Tuesday, February 10, 2009
We often wonder on Life After Death, how about life before death? Can we call a human alive by keeping a it alive with a feeding tube because said person cannot eat on their own after 17 years is true ignorance. Shall each person should have the right to die as they wish and not be kept alive by tube feedings. All she did is breathe. Takes more than that to be truly alive!!!
Doctors were removing all life support last night from an Italian woman in a coma (she died later ) whose “right to die” has triggered a constitutional crisis and provoked an intervention from the Pope. The case has sparked an open power struggle between Mr Berlusconi and President Napolitano. In a last-minute move on Friday Mr Berlusconi sided with the Vatican and drew up an emergency decree to prevent Ms Englaro’s death. President Napolitano refused to sign it on the ground that the Prime Minister could not arbitrarily overturn a legal ruling and that such a sensitive issue had to be fully debated by parliament.
Ethical Issues in Terminal Health Care
Medical science has brought remarkable changes to our lives. Because of advances in medical technology, more people live longer, and more productively, than any generation in history. Unfortunately, these advances have created problems as well. The longer people live, the more likely they are to encounter chronic disease that requires long-term health care. Medical advances have also brought economic consequences -- these new technologies have a price tag! Most important, these advances have created ethical dilemmas that no generation of doctors has ever had to face. New life-sustaining techniques and practices are forcing hospitals to ask questions that never needed to be asked before. Foremost of these is the question, How far do we go to save a life?
Other questions challenge the very notion of what it means to be a doctor. A doctor's commitment has traditionally been to sustain life, to comfort and to heal. Today, though, physicians are able to sustain lives which have no hope of ever again being meaningful, which brings us to the question: when suffering is immeasurable, and a patient's condition terminal, should doctors be permitted to end a patient's life?
Syndromes like persistent vegetative state and the immense suffering caused by prolonged cancers have many people, including some doctors, wondering if it wouldn't be more humane for physicians to do more than merely withdraw treatment, but to actually assist in hastening death.
Health Care at a Crossroads
When you prolong the life of a cancer patient, the natural history of the disease advances and you see complications you did not see before, doctors uses a term for these complications: Diseases of medical progress.I think this age might be called The Age of the Tyranny of Technology. Because technologies exist, there seems to be -- in the medical profession at least -- an assumption that the technologies must be used. We are coming now to see the terrible dilemmas that the overuse of technologies have brought to us but we are using what I feel are the wrong ways to address this. I believe there need to be more questions asked about when or whether to use the new machines and techniques in the first place. I believe that medical science and public policy should understand that when a technology is being used, it can be discontinued under the principle of the Benefit/Burden concept. When the burden to the total well-being of the patient outweighs the benefit, the treatment becomes senseless. Also morally, extraordinary means of treatment need not be used in the first place.
According to an article in Healthcare Executive magazine, more than half the nation's hospitals have created ethics committees for the purpose of understanding and addressing the various ethical dilemmas health care professionals are facing today. On the local scene, all three Duluth hospitals and an increasing number of nursing homes have ethics committees. This article is about the role these committees play in decisions made in our local hospitals, clinics and nursing homes.The committees serve three basic functions. The first is education, Education of its staff as well as its patients and the community about the ethical dimensions of health care. The second is policies, making sure the policies in that institution are ethical.The third is to review cases and care that is provided in the institution and to work as a consultant in those times when the cases are difficult.The people who serve on ethics committees come from many walks of life, though in many instances a majority are doctors.
How do ethics committees influence hospital medical decisions
I would guess that half the members are doctors, so that you have eight or ten members on each committee at each hospital that are physicians, and then there are nurses, lay people, clergy, lawyers, behavioral scientists and ethicists. The committees provide a forum for the exchange of ideas. They follow the literature from all of the disciplines -- the legal literature, the religious literature, the scientific literature, the political literature -- and meet on a regular basis to discuss the difficult issues. So they are sort of a think tank that keeps abreast of all these issues. The knowledge and understanding that has been gained through study and discussions within the committee is then spread by various means through the medical community -- to physicians and nurses. Some of it simply by talking to people, some of it by bringing an issue to the entire medical staff, inviting the medical staff to come and listen to a presentation on an ethical issue that is confronting the hospital or the doctors and the nurses on a regular basis. They also issue position papers, and share what they have discussed in medical staff newsletters and committee reports or minutes.In addition to these activities, committee members are also available as formal or informal consultants to doctors dealing with difficult issues.
