Euthanasia

1. Euthanasia Sarah Dupont, Sarah Froebel, Barbara Hill, MeredythHarple, Jeffrey Danyew

2. Outline • Defining Euthanasia? • Where is it legal? • History/Famous Cases • Ethical Issues • Sources for more information

3. The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." • The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma (Oxford Dictionary) • The death must be intended, rather than being accidental, and the intent of the action must be a "merciful death" Defining Euthanasia

4. Defining Euthanasia Continued Ancient Greece defines Euthanasia as good death

5. What are the two types/categories of euthanasia?

6. Expanding the Definition… • Euthanasia is generally divided into two categories: • Active Euthanasia And • Passive Euthanasia

7. Active Euthanasia • Active euthanasia occurs when a deliberate action is taken in order to cause the death of an individual.   • An example of this would be a physician knowingly administering a lethal dose of medication.

8. Passive Euthanasia • Passive euthanasia occurs when a person is allowed to die because actions are not taken to keep them alive OR because something which keeps the person alive is discontinued.   • Examples of this would be discontinuing a feeding tube or respirator, or not performing a procedure which would sustain a person’s life.

9. Active Euthanasia Example: Dr. de la Rocha •   In 1991, a physician in Ontario honored the wishes of a terminally ill patient who wished to be taken off of her respirator. • Dr. de la Rocha provided the patient with the standard comfort measures which consisted of medicating her with morphine. • He also elected to administer potassium chloride, an action which was not standardized and which stopped the patient’s heart.

10. Dr. de la Rocha continued •  Although the patient wanted to die, this action by Dr. de la Rocha hastened her death.   • Dr. de la Rocha was charged with professional misconduct and had his license temporarily suspended.

11. Passive Euthanasia Example: Karen Quinlan • Karen Quinlan was a 21-year-old woman who became comatose after a drug overdose.  She was put on a respirator. • Because she was in a chronic vegetative state and showed no signs of the possibility of recovery, her family ultimately asked for her breathing tube to be removed.   • Their hope was that she could die naturally since there was no hope for her regaining life; it was proven on more than one occasion that she could not breathe without the assistance of machines.

12. Karen Quinlan Continued... •  The family’s request was denied, as the physicians in charge of Quinlan’s care stated that she “did not meet the criteria for brain death”.   •  After several years and an intervention by the Supreme Court in New Jersey, Quinlan was removed from the respirator and allowed to die.

13. Questions to Consider? • How are these two cases different?  • Why would de la Rocha’s case be considered active euthanasia, while Quinlan’s case is passive?  Both patients had little or no hope of recovery.   • What are the moral and legal considerations?

14. History of Euthanasia • Death with Dignity in the US • First euthanasia bill drafted 1906 – Ohio • Euthanasia Society of America – 1938

15. Oregon, US • Physician assisted suicide is legal in Oregon. • Oregon Death with Dignity Act was passed in 1994 by a narrow margin, 51% to 49%. • Legal proceedings prevented the act from being used until 1997. • Act legalizes physician assisted suicide, not euthanasia.

16. California, Maine, and Michigan all rejected ballots to make physician assisted suicide legal. • Washington recently (2008) voted in favor of physician assisted suicide. • Passed by larger margin than Oregon, 57% in favor. • Same proposition was rejected in 1991.

17. Euthanasia in Holland • Regulated by the Termination of Life on Request Assisted Suicide Act from 2002. • Physicians report to a review committee who decide to grant/not request. • 2,123 cases of euthanasia in 2000, 2,636 in 2008. • The majority of the cases are like the video in class, physician assisted.-In 1996 a euthanasia bill went into effect in Australia's Northern Territory only to be overturned by Australian Parliament in 1997.

