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When Is Enough, Enough? PowerPoint Presentation
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When Is Enough, Enough?

When Is Enough, Enough?

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When Is Enough, Enough?

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  1. When Is Enough, Enough? Respiratory Therapists Workshop April 14, 2011 Thomas A. Welk, DMin Harry Hynes Memorial Hospice

  2. What Is the Role of Medicine? To Cure? Sometimes To Relieve? Often To Comfort? ALWAYS

  3. Life Support Interventions Basic Physiological Needs - Air - Water/food - Delivery system - Waste removal

  4. Compromised Systems? Recent past Death followed in short order Today Medical interventions

  5. What Is the Purpose of Medicine Make things worse? No! Want to make things better Enhance patient well-being Ethical principle? Beneficence Tension: Benefit vs. burden

  6. How Determine Benefit? Quality of life How define? LIFE always good Definition of “life”? Relates to cognitive/affective functioning

  7. When is physical intervention futile? Can’t just relate it to physical functioning Question to ask: Is the body still able to serve knowing/loving? Rather than refer to “quality of life,” better to refer to “quality of PHYSICAL FUNCTIONING”

  8. Which is better way to describe basic physiological support systems? 1) Life support? or 2) Body support? No legal or ethical mandates to support vital functioning indefinitely

  9. Ordinary vs. Extraordinary Care Ordinary 1) Medical Successful clinical outcome 2) Ethical Does it provide opportunity for supporting life

  10. Extraordinary 1) Clinical Intervention unsuccessful Costly Complicated Risky Uncommon

  11. 2) Ethical? None of the above are applicable Consideration given to carrying out deeper functions

  12. Withholding vs. Withdrawing Once started, always have to maintain? NO Whether starting or withholding, determination made on benefit vs. burden

  13. Killing Vs. Allowing to Die Killing 1) Introduction of outside agent to bring about death 2) Homicide vs. suicide 3) Cause death by removing ventilator?

  14. Allowing death 1) Why on a body support intervention? Underlying condition which compromises a basic physiologic function

  15. 2) Why continue or remove support? Dependent on benefit/burden determination

  16. 3) Remove, cause of death? UNDERLYING CONDITION is now ALLOWED to run its course 4) Key issue? INTENTION

  17. EUTHANASIA Literally, a good death Today, death caused by an outside agent

  18. Past Distinctions 1) Active Cause death by external means, e.g., bullet, knife, rope, drug 2) Passive Remove/withhold an intervention required to sustain life Only holds with regard to INTENTION

  19. Decisions on Ventilator 1) Depends on benefit/burden 2) Cause death if discontinued? Underlying medical condition 3) Intention is not to cause death, but to remove burdensome medical intervention

  20. Further Questions?