Euthanasia

Huntington cleaned Welles' gun & suggested where Welles should point it.
On the day of the suicide, Welles cleaned the .38- caliber revolver. He shook Welles' hand a left. As Williams left, he hear a gunshot.
Williams told police, "I had a comfortable feeling that this was right for him knowing the man."

Summarized from a Norwich Bulletin article dated 3/5/05 "Case Puts Spotlight on Assisted Suicide, page B2, Associated press

A slippery slope (domino effect) editorial was included in the USA Today Editorial page (3/3/2005 page 12A): "Regardless of whether Terri Schiavo has any feelings or experiences pain during the starvation period, it is cruel that her family and loved ones have to watch her waste away. If we are going to allow food and water to be withheld from terminally ill patients, shouldn't we also allow for that death to be quick and painless too?" ==========================================================================

In 1957 Pope Pius XII addressed anesthesiologists and described two means for keeping people alive: ordinary and extraordinary means. He said doctors are obliged to used ordinary means.

Most moralists (both religious and secular) argue that health professionals should provide ordinary treatment for the moribund, but not extraordinary.

How did Pope Pius XII define extraordinary or heroic means?
Those "according to circumstances of persons, places, times, and cultures...involve a grave burden for oneself or another" (From "The prolongation of Life")

How does Ramsey define extraordinary treatment?
Measures that are unusual, extremely difficult, dangerous, inordinately expensive, or that offer no reasonable hope of benefit to the patient.

How does Paul Ramsey define "Ordinary Treatment"?
All medicines, treatments, and surgical procedures that offer a reasonable hope of benefit to the patient but do not involve excessive pain, expense, or other inconveniences.

Most moralists (both religious and secular) argue that health professionals should provide ordinary treatment for the moribund, but not extraordinary. Thiroux suggests we substitute appropriate & inappropriate care for the particular patient rather than thinking in terms of generic ordinary & extraordinary care.

What happens when one discontinues nutrition and hydration?
The effect of removing feeding tubes "can be seen by the third or fourth day, when the patient's mouth begins to look dry and the eyes appear sunken. From days five to 10, respiration becomes irregular with periods of very fast and then very slow breathing. By the final days, kidney function declines, toxins begin accumulating in the body, and multiple organ systems fail from lack of nutrition."

Is this dying process painful?
That's up for debate. Schiavo's parents' doctors say it is painful. Schiavo's parent want to keep her alive because she is responsive. She has smiled, laughed cried and responded to people's voices.

Schiavo's husband, Michael, wants the feeding tube discontinued. His court-appointed doctors way there is not pain. He has a new woman, other children, and much to gain financially by doing away with his "wife."

The dying process is also described as follows: "A conscious person would feel it [dehydration] just as you and I would...Their skin cracks, their tongue cracks, their lips crack. They may hae nosebleeds because of the drying of the mucous membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining. ...It is an extremely agonizing death." (Quoted from Wesley Smith's book, "Forced Exit" in Kathleen Parker's Something went terribly wrong" 4/3/05 Norwich Bulletin, Page D3)

Parker continues: "Whether Terri Schiavo was conscious of her suffering is the question of essence. Michael Schiavo's lawyer, George Felos, reported during the deathwatch that Terri wasn't suffering and looked 'beautiful.' Terri's parents thought otherwise. Given the difference of opinion, we might consider the fact that Terri Schiavo was given morphine. Even those tending the dying woman apparently had reasonable doubt. In our world on this day, Death got the benefit of that doubt."

Thomas Sowell writes, "The nature of death by starvation and dehydration is also being depicted as 'gentle' in the words of the New York Times - the same New York Times which in 2002 reported starting people in India dying 'clutching pained stomachs.'" (Schiavo is hardly dying naturally, March 28, 2005, Norwich Bulletin, page A6).

What is the difference between killing and allowing to die per the AMA?
Killing is an act of commission.

Allowing to die presumably is an act of omission, whereby the steps needed to preserve someone's life simply are not taken. (failing to give an antibiotic shot to a terminally ill patient who has pneumonia) When the patient dies because of nontreatment, the proximate cause of death is the patient's disease, not the name of the person who did not provide treatment.
The American Medical Association says the distinction is reasonable.