18. Famous Cases: Nancy Cruzan • First US Supreme Court euthanasia decision • Injured in auto accident • Kept alive 6 yrs. via feeding tube • Repeated verbally before accident not to be kept alive via feeding tubes or other mechanical devices

19. Famous Cases: Original “Dr. Death”Dr. Jack Kevorkian • Made headlines 1990 – assisted in the death of Janet Adkins, pt. w/ Alzheimer’s • Campaigned for legality of assisted suicide – planned to run for congress • Most notable appearance: 1998 on CBS “60 Minutes”

20. Famous Cases: Dr. Kevorkian’s Patient Thomas Youk • Youk suffered from amyotrophic lateral sclerosis (ALS/ Lou Gehrig’s) • Barely able to lift hand & struggled to speak, breathe • The video that convicted Dr. Kevorkian of second degree murder: Here. • Prosecutors call Kevorkian a murderer • Youk's relatives hail him as a humanitarian; insist assisted suicide was only option & were grateful his suffering ended.

21. Final Exit Network • Supporting the Human Right to a Death with Dignity • Initially Hemlock Society, renamed End-of-Life Choices, merged with Compassion in Dying Federation to form currently existing group Compassion and Choices (efforts primarily promote legislative change) • Some former Hemlock Society's leadership formed Final Exit Network; focuses on providing compassionate support to the dying as opposed to promoting legislative change. • Final Exit Network is a member of the World Federation of Right to Die Societies

22. The Final Exit Network: John Celmer • Two surgeries took away cancer that was killing him • Left him with chronic pain and a disfiguring hole in his jaw. • Concerned about his appearance after surgeries to repair his deteriorated jaw and to graft over a hole in his lower jaw • The 58-year-old faced hip replacement surgery for arthritis • He secretly reached out Final Exit Network

23. The Final Exit Network: Jana Van Voorhis • Mentally ill but physically healthy 58 year old , committed suicide by helium asphyxiation • Believed she had breast cancer, holes in her belly and feet, and had been poisoned with pesticides, also believed roof rats were infesting home and attacking her, which caused her to remodel her home several times. • Police uncovered involvement with the Final Exit Network

24. The New Face of “Dr. Death”? • Van Voorhis’ death (2007): Four people indicted with assisted suicide of a Phoenix woman; two individuals who provided guidance were charged with manslaughter; Dr. Larry Egbert and Roberta Massey were indicted for conspiracy to commit manslaughter. • Clemer's death (2008): Georgia Bureau of Investigation indicted Egbert and three other Final Exit Network members on charges of racketeering, assisting a suicide, tampering with evidence Dr. Lawrence Egbert Final Exit Network

25. Famous Cases: Terri Schiavo: • Most notable legal battle in the United States 1998 to 2005. • Entered vegetative state in 1990 • Likely resulting in potassium deficiency that caused irreversible brain damage. • Chief doubt- removal of feeding tube amounts to slow death by dehydration and starvation, reflects her wishes. • No written directive

26. Famous Cases: Hurricane Katrina • Hurricane Katrina vs. Memorial Medical Center New Orleans : A desperate situation, only two choices: quicken their deaths or abandon them. • The AMA has commended Dr. Pou for her efforts, and the chair of its board of trustees, Edward L. Langston, MD, stated, “We believe these physicians served as bright lights during New Orleans’ darkest hour”. Dr. Anna Pou

27. Is euthanasia ethical?

28. Why euthanasia may be ethical • A right to privacy • a person has the right to do what they want with their life • a person has a right to abide by their own beliefs • A right to die • a person has the right to "die with dignity” • a person has the right to determine whether their own life is worth living • these rights are what make us human

29. Why euthanasia may not be ethical     • The involvement of other people • at face-value, euthanasia contradicts the role of the health care professional •  the involvement of family members and emotions can create complication and confusion • vulnerable people may be at risk (example: children, incompetent patient) • It may not be necessary • adequate health care can provide pain relief, proper nutrition, and safety measures    • It is very difficult to define, and therefore difficult to regulate • what kind of euthanasia would be "right”? • how would we know "for sure"?

