Death and Dying

PRINCIPLE OF GROWTH THROUGH

HUMAN SUFFERING

As bodily pleasure should be sought as the

fruit of the satisfaction of some basic need of
the total human person, so suffering and
even bodily death when endured with
courage can and should be used to
promote personal growth
in both private and
communal living.
 Why Should Life be Preserved?
• Human life is sacred, it is a gift from God
• By the principle of stewardship, we are
given a shared, not absolute dominion over
life
• God alone is the author of life and he alone
can determine when our life ends
Truth We Should Accept in Caring for
Dying Persons
• Sickness and death are natural parts of life
• Dying is a human process not a medical
event
• Dying persons are living persons
• Goal of care should be to help them live
well while dying (HOSPICE)
Crucial fears of the
terminally ill: Phases of Dying
1. Fear of unbearable - Denial
pain
- Anger
2. Fear of excessively
burdensome and - Bargaining
futile treatment - Depression
3. Fear of loss of - Acceptance and Hope
autonomy and
personal dignity
(E. Kubler Ross)
4. Fear of dying alone
in loneliness
 CARE FOR THE DYING
- Health care professionals must address their
own beliefs, anxieties and fears about their
personal mortality before they can care
appropriately for patients who face their
own dying
- We must accept that the dying process can
be aided by good medicine but can be
perverted by medicine (EUTHANASIA)
Goals of Care and Treatment in the
Terminally Ill
• Well-being of the patient achieved through
attention to the physical, mental, social and
spiritual needs of the dying person
• Appropriate pain management is to relieve
physical pain
• Skillful interventions to facilitate expression of
emotions that accompany mental pain
• We have to accept that dying persons are living
persons so we have to help them live well while
dying
• Supportive services are to allay guilt and sadness
over unfulfilled social commitments
 Dying with Dignity
2 perspectives:
• To some people dying with dignity means
that one should be able to make the
decision to die when dying will be better
than to go on living with an incurable
distressing illness
• To some people dying with dignity means
facing pain and suffering. People who face
the realities of life with courage die with
dignity
 Withholding or Withdrawing of Life
Support
• This may be compatible with beneficence,
non-maleficence and autonomy
• Brain death is not a necessary requirement
for withdrawal/withholding of life support
• Use of proportionate (morally obligatory)
and disproportionate means (morally non-
obligatory)
PRINCIPLE IN THE USE OF ORDINARY (proportionate)
and EXTRAODINARY MEANS (disproportionate)

• Ordinary Means:
Not only food, drink and rest, but all
medicines, treatments and operations, which
offer a reasonable hope of benefit for the
patient and which can be obtained
without excessive expense, pain or other
inconveniences.
 PRINCIPLE IN THE USE OF ORDINARY
(proportionate) and EXTRAODINARY MEANS
(disproportionate)
• Extraordinary Means:
When the means used do not offer reasonable
hope of any notable benefit to the patient.
When the burden or risks entailed in the
procedure outweighs the benefits it promises
PRINCIPLE
One is not obliged (normally bound )to use
extraordinary means based on the “duty of always
avoiding evil and that of doing good as much as it
is possible in the situation.”
 PRINCIPLE IN THE USE OF ORDINARY
(proportionate) and EXTRAODINARY MEANS
(disproportionate)

“Medical treatment is extraordinary when it is

futile and imposes grave burden on the
patient and family involved and therefore,
non- obligatory”
- Pope Pius XII-
 Do not Resuscitate (DNR)
• It must be made for the best interest of the
patient- not the family, health care provider,
insurance company or society at large
• All involved parties should agree what a DNR
means; i.e.; no CPR if heartbeat or breathing stops
• It must be treatment which is heroic or
disproportionate, futile or excessively burdensome
• It must periodically evaluated
 Advance Directives
• Document in which a person either states
choices for medical treatment or designates
an individual who should make treatment
choices if the patient should lose his
decision making capacity
• It can also apply to oral statements from
patients to the caregivers given at a time
when the patient was decisionally capable
 Forms of Advance Directives
• Living will
- Patient must be terminally ill
- Must lack decision making capacity
• Durable Power of Attorney
- document that designates a surrogate
decision maker should the patient becomes
incompetent. It does not require the patient
be terminally ill
 EUTHANASIA

(Good death, pleasant death “mercy-killing)

- an act (medical) that renders a patient dead to end
his suffering.- the intention is death for the
purpose of eliminating pain
2 Kinds:
1. Active - commission of an act (administration or
overdose of drugs; patient-assisted suicide, etc.)
2. Passive - omission of an act (denial of nutrition,
respiration or hydration, etc.)
Dysthanasia- unnecessary prolongation of the dying
process by employing disproportionate means
Orthothanasia- “right death”
- allowed to die by withdrawal or withholding
extraordinary or disproportionate means
- patient dies because of underlying pathology
Suicide- killing oneself either by acts of commission
or omission
 EUTHANASIA
MORAL EVALUATION: IMMORAL
- Intentional killing and opposes the natural
inclination to preserve life
- Maybe performed for self-interest or other
consequences
- Health care professionals may be tempted not to
do their best to save the patient; a simple way out
and to disregard any other alternative
 Allowing to Die
A time comes when prolonging life may not
contribute to the spiritual purpose of life
(serving God and others)
- This time might be used compose oneself
and come into terms with death, deal
spiritually with God and others
- Not rejecting life but accepting what God
has given him/her
 Moral Differences Between
Euthanasia and Allowing to Die
Euthanasia Allowing to Die
- intention brings about - patient dies because
death by performance of the fatal pathology
or withholding an act - Death is an unwanted
- Death directly side effect of a good
intended by the agent ethical action