Death with dignity, Psychology assignment help

  

Paper must be at least one page in a half, doubled space, 11 font, calbri fontDirections below:Death with Dignity:
This week we will
discuss a highly controversial topic, the Right to Die, or Death with Dignity.
What you will need to do
this week:
· 
Review the two slide sets I have attached below
· 
Read Chapters 16 & 18 in your Corr text
· 
Read the short NPR article (link below)
· 
Watch the brief Youtube video below
· 
Review the 10 right-to-die cases, and the Legal website (links
below)
· 
Answer the following questions by creating a thread, then respond
to at least one other student
Questions to answer:
1.  Based on the
slides, and your readings, I would like you to pick one of the 10 cases from
the link below, and reflect on how the legal process limits, neglects, or
removes the ethical or moral elements of the case you chose…what I mean, is
where should the laws protect the vulnerable from neglect/abuse, versus where
does humane treatment become obfuscated, or impeded by our legal and justice
system.
2.  Where do you
personally stand on the issue of right to die? Is it a right? Or is there an
obligation to survive? What is the role of your personal belief system in your
opinion?
3.  What is the role
of suffering in the developmental process? (I’m looking for your opinion, but I
want you to substantiate or support it with our readings)
SLIDES: See attachments
LINKS FOR DISCUSSION:
http://listverse.com/2014/11/15/10-heartbreaking-right-to-die-cases/ (Links
to an external site.)
http://law.justia.com/constitution/us/amendment-14/35-right-to-die.html

ARTICLE AND VIDEO:
NPR Article: http://www.npr.org/2011/09/12/140336146/for-the-dying-a-chance-to-rewrite-life