30. Sources For More Information • Euthanasia pro-con. (2011, December 01). Retrieved from http://euthanasia.procon.org/ • Website that offers differing views on euthanasia (pro and con) • Euthanasia. (2010, March 29). Retrieved from http://plato.stanford.edu/entries/euthanasia-voluntary/ • For more information of the definition of euthanasia. • Euthanasia.com. (2011). Retrieved from http://www.euthanasia.com/index.html • Basic facts, articles and information on different countries. • Final exit network. (2009). Retrieved from http://www.finalexitnetwork.org/ • Basic facts on the Final Exit Network, latest news and more resources

31. Sources Continued • CNN reporter. (2002). Euthanasia now legal in Holland. CNN World,1-2. http://articles.cnn.com/2002-04-01/world/netherlands.euthanasia_1_euthanasia-dutch-doctors-health-minister-els-borst?_s=PM:WORLD • (This site was used to find news information about the effects legalizing euthanasia has on Holland’s community. I found it searching CNN for euthanasia news reports.) • Fenigsen, R. (2011). Other people’s lives: reflections on medicine, ethics, and euthanasia: part two: medicine versus euthanasia. Issues in law and medicine, 27 (1), 51-70. • (I found this on CINAHL, a nursing based online database. Describes the medicine as well as ethical dilemmas involved with euthanasia.) • McGowan, C.M. (2011). Legal issues. Legal aspects of end-of-life care. Critical care nurse, 31(5), 64-69. • (Another CINAHL source, describes the ethical and legal issues involved.) • Ruler, A. (2011). Examining end-of-life care issues. Kai Tiaki New Zealand, 17(4), 17-19. • (This was again found in the CINAHL database. Examined hospice nursing and the ethical issues when the end is nearing for those patients.) • Span, Paula. (2011) Deciding to die, then shown the door. The New York Times, 1-4. http://newoldage.blogs.nytimes.com/2011/08/24/deciding-to-die-then-shown-the-door/?p • (Looking for new news reports on euthanasia, specifically in the US. Used these news sources to see how euthanasia is viewed by the press.)

32. Sources Continued • Advance directives. (2011). Retrieved from http://www.patientsrightscouncil.org/site/advance-directives-definitions • (This site describes advance directives, durable power of attorney, and protective medical decisions documents.  It provides further direction and information for those interested.) • Euthanasia and physician assisted suicide. (2011). Retrieved from http://www.bbc.co.uk/ethics/euthanasia/ • (This site defines active vs. passive euthanasia, weighs the pros and cons of both, discusses ethical dilemmas, and outlines the current legal issues.) • Gorman, D. (1999). Active and passive euthanasia: the cases of drs.claudioalberto de la rocha and nancymorrison. JAMC, 160(6), 857-860. Retrieved from http://www.cmaj.ca/content/160/6/857.full.pdf •  (This article discusses legal cases in active euthanasia and puts forth hypothetical situations to consider as well.) • McGowan, C. M. (2011). Legal aspects of end-of-life care.Critical Care Nurse, 31(5), 65. •  (This article discusses legal issues in end-of-life care and describes Karen Quinlan’s case, among others.)

33. Sources Continued • Fink, S. (2009, 08 25). The deadly choices at memorial. . Retrieved from http://www.nytimes.com/2009/08/30/magazine/30doctors.html?pagewanted=1 • Katrina newspaper article about the decision Dr. Pou had to make • Kevorkian case. (2007, December 31). Retrieved from http://www.cnn.com/2007/US/law/12/17/court.archive.kevorkian2/index.html • Dr. Kevorkian case • Lynne, D. (n.d.). World net daily. Retrieved from http://www.wnd.com/?pageId=29516 • The whole Terri Schivo story from beginning to end • MALCOLM, A. (1990, December 29). Nancy cruzan story . Retrieved from http://www.nytimes.com/1990/12/29/us/nancy-cruzan-end-to-long-goodbye.html

34. Sources Continued • Fenigsen, Richard, M.D., Ph.D., (2010). Other people's lives: reflections on medicine, ethics, and euthanasia. Issues in Law & Medicine, 26, 239-262. • Hoch, H. (2009, May 19). 4 indicted in assisted suicide. Retrieved from http://www.azcentral.com/news/articles/2009/05/14/20090514abrk-finalexit0514-ON.html Final Exit members indicted in Van Voorhisdeath • Huxtable, Richard, (2007). Euthanasia, ethics and the law: conflict to compromise. Taylor and Frances. • Workshop, Richard, (1992). Assisted suicide: should doctors help hopelessly ill patients take their lives? . The CQ Researcher, 2(7). 1-22.