Ethics Issues on Death and Dying Flashcards
was 75 years old in April 1960 when she consulted her personal physician, Dr. David Gurewitsch (Figure), for mounting fatigue.
Anna Eleanor Roosevelt
Anna Eleanor Roosevelt physician
David Gurewitsch
A series of abnormal blood tests led Gurewitsch to diagnosed ____
aplastic anemia
He warned Roosevelt that transfusions could bring temporary relief, but sooner or later, her marrow would break down completely and ____ _____would result.
internal hemorrhaging
Over the ensuing 2 years, Roosevelt was admitted repeatedly to ___ _____ Hospital for tests and treatments, which failed to halt progression of her pancytopenia
Columbia Presbyterian
____ produced only vaginal bleeding, necessitating dilatation and curettage, and transfusions temporary relief of her fatigue, but at the expense of severe bouts of chills and fever
Premarin
repeated courses of ____ produced only oral candidiasis, iatrogenic Cushing syndrome, and rectal bleeding.
prednisone
Eight days after leaving the hospital, _____ ______ was cultured from her bone marrow.
Mycobacterium tubercolosis
Undeterred, Gurewitsch doubled the dose of ____, gave additional transfusions, and ordered tracheal suctioning and a Foley catheter inserted. Despite these measures, Roosevelt’s condition continued to worsen.
isonazid
A young woman had just given birth, in ____. She was unmarried, had no close relatives who could help her raise this child, and had a malignancy of the breast
Tokyo
My child is a girl. My child has a deformed ___. That close bond between mother and child is destroyed forever with my death. So my child will never be able to do well.”
hip
In 2008 physicians in ___published an account of their procurement and successful transplant of ___from three infants who were terminally ill and whose parents had chosen to forgo further life-support.
Denver
hearts
Controversy erupted in part because it was questioned whether the infants from whom the hearts were taken were actually dead. They were not pronounced dead based on loss of brain function. The deaths were based on ___ function loss.
heart
have moral standing.
humans
special cases debating if they have moral standing
Extremely abnormal humans, i.e. those in permanent vegetative state or are mentally
challenged
non-human animals
plants
inanimate objects
Whenever we consider our duties to a human, an animal, plant, or any inanimate
object, we consider them to have moral standing. Though not all moral ___
can apply to all of these
principles
Other ___ ____ animals may be seen as individuals that humans owe some kind of
duty.
non-human
■____ are said to have a maximum moral standing. The standing of each is equal -
> human have a ____ and ___ moral standing.
humans
full and equal
What establishes full moral standing is undefined – instead we have beliefs that
others will not be convinced if they do not share such beliefs – proofs that can be
___ or ___.
secular
religious
– Humans and other beings who possess one or
more critical physical or mental capacities such as self-awareness and rationality
what kind of definition of a person
non moral definition
Some humans are persons in some sense but may not possess full moral
standing.
what kind of definition
non moral definition of a person
who defined moral and non moral definitions of a person
Veatch and Guidry-Grimes
Humans and other beings who possess full or maximal
moral standing.
what kind of definition
moral definition
Late term fetuses are not persons because they lack self-awareness (or selfconsciousness or ability to reason). But, since lacking personhood means one lacks
full moral standing, fetuses can be aborted.
what is wrong about this?
+1
Once an individual is said to have ____ , our moral (and legal) duties toward
that individual are not the same.
died
To say that someone has died therefore means, among other things, that we
no longer attribute ___ moral standing to that individual.
full
When there is a ____ change so that full moral standing is lost, we say that
an individual has died.
quantum
- irreversible
loss of cardiac and respiratory functions
what definition of death
cardiac definition/somatic integration definition
Irreversible cessation of circulatory and respiratory functions (heart,
blood vessels, and lungs)
cardiac definition of death
Can you consider a person who suffered cardiac arrest and
whose heart was not beating for a while but was successfully resuscitated
as clinically dead for that while?