end_of_life_issues.ppt

death_with_dignity.ppt

Unformatted Attachment Preview

End-of-Life Issues and Decisions
FROM DESCRPTION
TO DECISION MAKING
Since death will certainly happen, we should think
about some end-of-life issue and decisions.
Much depends on the adequacy of communication
among health care professionals, terminally ill patients,
and their families.
WHO SHOULD PARTICIPATE
IN END-OF-LIFE DECISIONS?
The idea that all individuals should make decisions for
themselves has a lot of appeal in societies that value
individual personality and achievement.
Not all cultures share that view – in some cultures the
family is the center of life, and some cultures deeply value
respect for the past.
THE LIVING WILL AND ITS IMPACT
Advance directives are instructions for actions to be
taken in the future if certain events occur and we
are unable to speak for ourselves at the time.
• The living will was the first advance directive
to receive general attention in the U.S.
• First introduced in 1968 by a nonprofit
organization
• Proved to have limited effectiveness, as lack of
specificity made it difficult for physicians to
respond, and it might not come to the
attention of health care personnel when
needed
RIGHT-TO-DIE DECISIONS
THAT WE CAN MAKE
From Living Will
to Patient Self-Determination Act
The law recognizes a mentally competent adult’s right to
refuse life support procedures.
Individuals are entitled to select representatives who will
see that the advance directive is respected if they are
unable to act in their own behalf.
Advanced Medical Directives:
What Should We Do?
Facts about advance directives (Sabatino (2005):
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They are legal in every state
One that is legal in one state is generally legal in all states
Can change the wording of preprinted forms
A lawyer is not required to make it a legal document
It doesn’t restrict treatment efforts within accepted medical
standards; allows for pain control and comfort care
Health care providers are legally obligated to follow it
With and Without an Advance Directive
Teno, et al. (2007) examined the role of advance
directives more than a decade after the SUPPORT
study and the introduction of the Patient SelfDetermination Act.
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About 70% of people had an advance directive
Those who died in a hospital were least likely to
have an advance directive
Two clear differences between those who had an AD and
those who didn’t during their end-of-life period:
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Fewer people with an AD were on respirators
Physician communication with patient and family was
perceived as more problematic when no AD had been
prepared
Informed Consent and Advance Directives:
How Effective?
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Patients are often too rushed to make an informed
consent decision
Many physicians continue to ignore patients’ stated
wishes
Communication among patient, doctor, and family
remains limited
People often have difficulty making decisions as health
and cognitive functioning declines
A RIGHT NOT TO DIE?
THE CRYONICS ALTERNATIVE
Available since 1967
Choosing to have your certified dead body placed in
a hypothermic condition for the possibility of
resuscitation at a later time
First person to chose a cryonic alternative was a
psychologist, Dr. James H. Bedford
A Longer Life? Historical Background
The desire to extend our lives is one of the most enduring
themes in human history.
In pretechnical times it was attempted through physical
ordeals, magical spells, secret rituals, and experiments
with a variety of substances and concoctions.
We are now on the cusp on genetic/stem cell research
that might or might not be successful.
Rationale and Method
Advocates of cryonics believe it is possible to maintain
“deceased” people at very low temperatures for long
periods of time.
Eventually medical breakthroughs will cure the
conditions that led to their “death” and the “deceased”
will be resuscitated.
Heads of Stone:
A Radical New Development
New methods have increased effectiveness of the
cryoprotectants to prevent formation of crystals as a
result of freezing
Two major changes:
Neural (head-only) preservation has replaced wholebody preservation
Cooled tissues are vitrified (transformed into a stonelike substance)
More Questions
Should we regard cryostasis:
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As body preservation, like mummification?
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As body disposal?
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As an affront to God and Nature or just one more lifeprolongation effort?
As a new chapter in the ancient mythology of journeys
of the dead?
As a fantasy addition to the category of “sleepers” who
are neither living nor dead in traditional terms?
ORGAN DONATION
Kidneys and livers are the most needed
Restraining influences on the number of successful
transplantations:
• Willingness of people to donate
• Condition of the donated organs
• Biological match between donor and recipient
• Overall condition of the recipient
• Expense and timely delivery
Approximately 7,000 people donate organs while they
are still alive (such as donating a kidney)
• Victims of fatal motor vehicle accidents are one of the
most available sources
• About 75,000 people are on the waiting list is the
U.S. at any given time
• Demand and short supply creates:
• Discrimination
• Conflict
• Illegal sales of organs to affluent clients
•
Competition, Tension, Controversy
Should an available organ go to the person who is
in the most need and has the highest probability of
surviving with it – or to a person who resides in the
local area from which the donation was received?
Some potential recipients face discrimination
(ethnicity or race?).
Disadvantaged people may be selling their organs for
use by those more affluent.
The relationship between organ donation and the
diagnosis of brain death has been subject of concern for
years.
Would the pressure for quick harvesting of organs
lead to premature certification of death?
Becoming a Donor
It is useful to think ahead of time about organ
donation.
Donate all organs or tissues, or exclude some?
Donate for therapy, education, or research?
FUNERAL-RELATED DECISIONS
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Funeral homes are required to provide a price list
Do thorough comparison shopping
Be aware of additional charges for additional services
and products
Do not hesitate to inquire about simple and immediate
burials or about cremation
The most expensive item in a traditional funeral is the
casket
Use good judgment to resist services or products that
your family really doesn’t want
A Perspective on End-of-Life Decisions
The new social and medical climate for end-of-life
decisions favors strengthened participation,
communication, and patients’ rights.