Local Perpsectives on the Right-to-Die Debate (ITALY)
For many people, the issue of doctor assisted suicide is very disturbing. The whole concept of doctor assisted suicide is a sad commentary on where we are societally. My personal viewpoint is that the whole concept is a total distortion of the basic commitment of the physician to support and help life. I cannot see how a physician can legitamize bringing about death.Nevertheless, this is not a universal consensus. More than one person has suggested -- a Michigan physician whose "suicide machine" has been used by three patients -- has brought attention to an important problem, even though he is "the wrong spokesman for the right issue." David Mayo, Ph.D. and professor of philosophy at UMD and member of The Hemlock Society, put it this way. "I'm sympathetic to what Kervorkian is doing, but I'm unsympathetic to his modus operandi. I think he's a bit of a loose cannon, to be perfectly honest. A loose cannon who loves publicity." Dr. Mayo stated that he prefers Derek Humphry as the spokesman for this issue. Derek
Humphry and other proponents of doctor assisted suicide usually build their case around two main arguments. Those two arguments, according to Dr. Mayo, are the mercy argument -- the notion of sparing someone unnecessary suffering -- and the self-determination argument, the right to determine one's own fate or level of care while dying."Against that," Dr. Mayo adds, "the primary argument is the 'very slippery slope' argument. What will this lead to?"
WHERE DO WE DRAW THE LINE?
What is evident, then, is the problem of where to draw the lines. There is a wide range of opinions as to what is acceptable and unacceptable here. Many of the doctors interviewed by The Senior Reporter seemed to place that line between passive and active euthanasia. Do Not Resuscitate Orders might be considered a form of passive euthanasia. Several doctors refered to the concept of "futile treatment", wherein a doctor is not obligated to use extraordinary intervention when its ultimate effect is obviously going to be futile.
Carolyn Schmidt, who opposes both doctor assisted suicide and active euthanasia, strongly supports the non-use or withdrawal of extraordinary means of treatment such as respirators. "I don't feel morally we are required to use these," she said. "But there is a big difference between withdrawing or not using a technology and developing a technology of killing."Identifying and clarifying these terms and developing rational standards for making difficult decisions has been a major role of the hospitals' medical ethics committees.
IF NOT HIPPOCRATES, WHAT THEN?
- At bottom in all these matters is the question,
- How do we go about determining what is right and wrong in a given situation?
- What are the components of an ethical decision?
- How can physicians, patients and their families -- or courts -- decide?
- Ethics has to do with decisions that involve making a distinction between right and wrong.
In its simplest form, an ethical determination is an assessment of a moral act based on
- (1) what we do,
- (2) how we do it,
- (3) when we do it, and
- (4) our motivation for doing it, or why we do it.
But behind these criteria are also underlying assumptions about the meaning and value of life.
- Is human life inherently sacred?
- Or is value determined by one's current contributions to society as a whole?
- This latter utilitarian view comes dangerously close to resembling the social engineering of physicians and geneticists under Hitler's Germany of the thirties.
Making The Final Choice: Should Physician-Assisted Suicide Be Legalized?
Medical advances have created ethical dilemmas which no previous generation of doctors has ever faced. New life-sustaining techniques and practices are forcing physicians to ask questions that never needed to be asked before. Foremost of these is:
How far do we go to save a life? Other questions challenge ethical traditions which have been in place for centuries.
- When suffering is immeasurable and a patient's condition terminal, should doctors be permitted to end a patient's life?
- Should doctors take an active role in hastening a patient's death?
- Today, more than ever, the push is on to "change the rules.,
By all accounts a time of decision is upon us. When a fully conscious person requests death, should a physician -- contrary to the Hippocratic oath -- assist the person in dying? It is the purpose of this brief article to present a concise overview of the primary arguments for and against the legalization of physician-assisted suicide. Without a careful consideration of the concerns on both sides, we can find ourselves saddled with ill-conceived policies that do not serve our best interests and will not be easily dislodged.There are four primary arguments for legalizing physician-assisted suicide.
!.The Mercy Argument, which states that the immense pain and indignity ofprolonged suffering cannot be ignored. We are being inhumane to force peopleto continue suffering in this way.
2. The Patient's Right to Self-determination. Patient empowerment has been atrend for more than twenty-five years. "It's my life, my pain. Why can't Iget the treatment I want?"
