The Legal and Ethical Issues of Death and Dying

The Legal and Ethical Issues of Death and Dying End of Life Issues Advance Directives Why do we need an advance directive? Physicians used to subjectively decide for the patient, and the patient did not have autonomy, such as CPR for cardiac arrest. Now this decision making has shifted to the patient. Most family members, having not been in an ICU before, are not prepared to make decisions.

Physicians have a sense of whether the patient in the ICU is going to live or die. Typically the family will prolong life until the physician tells them that they don’t think the patient will survive. Navasky & O’Conner, 2010) A living will can make your preferences known regarding end of life care. Setting up this legal document will speak for you when you are unable to speak for yourself, for example if you are in a coma.

These situations can come up at any age. All adults should have an advance directive, which should be clearly written and witnessed. (Sabatino, 2007) A durable power of attorney is not the same as authorizing someone to take care of finances.It is a legal document that allows another individual, your health care proxy, to make medical decisions for you if you are incapacitated. This document goes into effect after the patient become incapacitated, and only pertains to healthcare decisions.

(Sabatino, 2007) Euthanasia The word euthanasia is from the Greek word for “good death”. It is defined as the act or practice of ending a person’s life by lethal injection or terminating medical treatment. There are many types of euthanasia-voluntary, active, passive, physician-assisted, suicide, and assisted suicide.Euthanasia can provide relief for the family, and a means to end a patient’s suffering. (Porter, Johnson, & Warren. 2005) Physician-assisted suicide and euthanasia are legal and practice widely in the Netherlands.

Oregon has legalized physician-assisted suicide. The Supreme Court has ruled there is no constitutional right to assisted suicide. (Porter, Johnson, & Warren. 2005) Some would argue that euthanasia may be used by families under financial pressure, a cure may be found for a terminal disease, or it may be used indiscriminately. Withdrawing TreatmentThe Patient’s Decision The first Federal legislation for the protection of the rights of an individual to make healthcare decisions was the Patient Self Determination Act. The goal of the PSDA is to ensure that everyone can fill out an advance directive.

Then their wishes can be clearly known by family and friends regarding termination of medical treatment. (Porter, Johnson, & Warren. 2005) Many people refuse treatment because they fear they will suffer intolerable pain. Many are not willing to be a financial burden to their family or to use a treatment that is futile.Congress acted to educate Americans about the need to put their wishes in writing to avoid unwanted life-saving procedures. (Porter, Johnson, & Warren.

2005) DNR Laws A DNR order requires the consent of the patient or designated spokesperson before it can be carried out. According to the Department of Health and Human Services, consent is not needed if the opinion of the doctor is that it will not benefit the patient. The Karen Ann Quinlan case was the first major right to die case in the United States in 1976.In January of 1983, Nancy Beth Cruzan suffered irrepairable brain damage from a car accident, and it was determined she was in a persistent vegetative state by her doctors. After five years of tube feeding and physical deterioration, her parents decided to stop treatment.

They felt she would not have wanted to live that way, even though she never stated that to them. There was a long battle in Missouri courts, and on December 14, 1990, it was determined that her wish be carried out, and the feeding tube was removed.She died eight days later. (Porter, Johnson, & Warren. 2005) In the years between those two cases, Derek Humphrey founded the Hemlock Society. His own personal tragedy with his wife Jean introduced him to assisted suicide, and he formed the Hemlock Society to change the laws.

The Hemlock Society claims that they educate, inform, and advocate by providing resources to help patients maintain control over the end of their life. (Porter, Johnson, & Warren. 2005) Conclusion Individual RightsIf an individual becomes terminally ill or mentally incompetent, they have the right to determine what they want as far as treatment or to withhold treatment if they become terminally ill or become mentally incompetent. Everyone should make their wishes known.

A living will and durable POA should be drawn up and clearly state what the patient’s wishes are. An explicit agreement should also be on the patient’s chart so that their wishes are actually followed. Compassionate care is available-hospice may be right for many people.Doctors need to counsel both the patient and the family to let them know if things will not go well with more treatment, and Insurance should be available to all, and in an adequate amount to address the patient’s needs. Pain relievers should be available to maintain a dignified and pain free state. (Porter, Johnson, & Warren.

2005) If euthanasia and assisted death were legalized in the context they would become “law” allowing physicians and others to end a patient’s life based on a set standard or at their discretion, what may happen if it was legal and out of control? (Porter, Johnson, & Warren. 005) “One doctor; one patient; one moment; one decision. Let it be a shared decision, informed by best evidence and considering physical, emotional, and financial costs. ”(Schmimpff, n.

d. ) References Navasky, M. , & O’Conner, K. (Writers/). (2011). Facing Death [Television series episode].

In M. Navasky & K. O’Conner (Producer), Frontline. Public Broadcasting Service.

Retrieved from http://www. pbs. org////death/ Frontline is America’s public TV flagship public affairs series since 1983, and has built a reputation for powerful reporting that addresses tough issues.Porter, T. , BSN.

, Johnson, P. , BSN. , & Warren, N. A.

, Phd, RN. (2005, January 12). Bioethical Issues Concerning Death: Death, Dying, and End-of-Life Rights. Critical Care Nursing Quarterly, 28(1), 85-92. Retrieved from http://www. ncbi.

nlm. nih. gov/d/? Critical Care Nursing Quarterly is a peer-reviewed journal that provides current practice-oriented information for the CE and improved clinical practice of critical care professionals, including nurses, physicians, and allied health care professionals. Sabatino, C. JD. (2007, October).

Capacity to Make Health Care Decisions. Retrieved July 28, 2011, from The Merck Manual Home Health Handbook website: http://www. merckmanuals. com////b.

html Merck & Co. , Inc. , is one of the world’s largest pharmaceutical companies. Merck is committed to providing excellent medical information and, as part of that effort, continues to proudly provide all of The Merck Manuals as a service to the community. Schimpff, S.

C. , MD. (n. d. ). When to Use New Technology and When to Die With Dignity.

Retrieved August 2, 2011, from KevinMD website: http://kevinmd. com//? /? /die-with-dignity. html KevinMd. com was founded by Kevin Pho, MD, and is the web’s leading destination for physician commentary on breaking medical news. References Navasky, M. , & O’Conner, K.

(Writers/? Directors). (2011). Facing Death [Television series episode]. In M. Navasky & K.

O’Conner (Producer), Frontline. Public Broadcasting Service. Retrieved from http://www. pbs.

org/? wgbh/? pages/? frontline/? acing-death/ Frontline is America’s public TV flagship public affairs series since 1983, and has built a reputation for powerful reporting that addresses tough issues. Schimpff, S. C. , MD.

(n. d. ). When to Use New Technology and When to Die With Dignity. Retrieved August 2, 2011, from KevinMD website: http://kevinmd.

com/? blog/? 2011/? 07/? technology-die-with-dignity. html KevinMd. com was founded by Kevin Pho, MD, and is the web’s leading destination for physician commentary on breaking medical news.