More people are concerned about making end-oflife decisions that respect patient and family
wishes, but how to do this in an effective and
timely manner is a challenge that still must be
addressed.
Euthanasia, Assisted Death,
Abortion, and the Right to Die
“I SWEAR BY APOLLO THE
PHYSICIAN”: WHAT HAPPENED
TO THE HIPPOCRATIC OATH?
It is often assumed that (a) all physicians have sworn
allegiance to this oath and that (b) this does, in fact,
represent the core belief system for physicians.
Neither assumption is correct.
http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html
KEY TERMS AND CONCEPTS
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Hippocratic Oath – an ancient, optional code of
ethical principles
Euthanasia – intentional shortening of the life
of a person or animal to spare further
suffering
Active euthanasia – taking some action to
cause death
Passive euthanasia – withholding treatment
that might prolong life (generally tolerated by
society)
KEY TERMS AND CONCEPTS
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Terminal sedation – relieving dying patients’
distress by keeping them in a deep sedation or
coma until death
Liberty principle – individuals can make their
own decisions
Informed consent – patients must be fully
informed before proceeding with treatments
Competence – the mental ability to
understand the information and make a
rational decision
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The Black Stork – the movement in the U.S. in the early
1900s to allow “defective” infants to die
Eugenics – the movement aimed at sterilizing
people with “defective genes” – led to other ideas,
such as letting “defective” infants die and ending the
lives of “incurable” patients
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Nazi “Euthanasia” – the false name given to the
murder of innocent people and associated genocide
To Ventilate or Stop: and the Slippery Slope –
opposing any instance of assisted death because it
could contribute to widespread abuse in other
instances
OUR CHANGING ATTITUDES TOWARD
A RIGHT TO DIE
In recent years, public has had more opportunity to
learn about right-to-die choices.
Hayslip and Peveto (2005) found respondents believe
physicians should tell terminally ill patients about their
conditions.
The American College of Physicians continues to oppose
assisted death.
The Ethics of Withdrawing
Treatment:
The Landmark Karen Ann Quinlan
Case
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THE RIGHT TO DIE DILEMMA:
CASE EXAMPLES
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21yr old female
Found not breathing at party; mouth to mouth started by one
friend, while other called police.
Started breathing again; never regained consciousness.
Allegedly valium and quinine found in system
Dx: drug-induced coma (later argued).
Suffered severe, irreversible brain damage as a result of
oxygen deprivation (April 14, 1975)
Spent months on a ventilator, dropped to 60-pounds, curled
into a fetal position, in a “persistent vegetative state”
Parents asked physicians to turn off ventilator; they refused
THE RIGHT TO DIE DILEMMA:
CASE EXAMPLES
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New Jersey Supreme Court ruled that a ventilator could be
turned off if physicians agreed that the patient had no
reasonable chance of regaining consciousness
The ventilator was removed (in 1976)
She remained alive until dying of pneumonia in 1985
It’s Over, Debbie
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The call came in the middle of the night. As a gynecology resident rotating through a large, private hospital, I had come to
detest telephone calls, because invariably I would be up for several hours and would not feel good the next day. However,
duty called, so I answered the phone. A nurse informed me that a patient was having difficulty getting rest, could I please
see her. She was on 3 North. That was the gynecologic-oncology unit, not my usual duty station. As I trudged along,
bumping sleepily against walls and corners and not believing I was up again, I tried to imagine what I might find at the
end of my walk. Maybe an elderly woman with an anxiety reaction, or perhaps something particularly horrible.
I grabbed the chart from the nurses station on my way to the patient’s room, and the nurse gave me some hurried details:
a 20-year-old girl named Debbie was dying of ovarian cancer. She was having unrelenting vomiting apparently as the
result of an alcohol drip administered for sedation. Hmmm, I thought. Very sad. As I approached the room I could hear
loud, labored breathing. I entered and saw an emaciated, dark-haired woman who appeared much older than 20. She was
receiving nasal oxygen, had an IV, and was sitting in bed suffering from what was obviously severe air hunger. The chart
noted her weight at 80 pounds. A second woman, also dark-haired but of middle age, stood at her right, holding her hand.
Both looked up as I entered. The room seemed filled with the patient’s desperate effort to survive. Her eyes were hollow,
and she had suprasternal and intercostal retractions with her rapid inspirations. She had not eaten or slept in two days.
She had not responded to chemotherapy and was being given supportive care only. It was a gallows scene, a cruel
mockery of her youth and unfulfilled potential. Her only words to me were, “Let’s get this over with.”
I retreated with my thoughts to the nurses station. The patient was tired and needed rest. I could not give her health, but
I could give her rest. I asked the nurse to draw 20 mg of morphine sulfate into a syringe. Enough, I thought, to do the
job. I took the syringe into the room and told the two women I was going to give Debbie something that would let her rest
and to say good-bye. Debbie looked at the syringe, then laid her head on the pillow with her eyes open, watching what
was left of the world. I injected the morphine intravenously and watched to see if my calculations on its effects would be
correct. Within seconds her breathing slowed to a normal rate, her eyes closed, and her features softened as she seemed
restful at last. The older woman stroked the hair of the now-sleeping patient. I waited for the inevitable next effect of
depressing the respiratory drive. With clocklike certainty, within four minutes the breathing rate slowed even more, then
became irregular, then ceased. The dark-haired woman stood erect and seemed relieved.
–Name withheld by request
From A Piece of My Mind, a feature in the Jan. 8, 1988, issue of JAMA (Vol 259, No. 2). Edited by Roxanne K. Young, Associate Editor.
“It’s Over Debbie”: Compassion or Murder?
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Story published in the Journal of the American Medical
Association in 1988 by “Anonymous”
Debbie, 20 years old, dying of ovarian cancer,
emaciated, hadn’t eaten or slept in two days, hadn’t
responded to chemotherapy, breathing with great
difficulty
Her only words to the doctor were “Let’s get this over