Basically PSDA requires health care providers to inform patients of their rights and to make advance directives.

1990: U.S. Supreme Court Cruzan v. Missouri Health Services (227)
Recognized the right of a competent patient to refuse life-preserving medical treatment including artificial (non-oral) delivery of nutrition and water. Decision may be made by a surrogate who knows the patient's wishes when patient is non-competent

Before this case the question of informed consent was not a major issue, because the decision of whether a patient lives or dies was answered by the parents of the incompetent patient. The Cruzan case brought with it the uncertainties of whether or not a parent or friend is choosing what the patient would want, or the parent themselves would want.

Hospice: origin of word - refuge for wayfaring strangers
Hospice: A place where the sick go for comfort and care before dying.
See the 7 aspects of patient care per Thiroux::
1. Comforting and caring for patients
2. A team approach
3. Pain & symptom control
4. Outpatient & home care
5. Humanized inpatient care
6. Freedom from financial worry
7 Beavement & counseling services

Derek Humphry - assisted his first wife in committing suicide & founded Hemlock Society
Derek married Ann shortly after the "death" of his first wife Jean.
Derek & Ann assisted in the death of Ann's mom by placing a laundry bag with soiled laundry over her mouth.
Ann wrote, "I walked away from that house thinking we're both murderers and I can't live like this anymore ("Deadly Compassion" 72).
Derek's second wife , Ann, committed suicide.
Many people who have committed suicide as a copy of Derek's how-to book, Final Exit by their side.

Dr. Jack Kevorkian - helped over 130 people commit suicide & is now in prison
Kevorkian was an advocate of "obitorias, ' a professional place where people could use his suicide machine, "mercitron, "which releases potassium chloride

Kevorkian's Calculus:
Kevorkian states in prescription: medicide:
"If the patient opts for euthanasia, or if someone is to be executed, and at the same time opts to donate organs, he or she can save anywhere from five to ten lives. Now the death becomes definitely positive."

DeMarco writes in Architects in a Culture of Death:
In a court statement he prepared on August 17, 1990, Kevorkian admitted that the suicide of disabled people represents a good for the general public. In his view, such deaths, by making bodily organs available, can contribute only to the good of society. The part, in Kevorkian's calculus, is more important than the whole person, if that person happens to be disabled."

Thiroux also lists
Court Decisions
Pending Legislation
Lack f Autonomy of patients
Health Care personnel have practiced forms of assisted suicide
A stronger desire for autonomy and control over life and death

What safeguards does Thiroux mention?
Written and oral request
15 day waiting period
Two witnesses and a second doctor are required
Patients must be informed about other options
Patients take medication themselves

What does Thiroux consider to be reasonable safeguards - his preferences?
Permissive rather than compulsory or mandatory
Written Request - no secrecy - all in the open
A waiting period - approximately 2 months -
Other options must be explained - pain control, hospice, care options
Counseling
More than one doctor
Assisted suicide should be painless
Abuse is punishable

Mercy Killing
What is the difference & similarity between mercy killing & mercy death?
Both involve a direct action taken in order to end someone's life
The difference is that he who does the mercy killing does not know for sure if the individual want to be killed.

Thiroux's definition of mercy killing:
"The termination of someone's life, without that person's explicit consent, by a direct means, from a motive of mercy, that is in an attempt to end suffering and/or 'a meaningless existence.'"

Karen Ann Quinlan 3/29/54 to 7/1l/85

Brought debate to the fore
At 21, swallowed alcohol & tranquilizers at party & collapsed
Failing mouth to mouth
Newton Memorial Hospital, New Jersey
April 15, 1975, ceased breathing for at least two 15-minute periods
Temp:   100
Pupils:   unreactive
Described as “chronic, persistent, vegetative state”
November 1975: Judge Robert Muir: He could not grant petition to remove respirator "humanitarian motives cannot justify the taking of human life"
Spring 1976: New Jersey Supreme Court overruled Judge Muir. He ruled Karen's right to privacy had been violated by the hospital.
Karen then transferred from St. Clare's Hospital to a nursing home. She continued to live with the assistance of feeding tubes.
Karen remained at the nursing home in a vegetative state until 1985.