A person who suffers a cardiac arrest and whose heart has stopped beating can be considered clinically dead during the period when there is no heartbeat and no blood circulation. Clinical death is defined as the cessation of blood circulation and breathing, which are essential for sustaining life
■No viable organs for transplantation/harvesting
what kind of death
cardiac defition/somatic integration
irreversible loss of all functions of the entire
brain
what kind of definition of death
whole-brain death
An individual dies when there is an irreversible cessation of all brain
functions including the brain stem
brain death
An individual dies when there is an irreversible cessation of all brain
functions including the __ ____
brain stem
removes the essence of humans to integrate
body functions by means of a fully-functional brain
brain death
■One is dead only when the ____ ceases to function and this cessation is
irreversible. The last single function is gone.
brain
■One can lose other functions of the brain but may still be considered alive.
The deal breaker is the lost of ____ capacity.
integrating
■kind of death that is the current definition adopted by many.
brain death
- irreversible loss of higher-brain functions
higher brain death
■Some functions of the brain may not be so important to consider an individual as
alive.
higher brain
■Not yet legal/widely accepted in many parts of the world
higher brain
■Irreversible cessation of critical brain functions
higher brain death
Controversy on defining what functions can be considered critical to be considered
alive
this includes (3)
function of cerebrum
critical sensory function
critical motor functions
part of the brain that is responsible for personality, social skills, judgement, emotion regulation, movement, speech, reasoning, executive function
frontal lobes
part of the brain that is responsible for memory, combine senses with memory, object recognition, understanding language, art/music, speech, hearing
temporal lobe
part of the brain that is responsible for spatial attention, depth perception, relay center for information from the body to the brain, consciousness, alertness, sleep
thalamus
part of the brain that is responsible for memory, emotion, coordination of motor movement
basal ganglia
part of the brain that is responsible for depth perception, spatial orientation, receives sensory input, language processing, spatial attention, writing/reading, calculation
parietal lobes
part of the brain that is responsible for sight, processing visual information
occipital lobes
part of the brain that is responsible for balance, learning, emotion, coordinate movement, attention
cerebellum
part of the brain that is responsible for breathing, heart rate, bloodflow throughout the body, motor and sensory pathways cross sides of the body, alertness and sleep batterms
brainstem
”__as separation of soul (understood as organising principle) and body, which is
then fleshed out as loss of organismic integrity
death
”The ___ ___ body is the body of the dead person in name only; it has been
replaced by a lump of flesh on the way to carrion.”
post-mortem
■The Brain and Circulatory criteria used in establishing loss of this integrity are weak
arguments under this view
death as separation
■Integrity/integration is not an all-or-nothing matter.
what kind of argument about death
death as disintegration
‘the anti-entropic mutual interaction of all the cells and tissues
of the body, mediated in mammals by circulating oxygenated blood’
who defined integrity about the human body?
Shewmon
‘intercommunication between the parts in such a way that
the body remain[s] a functional whole’; ‘the parts of the whole are intercommunicative
with each other as a dynamic unity,’
who defined integrity this way
Tonti-Filippini
> ‘the spontaneous and innate interrelationship of all or most of
the remaining subsystems and the interaction of the perhaps impaired organism with
its environment is to be regarded as the functioning of the organism as a whole,’
who defined integrity this way
Bernat et al.
four basic distinctions in death and dying
active killing vs letting die (action vs omission)
withholding vs withdrawing
direct vs indistinct
ordinary vs extraordinary means
Simply allowing patient to die by forgoing
treatment may be acceptable depending on circumstances
what distinctions
active killing vs letting tie
active killing vs letting die has a moral difference based on what belief
AMA
Roman Catholic Theology
active killing vs letting die has no moral difference based on what belief
Unorthodox Judaism
Right to Life Groups
■It is common to feel that it is morally worse to withdraw a treatment once it has begun
than to avoid starting it in the first place.
what distinction
withholding vs withdrawing
Forgoing Treatment; morally required by autonomy when consent to
treatment is canceled
withholding
is morally like an omission than a commission
withdrawing treatment
The unintended, undesirable effect is morally tolerable if the action itself is
not immoral, the undesirable consequence is not a means to the desirable one, and
the desirable effect produces a great enough amount of good to be proportional to the
undesirable effect
what effect
doctrine of double effect
-Results from an action (or omission) in which the intention of the actor is the
death of the individual.
