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