with.”
The doctor gave her a lethal injection
Issues with Debbie’s case:
• The physician had no prior acquaintance with the
patient
• The physician was fatigued, had high anxiety, and
made a quick decision
• The room’s atmosphere made an impact on the
physician
• The nurse was ordered to prepare a lethal injection
• The physician could have provided non-lethal relief or
halted the procedure that produced distressing
symptoms
• The physician could have tried more communication
• The physician projected his/her own feelings and didn’t
seem to be concerned with “leave taking” (saying
goodbye)
An Arrow Through the Physician’s Armor
The painful lesson in Debbie’s case involves the
physician’s own physical, mental, and spiritual state and
the nature of the health care system.
Physician had several options:
• Taking other measures to relieve the patient’s
distress
• Could have consulted with others
• Could have made an effort to learn more about
the patient
Much of the critical response called attention to the
physician’s disregard of standards and due
procedures.
The Nancy Cruzan Case
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A Supreme Court Ruling:
The Nancy Cruzan Case
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~26 years old, auto accident, brain trauma due to
oxygen deprivation
Maintained with feeding tube; no communication
Parents decided to stop tube feeding; hospital refused
without court order (did not meet full criteria for brain
death)
U.S. Supreme Court ruling: a competent person had
the right to refuse medical treatment, and if the
person wasn’t competent the State could decide what
constituted clear evidence of the person’s wishes
Nancy’s physician withdrew his opposition after 6 years
Nancy died after the tubes were removed
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TERRI SCHIAVO
TERRI SCHIAVO: WHO DECIDES?
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Suffered a heart attack (2-25-90)
On life support; showed only reflexive movements,
random eye opening, and no communication ability
Terri’s husband and parents had intense conflict
1994 Terri developed a urinary tract infection;
husband and physician agreed not to treat it; also
DNR posted
1997 husband petitions to discontinue life support;
many court battles between husband and parents
Much rested on testimony that Terri said she wouldn’t
want life support
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On several occasions courts ruled in favor of
removing life support, but each time it was blocked
Media got involved; Florida Governor Jeb Bush
passed “Terri’s Law” to return feeding tube; the U.S.
House and Senate agreed to a federal bill to return
feeding tube
Terri died (3-31-05) of dehydration
Autopsy showed that her brain had shrunk to half
its size; she had severe and irreversible damage
Schiavo case: Kastenbaum’s comments
Significant elements of Schiavo case:
• When it started – because of an effective
emergency response system, Terri was able to be
saved
• Who decides? – who should make the decision
about Terri’s fate and on what basis
• Whose fault? – medical facts do not allow for a firm
conclusion as to the cause of the heart attack
The public controversy:
• Schiavo case came to public awareness when Michael
petitioned the court for removal of Terri’s feeding tube
• Court ruled Terri would not want to be kept alive but
stayed the order to give the Schindlers (Terri’s
parents) time to appeal
• Schindlers pursued other courses of action in the legal
system
• Terri Schiavo died after seven years of heated public
controversy
DR. KEVORKIAN AND THE ASSISTEDSUICIDE MOVEMENT
Objections of the medical community to assisted
death:
• Taking a life is inconsistent with the responsibilities
and values of a physician
• Religious convictions forbid taking a person’s life
under any circumstances, with the possible exception
of self-defense
• The life might be mis-taken
• Serious legal consequences might be expected to
befall any physician who engages in assisted death
Kevorkian’s Agenda
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Hoped to shatter the taboo of planned death now
that legal sanctions against abortion and suicide
have weakened
Proposed orbitoria – centers where people could
have assisted deaths and where medical research
could be conducted
Strong advocate of organ donation
Kevorkian’s Method
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People turned to Kevorkian when there didn’t seem to
be any hope for improvement or relief from suffering
Kevorkian discussed the situation with patient and
family members
Kevorkian emphasized he did not pressure patients
Kevorkian developed the “Merciton,” what the media
called “the suicide machine”
Evaluating Kevorkian’s Approach
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Most of the people were not terminally ill
Gender bias – encouraged and increased suicidality
among women
Clients fit the profile of suicide attempters rather than
terminally ill
He functioned without adequate medical information
and consultation
Death is much too extreme a solution for the relief of
suffering
Despite his disclaimers, it appears that he rushed
people into assisted death without adequate
safeguards and consideration
He used “silencing” techniques to defend his actions
The Netherlands: A Social Experiment
Watched Closely by the World
ASSISTED DEATH IN THE UNITED STATES
Oregon Death with Dignity Act
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Has many requirements and safeguards
Physicians write prescriptions for lethal doses of
medication after an adequate waiting period
Patient must be 18 or older with an incurable,
irreversible terminal illness and life expectancy of less
than 6 months
Basic provisions:
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The DWDA allows terminally ill Oregonians to obtain and use
prescriptions from their physician for self-administered, lethal
medications
Ending one’s life in accordance with the law does not constitute
suicide
The DWDA specifically prohibits euthanasia, where a physician
or other person directly administers a medication to end
another’s life
Eligibility:
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18 years of age or older
A resident of Oregon
Capable of making and communicating health care decisions
Diagnosed with a terminal illness that will lead to death within 6
months
Procedure:
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Patient must make two oral requests to
his/her physician, separated by 15 days
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Patient must provide written request to
his/her physician, signed in the presence of 2
witnesses
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The prescribing physician and a consulting
physician must determine whether the
patient is competent to make and
communicate the decision
Procedur …
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