Controversy 7

1. Controversy 7 Should People Have the Choice to End Their Lives?

2. Should People Have the Choice to End Their Lives? • More than two-thirds of all deaths in the U.S. occur among people over age 65 • Medical advances force us to make decisions unforeseen just a few decades ago

3. Should People Have the Choice to End Their Lives? (cont.) • Euthanasia – from the ancient Greek meaning simply “good death” • Active euthanasia – denotes some deliberate intervention to end the patient’s life, such as giving a fatal dose of painkilling medication • Passive euthanasia – not doing something, such as withdrawing life-support therapy • Assisted suicide – a doctor or family member actively provides the means or carries out the instructions required for an individual to end his or her life

4. Depression and Suicide • Several common predictors of suicide include: • Intolerable psychological pain and frustration • A feeling of hopelessness or helplessness • Communicating the intent to kill oneself • Clinical depression – differs from the “down” state that is a common response to setbacks and is temporary • Can be difficult to diagnose because it can manifest with a variety of symptoms • Insomnia, fatigue, inability to concentrate, anxiety, and other physical or emotional comforts

5. Depression and Suicide (cont.) • It can be difficult to determine whether an elderly patient’s rejection of lifesaving treatment is an informed choice or a sign of depression • But depressed patients are more likely to refuse procedures in situations where the medical prognosis is actually good • Doctors are committed to keeping patients alive at all costs • But the attitude of “treatment at all costs” may not respect someone’s decision to end their life

6. The “Right to Die” • Widespread public discussion of the ethics of death and dying began during the late 1960’s • First major “right-to-die” case involved Karen Ann Quinlan in 1976 • First important “right-to-die” law passed was the California Natural Death Act (1976) • Under common law in the U.S., people have a basic right to accept or reject medical treatment, and therefore a right to refuse treatment

7. The “Right to Die” (cont.) • Guardian at litem – a designated spokesperson who represents the interests of an incapacitated person and reports to the court • Courts rely on two kinds of standards to determine when to withhold or withdraw treatment • Standard of substituted judgment – asks “What would this patient have wanted under these circumstances?” • Best-interest standard – asks “What is the balance of benefits and burdens that a “reasonable person” might want under these conditions

8. The “Right to Die” (cont.) • Gerontocide – the killing of the old, a practice in some premodern societies facing conditions of extreme scarcity • Advance directives – legal documents such as a living will or power of attorney for health care instructions • In most jurisdictions in the U.S., assisting a suicide is a crime • Americans lack a clear consensus about exactly how “dying well” might be defined • At a minimum, ‘dying well’ typically refers to having the right to know one’s medical condition, and the choice to accept or reject life-prolonging treatment

9. Outlook for the Future • The Netherlands has gone the furthest in legalizing euthanasia and physician-assisted suicide • Critics of assisted suicide and euthanasia believe we should focus more on palliative care – such as hospice and better pain medication • Patient Self-Determination Act (PSDA) – a 1991 law that requires hospitals, nursing homes, and other health care facilities to advise all patients at the point of admission about their right to accept or refuse medical treatment