direct
-Results from an action (or omission) in which the effect may be foreseen by
the actor, but is not intended and is not a means to a desired effect.
indirect killing
-Treatments that are morally required
ordinary means
Treatments that could be acceptably/morally foregone
extraordinary means
■Bioethicists have never used the term ordinary to mean either common or simple;
they have not used extraordinary to mean either uncommon or complex. Rather the
terms have been used to refer to morally required (____) and morally expendable
(_____) treatments
ordinary
extraordinar
ethical issues about death and dying
levels of moral discourse
Casuistry
Rights and Rules
Normative
Metaethics
Normative ethics has three levels
action
value
virtue
ask what is the source of ethics? how do we know what is ethical?
metaethics
source of ethics based on metaethics (3)
religious answers
secular answers
relativist answers
how do we know what is ethical based on methaethics (2)
religious answers
secular answers
religious answers confirmed by metaethics is based on
the divine will
the divine law
secular answers confirmed by methaethics is based on
universal sources
relativist answers
universal answers include
natural law
hypothetical contract
relativist answers include
one’s culture
one’s personal preference
actual social contract
religious answers in clude
revelation
scriptures
church tradition
experience
secular answers icnlude
reason
experience and observation
intuition
social agreement or contract
no rules apply
antinomianism
rules apply rigidly
legalism
the use of clever but unsound reasoning, especially in relation to moral questions; sophistry.
casuistry
is the direct, willful destruction of one’s own life.
suicide
three elements of suicide
direct
willful
destructive
– primary object is to kill oneself
what element of suicide
direct
– deliberate, intentional, and voluntary
what element of suicide
willfull
process of terminating one’s life is often brutal, violent, or very harsh
what element of suicide
destructive
reasons why suicide happens
personal
health
cultural
social/political
religious
finacial
Suicide is self-murder and is prohibited by the principles of stewardship and
inviolability of life.
what application of ethics on suicide
pro-life
____ categorical imperative prohibits suicide
Kantians
Ourselves as ends and not means
what application of ethics on suicide
Kantian
Utilitarian ethics justify that an individual may deliberately terminate his
own life if and when suffering becomes too much to bear – Principle of the Greatest
happiness for the greatest number.
what application of ethics on suicide
pro-choice
justify that an individual may deliberately terminate his
own life if and when suffering becomes too much to bear
what kind of ethics
utilitarian ethics
: Utilitarian ethics justify that an individual may deliberately terminate his
own life if and when suffering becomes too much to bear
what principle
Principle of the Greatest happiness for the greatest number
grounds suicide as an individual
also possesses the right to die with dignity,
what application of ethics
principle of self autonomy
Easy death”
euthanasia
euthanasia is popularly known as
mercy killing
■Painless, easy death. Deliberate putting to death, in an easy, painless way, of an
individual suffering from an incurable and agonizing disease
euthanasia
euthanasia can be
self-administered
other-administered
- Commission (Painless methods)
what kind of self-administered euthanasia
active (positive)
- Omission (Refusal to take medicine)
what kind of self-administered euthanasia
passive (negative) euthanasia
other administered euthanasia can be (4)
–Active and Voluntary Euthanasia
–Passive and Voluntary Euthanasia
–Active and Nonvoluntary Euthanasia
–Passive and Nonvoluntary Euthanasia
Another person will terminate a patient’s life upon the latter’s request.
active and voluntary other-administered euthanasia
A terminally-ill patient is simply allowed to die by another person.
Passive and voluntary other-administered euthanasia
Another person decides that the life of a terminally-ill patient should be terminated.
active and non-voluntary other-administered euthanasia
A terminally-ill patient is just allowed to die as requested by the immediate family
members or attending physician
passive and nonvoluntary other administered euthanasia
The preservation of an individual’s ___even up to that individual’s last breath.
dignity
different view in euthanasia
pro-life
pro-choice
– Euthanasia is morally wrong because it is intentional killing
that opposes the natural moral law.
what stand about euthanasia
pro-life
Can be performed for the purpose of self-interest
–Mistaken diagnosis are justified if euthanasia is legal
–Mediocre performance of healthcare providers
what arguments of view of euthanasia
pro-life
: Euthanasia is humane as it brings suffering to a speedy end. The
wrongness or rightness of killing depends on the circumstances involved.
what stand about euthanasia
pro-choice
according to him,
the seven prima facie duties are:
fidelity, reparation, gratitude, non-maleficence, beneficence, self-improvement, and justice
William David Ross
also known as conditional duties, states that in any given situation, one or more of these duties may apply
Ross’s theory of prima facie duties
application of ethics on euthanasia
wrong/not acceptable
Euthanasia is intrinsically wrong because it is direct, deliberate killing – MURDER.
