The Hippocratic Oath

It probably originated in the fifth century B.C.
All physicians are not required to swear allegiance to this oath.
"I will give no deadly medicine to anyone if asked."
"I will not give to a woman an abortive remedy."


Euthanasia

Originally meant:
Dying without pain and suffering.
Good or happy death.
Care for the Dying
The Sanctity of Life Seduced: A Symposium on Medical Ethics

Active

Actions intended to end the life of a person who is suffering greatly and has no chance of recovery

Passive

Intentional withdrawing or withholding of treatment that will prolong life.

Slippery Slope

We should not approve assisted death for any person because that will encourage more such deaths and with less selectivity.

The Black Stork Movement

Originated in the United States in early 1900’s
Eugenics - allowing the death of "defective" infants.
Attracted the attention of Germany

Living Wills

Most people know about the living will but have not made living wills for themselves.

Times Mirror Survey

"There are circumstances in which a person should be allowed to die." 80% agree
The right of dying people to have medical treatment withdrawn if that is what they wish.
86% agree

Karen Ann Quinlan

Suffered severe and irreversible brain damage as a result of oxygen deprivation.
The court rejected the argument that religious freedom should be the basis for her removal from the life support system.
Court ruled after appeal on the basis that she had no reasonable basis for regaining consciousness.
Remained alive ten years after she was disconnected from the ventilator.

Persistent Vegetative States

It is estimated that about between five and ten thousand Americans exist in persistent vegetative states as the present time.

"It's Over, Debbie"

The patient was a young woman who was dying of ovarian cancer.
The physician observed that the patient was making "a desperate effort to survive."
Another woman was with the patient, holding her hand.
The physician did not know the patient.
Did not consulted with a supervising physician.
Ordered the nurse to fill the syringe with the lethal dose.
Did not converse with both the patient and her companion until becoming convinced that a lethal dose was the best action to take.

Elizabeth Bouvia's

Elizabeth Bouvia's situation represented a different type of dilemma than Quinlan's or Debbie's because Bouvia was not terminally ill.
Cerebral palsy

Joseph Saikewicz

67 year-old resident
Mental age of less than 3
Myeloblastic monocytic leukemia, which is incurable.
The state does not has the right and the obligation to subject a dying person to treatment if treatment is available.

Nancy Cruzan

Suffered critical injuries in an automobile accident.
Had told a friend in the past of her wishes.
Remained on a feeding tube for months while controversy about her case continued.

Court Decisions in the Nancy Cruzan Case

The trial court ruling that people have a right to refuse or accept the withdrawal of what it termed "death prolonging procedures."
This lower court's ruling was overturned by the Missouri Supreme Court on the grounds that Cruzan had not prepared a living will.
The U.S. Supreme Court upheld a competent person's right to die, but did not overturn the state's decision to require a written document to establish intention.

Resolution of Nancy Cruzan's Situation

Her physician changed his mind and the County court then agreed that life support could be withdrawn.

The Netherlands

The first nation to enact a law that made it legal for a physician to assist in ending a patient's life.
Patient is terminally ill.
Patient has explicitly requested "life termination".
Physician informs the coroner.
42995 infant born in pain injected with a muscular relaxant that stopped breathing.

Dr. Kevorkian

Only 28% were terminally ill.
More women.
Profile of suicide attempters.
Not proficient in palliative care.

The Oregon Death with Dignity Act

It was the first assisted death legislation to be passed in the U.S.A.
Eligibility is limited to adults in Oregon.
Eligibility is limited to people older than 18 who are terminally ill (six months).
A 15-day waiting period is required between a repeated request and writing a prescription for a lethal dose of medication.

Compassion in Dying
Adult, mentally competent who are terminally ill.
Condition must cause severe, intolerable suffering.
Patient must understand condition, prognosis, and alternatives.
Independent physician.