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1990: U.S. Supreme Court Cruzan v. Missouri Health Services (227)
Recognized the right of a competent patient to refuse life-preserving medical treatment including artificial (non-oral) delivery of nutrition and water. Decision may be made by a surrogate who knows the patient's wishes when patient is non-competent

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What is the meaning of the narrow vs. broad interpretations of euthanasia?

Narrowly, some philosophers have taken euthanasia to be the equivalent of killing.
Since allowing someone to die does not involve killing, allowing to die would not actually be an act of euthanasia.

A broader interpretation includes acts of allowing to die.

Narrow: Killing a person is always morally wrong
Allowing someone to die does not involve killing, so it is not euthanasia.

Broad: Includes acts of killing & acts of allowing to die
Most favoring broad interpretation state allowing patients to die is not always wrong . With possible moral justification for euthanasia, it is conceivable that acts of active euthanasia, as well as passive, may be moral.

In other words, euthanasia can take on active or passive forms.
Active euthanasia: the act of painlessly putting to death persons suffering from incurable conditions or diseases.
Passive euthanasia refers to any act of allowing a patient to die.

What is the difference between voluntary and nonvoluntary euthanasia?

Voluntary decisions about death refer to cases in which a competent adult patient requests or gives informed consent to a particular course of medical treatment or nontreatment

A nonvoluntary decision about death refers to cases in which the decision is not made by the person who is to die. ( because of age, mental impairment, unconsciousness..)

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In 1975 CDC presents higher suicide statistics:

• 24.1% of students had thought seriously about attempting suicide .
• 17.7% of students had made a specific plan to attempt suicide .
• 8.7% of students had attempted suicide .
• 2.8% of students had made a suicide attempt which resulted in an injury, poisoning, or overdose that required medical attention
quoted from http://www.dianedew.com/suistats.htm

Comments from Thomas Sowell regarding dying naturally:
"We are being told Terri Schiavo is being 'allowed"' to 'die a natural death.' Such an argument might make some sense if this were a terminally ill person. But Terri schiavo is not dying from anything other than a lack of food and water, from which anyone would die."

"When Sean Hannity said this [ Terri's not wanted to live under extreme circumstances] on the Fox News channel's 'Hannity & Colmes' program, he was assured by a lawyer who was defending the removal of the feeding tube that Michael Schiavo was not the only one to hear Terri say this. But, when Hannity demanded to know the name of just one other person, the lawyer shouted and waxed indignant - but did not produce the name."

...The nurse's sworn statement. under penalty of perjury , is she reported to the police she found Terri in both medical and emotional distress after a closed door visit by her husband - and that she also found a vial of insulin, as well as needle marks on Terri, after Michael Schiavo's visit."

(Schiavo is hardly dying naturally, Thomas Sowell, March 28, 2005, Norwich Bulletin, page A6).

Jesse Jackson

"I feel so passionate about this injustice being done — how unnecessary it is to deny her a feeding tube, water, not even ice to be used for her parched lips," Jackson said. "This is a moral issue, and it transcends politics and family disputes." http://family.org/cforum/extras/a0035935.cfm March 29, 2005, Jesse Jackson Pleads for Schiavo's Life by Pete Winn, associate editor

Epitath

"I kept my promise" An inscription by Michael Schiavo on the grave. This refers to a pledge he made before Terri's brain damage that he would not keep her alive artificially.

"Aristotle believed that willful euthanasia was wrong. Virtue, he argued, requires that we face death bravely rather than take the cowardly way out by quitting life in the face of pain and suffering. The Pythagoreans, who wrote the Hippocratic oath, also opposed euthanasia on the grounds that the gods are our keepers and we are the possessions of the gods. To kill ourselves is to sin against our gods" 'Never will I give a deadly drug, not even if I am asked for one, nor will I give any advice tending in that direction.' Hippocratic oath." Boss Analyzing Moral Issues, Chapter 5 Euthanasia and Assisted Suicide, page 201, 2 end edition.