The motive may be good but the end does not justify the means (Principles of
Stewardship and Inviolability of Life)
An autonomous rational being has a dignity to preserve. We are duty
bound to preserve our life.
The motive may be good but the end does not justify the means (
what principle
principles of stewardship and inviolability of life
An autonomous rational being has a dignity to preserve. We are duty
bound to preserve our life.
what ethics
Kantian ethics
what application of ethics on euthanasia
right/acceptable
There is no moral obligation to continue treatment if the patient is terminally-ill and
hopeless
For comatose patients, active and nonvoluntary euthanasia may be
regarded as our duty to honor the autonomous state that our patient used to have
Maximize happiness and benefits à if one has become a financial liability
by being vegetative or comatose or terminally-ill, euthanasia may be an option.
Another view is the argument of organ-transplant advocates that a terminally-ill patient
will die anyway.
what view on right/acceptable on euthanasia
: For comatose patients, active and nonvoluntary euthanasia may be
regarded as our duty to honor the autonomous state that our patient used to have .
Kantian ethics
Maximize happiness and benefits à if one has become a financial liability
by being vegetative or comatose or terminally-ill, euthanasia may be an option.
Another view is the argument of organ-transplant advocates that a terminally-ill patient
will die anyway.
what view on euthanasia as right and acceptable
utilitarian
was the first to legalize (1995) but later was rescinded at the
national level
Northern Australia
MAID means
medical aid in dying
-Current countries where active killing for mercy is legal:
Belgium
Luxembourg
Colombia
Germany
USA
-In ___, requesting people/patient can be granted assisted suicide under 3
conditions: person/patient performs the fatal act, person/patient has decisional
capacity, and assisting person’s actions are not selfishly motivated
Switzerland
In Switzerland, requesting people/patient can be granted assisted suicide under 3
conditions
person/patient performs the fatal act
person/patient has decisional
capacity
and assisting person’s actions are not selfishly motivated
-In ___, medical assistance in dying follows a legal framework (Medical
Assistance In Dying Law)
Canada
framework in Canada that follows a legal framework
Medical Assistance in Dying Law
Assisted dying/suicide is different from
homicide on request
MAID Law in Canada
-Who can provide MAID? =
physicians and nurse practitioners
■MAID Law in Canada
Who can help provide MAID? =
pharmacists
pharmacy assistants/technicians
application of ethics on MAID
. Invoking the principle of avoidance of killing - A duty-based principle that may
conflict with consequence-based principles, e.g.
Beneficence - action has no direct ‘benefit’
Nonmaleficence - action results to ‘harm’
- Human dignity is desecrated
For mentally-capacitated persons/patients, MAID may be regarded
as our duty to honor the autonomous state that the person/patient chose to halt.
what application of right and acceptable on MAID
Kantian ethics
: Maximize happiness and benefits as perceived by the person/patient
requesting MAID
what application of MAID on ethics
utilitarian
A very social activity that requires bioethical discussion
organ transplantation
■Three issues concerning organ transplantation
-Fundamental morality of transplanting body parts
-Ethics of organ procurement
ethics of allocation
■ Tampering with the human’s basic nature in ways that go beyond what is acceptable
human conduct
■ Exacerbated when the organs come from nonhuman animals.
