Ethics and Law at the End of Life Flashcards
Why is defining death significant?
Our obligations towards a living person and a dead person are completely different: for example, ORGAN HARVESTING (is morally acceptable in a corpse), REMARRIAGE (morally acceptable when someone is widowed), PROPERTY (division of financial assets amongst remaining family members and friends is permitted).
Having a life and being alive are two different things: How does John Locke define a ‘person’?
A thinking intelligent being, that has reason and reflection, and can consider itself, the same thinking thing, in different times and places; which it does only by that consciousness which is inseparable from thinking.
Having a life and being alive are two different things: How does John Harris define a ‘person’?
A person will be any being capable of valuing its own existence.
Argument of defining death: What are the possible criteria for death? (x6)
- Permanent loss of conscious awareness: this is more closely aligned to the MORAL aspects of life
- Ending of breathing and heartbeat: this was the accepted definition prior to the 1960s. With the advent of circulatory and ventilatory support, it became apparent that this definition was inadequate.
- Permanent loss of brain stem function: loss of function means that an individual can no longer breath spontaneously, and any residual cerebral activity is thought to not be compatible with consciousness. Even with ventilatory support, organ necrosis will be inevitable because you are no longer able to have integrated organ function.
- Cessation of all cellular functions and processes: the body will have to be decayed for this to be occurred. Such a definition would preclude organ harvesting – but this is one of the significant points about death in medicine!
- Death as a process: this definition would allow for different things to be carried out at different stages e.g., organ retrieval or burial may require different end points.
- Desoulment
What is the difference between brain stem death and cerebral death?
CEREBRAL: permanent cessation of higher cortical cerebral activity; BRAIN STEM: irreversible loss of brain stem function.
What is the legal definition of death?
There is no statutory definition, but in cases when a legal definition is needed, UK law recognises death as the following: permanent loss of brain stem function which causes: (i) coma not due to reversible causes, (ii) several components of the brain stem permanently destroyed, this includes the respiratory centre, (iii) unable to breath spontaneously.
Case of Baby Wyatt?
- Premature with chronic lung disease, blind, deaf, incapable of voluntary movement and thought to be in pain.
- Parents and doctors disagreed on whether to continue sustaining life or allowing baby to die
- Case taken to High Court where original judgement concurred with doctors’ decision not to provide further ventilatory support. But baby Charlotte Wyatt continued to survive.
- Her case was revisited, she made improvement, her case was overturned, and was discharged from hospital at age 3.
What are the two definitions of futile treatment?
- It fails to meet its own objective e.g., course of chemotherapy does not improve prognosis
- It is undesirable in a particular case due to the quality of life which results following the treatment e.g., CPR for a patient with terminal prognosis who is suffering
Arguments for there being a moral distinction between acts e.g., lethal injection, and omissions e.g., withdrawing treatment? (x3)
- In the case of withdrawing treatment, the cause of the patient’s death is the underlying medical condition, and it could be argued that the doctor is not intending to kill the patient
- In the case of withdrawing treatment, the patient is being returned to a situation that would have risen had treatment not been given
- Phillipa Foot’s case study
Arguments against there being a moral distinction between acts e.g., lethal injection, and omissions e.g., withdrawing treatment? (x2)
- Both result in the same outcome
- James Rachel’s case study
What is James Rachel’s case study?
Smith will inherit a fortune if his 6-year-old cousin dies. He is babysitting his cousin. One evening, Smith drowns the boy in his bath. Jones will also inherit a fortune if his 6-year-old cousin dies. One evening, Jones sees the boy fall over, hit his head on the side of his bath, and drown. Jones is delighted and he doesn’t rescue the child.
What is the argument against a moral distinction being drawn between acts and omissions in the James Rachel case study?
Legally, Smith could be convicted of murder and Jones would not. But Jones’ omission resulted in the same outcome and both are arguably morally equally as bad, because both intentions were for their cousin to die.
What is Phillipa Foot’s case study?
Scenario 1: I hear an appeal for funds to provide food for starving children in Africa. Funds will prevent child deaths and sending money would prevent 100 deaths. However, I decide not to send the funds. Scenario 2: I decide to send a food parcel to the starving children but send bread that is laced with poison. This result in 100 children dying.
What is the argument for moral distinction being drawn between acts and omissions in the Phillipa Foot case study?
In this case, the outcomes are the same, but we are able to say that failure to perform an act with foreseeable bad consequences is less bad than performing an act with similar bad consequences.
What is the LEGAL distinction between acts and omissions in medicine?
We are not permitted to perform acts that intentionally result in death. However, there are some omissions that we are morally responsible for: patients may not wish to have treatment, so we are permitted AND obliged to withhold treatment. OR, when there is no consent or not in best interests, withdrawing treatment is morally and legally permissible.
