motive of mercy. Not to be confused with mercy death. DIFFERENTIATING CHARACTERISTIC: Mercy killing does not have consent of the patient to die and the termination of life is SOLELY out of the motive of MERCY. ARGUMENTS AGAINST MERCY KILLING 1. DIRECT VIOLATION OF THE VALUE PRINCIPLE: Murder is murder, regardless of motive. 2. THE DOMINO ARGUMENT: Because the consent of patients cannot be obtained, mercy killing involves an outside decision about the worth of their lives and sets a dangerous precedent for eliminating others who may be considered “useless” to society. Who should be entrusted with decisions concerning the worth of people’s lives? 3. THE POSSIBILITY OF FINDING CURES: Cures may be found, or patients may come out of deep comas; if we kill them, we eliminate these possibilities. ARGUMENTS FOR MERCY KILLING 1. MERCY FOR THE ‘LIVING DEAD’: We are not violating the Value of Life principle because most of those who undergo mercy killing are not fully alive human beings; rather, they are mindless organisms. 2. FINANCIAL AND EMOTIONAL BURDENS: The longer people continue to “merely exist,” the greater the financial and emotional burdens on the family and on society. ARGUMENTS FOR MERCY KILLING 3. THE PATIENT’S DESIRE TO DIE: If patients in such situations could make their wishes known, they would say that they wanted to die. PROBLEMS: We cannot know if patients really would want to die because the patients cannot communicate with us. 4. THE POSSIBILITY OF ESTABLISHING LEGAL SAFEGUARDS: Legal safeguards can be clearly established so as to prevent abuses of legalized mercy killing.