■ Some people consider organ transplant not only psychologically repulsive, but
morally and religiously questionable as well. Nevertheless, the major Western religious
traditions all are supportive of organ transplant, even transplants involving the heart—
the traditional, romantic “seat of the soul.”
what view in organ transplantation
playing god
Organs can be taken even without explicit consent provided that no explicit
objection was registered
routine salvaging of organ procurement
Applied in some Latin, Scandinavian, and Asian countries
what kind of organ procurement
routine salvaging
-Individual has rights against the state and these rights extend to the control
of the corpse; Organs may, therefore, be procured only with the expressed consent of
the person from which they are taken (or that person’s representative).
what organ procurement method
opt-in model
Applied in countries such as the United States, Australia, Japan
what kind of organ procurement
opt-in model
applicaiton of ethics on organ procurement as wrong/not acceptable
- Humans playing God
- Tampering of human nature
- Desecration of human dignity (of the dead person that serves the as organ source)
- Principle of avoidance of killing
application of ethics on organ procurement as right/acceptable
Human organs of the deceased cannot possibly be of any use to the
dead person and should automatically become the property of the state to be used for
good social purposes, including not only transplant, but research, education, and other
medical therapies.
Human organs of the deceased cannot possibly be of any use to the
dead person and should automatically become the property of the state to be used for
good social purposes, including not only transplant, but research, education, and other
medical therapies.
what view in organ procurmeent
utilitaranism
has forced hospitals/healthcare facilities to
observe measures that prevent the further spread of the virus.
COVID-19
are similar as they describe feelings of conflict,
distress, and sadness when applied to situations where one is unable to
take the right action according to one’s belief system, professional
standards, religious beliefs, or other forms of personal conviction.
moral conflic tand distress
, the individual goes through a process of gradual termination before death occurs
death
who has sustained either the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem
death
stages of death mortis (4)
pallor mortis
algor mortis
rigor mortis
livor mortis
- the skin pales due to blood pooling
pallor mortis
- the body cools over time
algor mortis
- muscles stiffen and contract
rigor mortis
- where areas of pooled blood begin to take on a bruised-like discoloration
livor mortis
euthanasia come from greek words
Eu
Thanatos
it means “ Good Death”
“Gentle and Easy Death
euthanasia
means “the act of inducing an easy death” ,usually referring to acts which terminate or shorten life painlessly in order to end suffering where there is no prospect of recovery
euthanasia
The word “euthanasia” was first used in a medical context by ___ ____ in the 17th century, to refer to an easy painless, happy death, during which it was a “physician’s responsibility to alleviate the physical sufferings of the body”.
Francis Bacon
Is the most active area of research in contemporary bioethics
Euthanasia
Euthanasia means:
Deliberate and intentional action with a clear intention to end another person’s life under the following conditions:
The subject is a competent informed person with incurable illness
Who voluntarily asked for ending his life;
The person who is acting knows about the state of this person and about his wish to die and is doing this action with an intention to end life of this person;
The action is done with compassion and without any personal profit.
who defined euthanasia this way
World Medical Association
The question of euthanasia arises on three occasions
at birth
terminal stage
unforseen mishap
In case of severely physically and mentally handicapped infants
Decision rests on the parents or on the doctors aided by the law of the land
what stage of euthanasia
at birth
decision to mercy kil infants should be based on
Quality of life the child can expect and its consequent impact on the parents, society and the resources of the State and also
Care of the child after death of the parents
The dying conscious patient can give his own consent or decision as to continue or not the ongoing treatment if he wishes to.
what stage of euthanasia
at terminal stage
A common practice of this is a patient signing a ‘Do Not Resuscitate’ (DNR) document.
passive euthanasia
to give way to an ongoing inner-organismic process of disintegration, without supporting or substituting vital functions
letting die
Removal from a ventilator of incurably ill patient though a physical action with subsequent death, is not killing in its proper meaning..
extubation
does not produce the effect of death; it only influences the time of its occurrence.
extubation
When it is a doctor who helps another person to kill themselves it is called
doctor assisted suicide
Pose ethical contradiction for the doctors
Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 B.C.
hippocratic oath and international code of medical ethics
a process through which a doctor or nurse practitioner assists an individual, at their request, to intentionally end their life.
medical assitance in dying
In Canada, medical assistance in dying has been legal since
June 2016
is provided to a patient in accordance with the Criminal Code of Canada, which outlines the eligibility requirements and process.
MaID