3. The Economics Argument, which notes that the cost of keeping people aliveis exceedingly high. Who's footing the bill for the ten thousand peoplebeing sustained in a persistent vegetative state? Aren't we wasting preciousresources when an already used up life is prolonged unnecessarily?
4. The Reality Argument runs like this: "Let's face it, people are already doing it."
There are a variety of arguments against legalizing physician- assisted suicide. Here are the most widely cited concerns:
l. Medical doctors are not trained psychiatrists. Many, if not most, people have wished they could die rather than face some difficult circumstance in their lives. Doctors who are given authority to grant this wish may not always recognize that the real problem is a treatable depression, rather than the need to fulfill a patient's death wish.
I know many individuals with significant disabilities: quadriplegia, post-polio survivors, persons with MS, etc. A number of them have tried committing suicide in the past and are now thankful that a mechanism wasn't in place that would have assured their death, because they got over whatever was bothering them at the time and are happy with life again.
2. How will physician-assisted suicide be regulated? This is Carlos Gomez's forced argument, developed after investigating the Netherlands' experience, and presented in his book Regulating Death. "How will we assure ourselves that the weak, the demented, the vulnerable, the stigmatized -- those incapable of consent or dissent -- will not become the unwilling objects of such a practice? No injustice," Gomez contends, "would be greater than being put to death, innocent of crime and unable to articulate one's interests. It is the possibility -- or in my estimation, the likelihood -- of such injustice occurring that most hardens my resistance for giving public sanction to euthanasia."
3. The "Slippery Slope" Argument. A Hemlock Society spokesperson acknowledges this to be the strongest argument against legalization. In ethical dialogue, it is conceded that there are situations when an acceptable action should not be taken because it will lead to a course of consequent actions that are not acceptable. Our attitudes toward the elderly, people with disabilities and the devaluation of individuals for the "higher good of society" should be reflected upon. How long will it bebefore our "right to die" becomes our "duty to die"?
4. The "Occasional Miracle" Argument. Sometimes remarkable recoveries occur. Sometimes diagnoses are far afield of the reality. Countless stories could be told. I know a few first hand. How about you?
5. Utilitarian versus sacred view of life. This is probably a subset of the Slippery Slope argument, focusing on our cultural shift in attitude toward what it means to be human. Huxley's Brave New World vividly demonstrates an aspect of this argument. We need to be reminded of the role social engineers, doctors and geneticists played in 1930's Germany. Are weimportant only as long as we are making a contribution to society? Or is value something inherent in our being human? History has shown that when we devalue human beings, we open the door to abuse. The U.S. Supreme Court, inits Dred Scott decision, declared that blacks were not persons. This devaluation helped permit slavery and inhumane treatment of blacks to continue.
6. What effect will this have on doctor/patient trust? People who traditionally rely on their doctors to provide guidance in their health care decisions may become confused, even alarmed, when one of the treatment options presented is the death machine at the end of the hall. According to Leon R. Kass, distinguished M.D. from the University of Chicago, the tabooagainst doctors killing patients, even on request, "is the very embodiment of reason and wisdom. Without it, medicine will have lost its claim to be an ethical and trustworthy profession." Kass asserts that "patient's trust in the whole-hearted devotion to the patient's best interests will be hard to sustain once doctors are licensed to kill."
7. What about doctors who don't believe in killing? Will they be required by law to prescribe a treatment [death] they don't believe in?ConclusionsClearly, the ethical dilemmas surrounding terminal health care will be with us for years to come. There are more than seventy million baby boomers in this country, most of whom are currently grappling with the issue of aging parents. And in the decades to come we ourselves won't be getting any younger.Ironically, our current situation is due in large part to the successes of medical science, not its failures.
More people live longer today than ever in history because we have eliminated many of the diseases that once terrorized us as a society.But some of the problem is due in part to our love affair with technology. When machines, tubes and computers take over, compassion and common sense sometimes seem to suffer.
Fortunately, there seems to be an increased awareness of the intrusiveness of technology. Living wills, ethics committees and hospice care are all responses to this awareness.How we choose to die in America is a complicated subject that needs clear thinking and a fair discussion of the ethical and technical dilemmas surrounding it. But let's keep in mind that even if we agreed that death technologies are wrong, this would not be an endorsement of the notion that people must be kept alive for as long as possible at any cost.