The Right To Die

Welcome to Washington General

Ethical Committee of Washington General

Our mission
To look at each case presented to the committee with out being bias and using ethically correct tactics to come up with solutions that would be in the best interests of parties involved.

Case 1
Anna Maria, a 49 year old female attorney, has recently suffered a major cerebral hemorrhage. Her prognosis is considered extremely poor by one physician, but possibly hopeful by another. Her advance directives found on the chart very clearly state that if she was in a comatose condition with no hope for recovery, she did not want life sustaining treatment. Her family is called to make a decision about continuing lifesustaining treatment.

Anna Marie

Advance Directives
are considered a type of informed consent, as the client is made aware of the advantages and disadvantages of their decision, and consent is given voluntarily while the client is in a state of good mental and physical health (Hecht, RN , 2005)

Living Wills
is a type of advance directive document that an individual can have made most commonly provide general or specific advance directives a surrogate or healthcare proxy and a durable power of attorney for healthcare (DPOA) should be identified.

DNR, DNAR, or NFR

is a type of advance directive ordered by a physician that serves to prevent over treatment or cardiopulmonary abuse during cardiopulmonary resuscitation (CPR). type of advance directive is commonly seen in medical conditions involving the elderly, the terminally ill; i.e. final stage cancer and acquired immunodeficiency disease (AIDS) (Hecht, RN , 2005).

Pros of Advance Directives/Living Wills and DNR

The ability to decide what is the best care of treatment for you when the inevitable occurs it relieves the pressure off of family members, friends and doctors in making critical decisions. the ability to choose when and how you are wish to die providing dignity, even in death a DNR is sometimes necessary for the patient or physician to choose due to the extremeness of the case and it relieves pain from the patient.

Cons of Advance Directives/Living Wills & DNR

the vague use of terms may often lead to medical and legal discrepancies. living wills only become active based on the condition stipulated, i.e. physically or mentally incapacitated. Without the required diagnosis, the individual may receive treatment that is in contrast to the advance directives DNR orders only preclude resuscitative efforts in the event of cardiopulmonary arrest and should not influence other therapeutic interventions that may be appropriate for the patient" (Do-not-resuscitate orders endanger patients, 2002).

1.Recognizing the Ethical issue

5.Act and Reflect On It Frame Word for Ethical Decision Making

2. Get The Facts

4. Make a Decision and Test It

3.Evaluate The Pros and the Cons

Ethical Decision Making

1.

Recognize the ethical issue:

Ethical issue is the choice to follow the advance directive or not; Due to the conflict between physicians.

2.

Get the Facts

Patient has suffered major cerebral hemorrhage Her prognosis is hopefully by one physician and doubtful by another She has an advance directive that is clear Her family is called in to

Ethical Decision Making

3. Considering the Pros and the Cons PROS Respect for autonomy She will not be in pain any more She could suffer more extensive damage e.g. stroke The cost of sustaining life if kept alive. Cons Physician has to diagnosis you as being terminally ill. Relatives should not be given the choice due to the clear advance directive More money to obtain a third opinion.

Ethical Decision Making

4. Make a Decision and Test It. Pros Decision To Follow the Advance Directive Outcome of Decision The Patient Dies Her suffering and pain is ended. Cons Decision To Seek a Third opinion Outcome of Decision Patient may live Patient may due on her own.

ETHICAL DECISION MAKING

5. Act and Reflect on the outcome.

CASE 2
Martin Major is 26 years old with stage 4 liver cancer that has spread to the bone and colon. Martins cancer is terminal and the doctors have estimated his life expectancy to be about three months. He states that the symptoms are unbearable. He is in constant pain and medication offers little relief. The colon cancer had caused several bowel obstructions that resulted in him experiencing severe abdominal distention, shortness of breath, nausea, and painful vomiting of fecal matter. Martin is easily fatigued and is at a point where he is no longer able to care for himself. He has expressed several times that he no longer wish to live in constant pain and agony. Martin signed living will (when he was diagnosed) that stated that if he should stop breathing no extraordinary measures are to be attempted to prolong his life. He now wishes a peaceful death rather than continuing until he reaches an undignified end.

Martin Major

Assisted Suicide
is the common term for actions by which an individual helps another person voluntarily bring about their own death. "Assistance" may mean providing one with the means (drugs or equipment) to end their own lives, but may extend

Euthanasia
Comes from the Greek words, eu meaning good and thanatos meaning death Is the act or practice of killing or permitting the death of hopelessly sick or injured individuals in a relatively painless way for reasons of mercy The killing, by act or omission, of a dependent human being for their alleged benefit

Pros of Assisted Suicide and Euthanasia pain and suffering of patients can be saved. Tremendous

The right to die should be a fundamental freedom of each person. Patients can die with dignity rather than have the illness reduce them to a shell of their former selves. Health care costs can be reduced, which would save estates and lower insurance premiums. Nurse and doctor time can be freed up to work on savable patients. Prevention of suicide is a violation of religious freedom. Pain and anguish of the patient's family and friends can be lessened, and they can say their final goodbyes. Reasonable laws can be constructed which prevent abuse and still protect the value of human life. Vital organs can be saved, allowing doctors to save the lives of others. Without physician assistance, people may commit suicide in a messy, horrifying, and traumatic way.

Cons of Assisted Suicide and Euthanasia doctors' Hippocratic oath. It would violate
It demeans the value of human life. It could open the floodgates to non-critical patient suicides and other abuses. Many religions prohibit suicide and the intentional killing of others. Doctors and families may be prompted to give up on recovery much too early. Government and insurance companies may put undue pressure on doctors to avoid heroic measures or recommend the assisted-suicide procedure. Miracle cures or recoveries can occur. Doctors are given too much power, and can be wrong or unethical.

Ethical Decision Making

1.

Recognize the ethical issue:

Ethical issue is the choice to whether or not to follow the living will or assist him to die with dignity.

2.

Get the Facts

Patient has terminal cancer with a life expectancy of three months He states that his symptoms are unbearable because he is in constant pain and agony He can no longer care for himself and does not want to be a burden on others The patient has signed a living will but expresses several times that he no longer wishes to live

In Oregon and Washington the safeguard criteria must be meet to ensure there is no chance patients are coerced to hasten their deaths

The patient must verbally request the medication from the physician twice, and each request is separated by 15 days. In addition, the patient must make a written request to the attending physician, which is witnessed by two individuals who are not primary care givers or family members. The patient is notified and is able to rescind the verbal and written requests at any timeeven right before the patient ingests the medication. The patient must be able to self-administer and ingest the prescribed medication.
The attending physician must be Oregon or Washington-licensed

The physician's diagnosis must include terminal illness, with six months or less to live. The diagnosis must be certified by a consulting physician, who must also certify the patient is mentally competent to make and communicate health care decisions. If either physician determines the patient's judgment is impaired, the patient must be referred for a psychological examination. The attending physician must inform the patient of alternatives, including palliative care, hospice and pain management options. The attending physician must request the patient notify their next-ofkin of the prescription request. A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life shall be guilty of a Class A felony.

Pros

Ethical Decision Making 3. Considering the Pros and Cons

Cons

Respect for autonomy, he should be allowed to decide He will no longer be in pain and agony He can die with dignity and in peace

It violate doctors' Hippocratic oath causing death is causing harm It goes against the request of his Living will It demeans the value of human life Euthanizing him It could open the floodgates to non-critical patient suicides and other

Ethical Decision Making

4. Make a Decision and Test It.
Pros Decision
To allow Euthanasia Outcome of Decision The Patient Dies with dignity His suffering and pain is ended

Cons Decision
To follow the
living will