Ethics at the End of Life Flashcards
Why might people not want to discuss death ?
Discomfort
Distance
Disputes
Regrets
Disbelief in diagnosis
Disinterested
Misplaced hope in medicine
What is palliative care ?
Care at the end of life
Concept of palliative care
A concept where there is a shift of emphasis from conventional care that focuses on the quantity of life, towards a commitment to care that enhances the quality of life.
Who founded the hospice movement ?
Cicely Saunders
Values of the hospice movement
The focus of care in the hospice is based on a HOLISTIC view of the person :
- Physical
- Emotional
- Psychological
- Spiritual
- Social
Often a focus on pain management
Ethical Principles for the end of life
Respect for autonomy
Beneficence
Non-maleficence
Justice
Law and Sanctity of life
Euthanasia
X intentionally kills Y, or permits Y’s death for Y’s benefit
Active euthanasia
X performs an action which itself results in Y’s death
Passive Euthanasia
X allows Y to die.
X withholds life prolonging treatment or withdraws life-prolonging treatment.
Voluntary euthanasia
Euthanasia when Y competently requests death himself
Non-voluntary euthanasia
Euthanasia when Y is not competent to express a preference.
Involuntary euthanasia
Death is against Y’s competent wishes, although X permits or imposes death for Y’s benefit.
Suicide
Y intentionally kills himself
Assisted suicide
X intentionally helps Y to kill himself
Murder
X intentionally kills Y
What is euthanasia ?
The act of deliberately ending a persons life to relieve suffering.
R v Cox 1992
Active Euthanasia
Lillian Boyes , 70 years old, severe rheumatoid arthritis
Pain beyond reach of analgesics
Expected to die within days / weeks
Asked Dr Cox to kill her
Dr Cox injected a lethal dose of potassium chloride.
Charged with attempted murder
Found guilty of attempted murder.
Tony Bland
Passive Euthanasia
Airedale NHS Trust v Bland, 1993
1989, 21 years old, Anthony Bland
Crushed by overcrowding at football stadium.
Attempts to resuscitate resulted in him being permanently unconscious (permanent/persistent vegetative state)
After 3 years, Hospital trust applied to court ruling whether it would be lawful to discontinue life support.
Doctor and parents wanted to stop feeding and antibiotics.
Application was opposed by official solicitor representing Tony.
Case went to House of Lords.
Life-support was allowed to be turned off.
Daniel James
Voluntary Euthanasia
Daniel James, 23, seriously injured at rugby incident and paralysed.
Died at Dignitas 2008, accompanied by parents.
Enough evidence existed to prosecute Daniel’s parents and a family friend.
DPP decided is was not in public interest to prosecute Daniels parents and family friend.
Case of Diane Pretty
R v Director of Public Prosecutions, 2001
Diane suffered motor neurone disease
Mrs Pretty’s husband was willing to help her commit suicide, but the couple was anxious he would be prosecuted.
She asked DPP to give undertaking that he shouldn’t consent to Mr Pretty’s prosecution.
She dies 12 days after her appeal was rejected by the ECtHR.
IN the UK what assisted dying is acceptable ?
Passive is acceptable, Active is not.
Smith and Jones
Acts vs Omissions
Robinson and Davies
Acts vs Omissions
Doctrine of Double Effect
You cannot give a drug with the intention to kill another person.
However, increasing doses of painkiller can be given to alleviate pain, with the possibility of death.
Distinction between intending death and foreseeing death.
Some reasons for allowing active euthanasia
Consistency
From passive to active
(allow passive so allow active)
From painkillers to lethal injections
(allow painkillers so allow lethal injections)
Appeal to principles : autonomy and beneficence
Benefits of regulation
Some reasons against allowing euthanasia
Respect for sanctity of life
Palliative care
Exploitation / manipulation
Contrary to aims of medicine
Slippery Slope
When is euthanasia allowed in The Netherlands ?
If :
- patient is incurably ill
- patient is experiencing unbearable suffering
- patient has requested his/her life to be terminated
- termination is performed by the patients own doctor
3 Key points of euthanasia in The Netherlands
Advance directives are allowed
Children >12 years old can request euthanasia
Euthanasia of severely disabled newborns is allowed
Describe laws surrounding ending of life in Switzerland
Assisted suicide is legally condoned
Assisting someone to commit suicide is illegal ONLY if the motive is selfish.
Persons assisting doesn’t have to be a physician, person doesn’t need to reside in Switzerland
Organisations in Switzerland
EXIT
Dignitas
Ending of life in - Oregon USA
Physician assisted suicide is legal in Oregon - not euthanasia
Death with dignity act 1994
Only applies to residents of Oregon
IN PAS, the doctor provides the medicine but does not administer
Other places where euthanasia is legal
Belgium - 2002
Canada - 2015 - permits nurses to end patients lives
Scotland laws around euthanasia
Assisted death illegal
Describe organ donation in the UK
UK is moving away from an opt-in system
Do not allow directed/conditional donation
What factors determine who gets the organs ?
Reasons why potential donors don’t become actual donors
Tests for brainstem death not carried out
Refusal by relatives
Medical contradictions to donation
Relatives not asked about donation
Heart stopped beating before brainstem death complete
Organs offered but not retrieved
