ASB:SOC 353 ch.6 w: notes.ppt

ASB:SOC 353 ch.6 w: notes.ppt - Chapter Six End of Life...

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Unformatted text preview: Chapter Six End of Life Issues and Decisions Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Fundamental Ethical Principles Autonomy Beneficence Justice Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Informed Consent to Treatment Competency Freely given Adequate understanding Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Evolution of Informed Consent Early 1960s: strong tendency to withhold information Late 1970s: strong tendency to disclose information Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) Multicenter study to assess end of life care Fewer than half of physicians aware of patient preferences for or against CPR Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Medical Orders “DNR” -- Do not resuscitate “No code” -- No cardiopulmonary resuscitation (CPR) “CMO” -- Comfort measures only Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Choosing Death: The Right To Die Withholding or withdrawing unwanted or futile treatments Distinction between “allowing to die” and “helping to die” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Landmark Judicial Decisions 1975: Karen Ann Quinlan (artificial respiration) 1990: Nancy Beth Cruzan (feeding tube) 2006: Terry Schiavo (feeding tube) Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Aspects of the Schiavo Case 1998-2003 court struggle between Terri Schiavo’s husband and her parents “Terri’s Law” initiated by Florida legislature The importance of legal advance directives Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Intentionally Hastening Death of a Person Physician-assisted suicide (PAS) Active euthanasia Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Physician-Assisted Suicide: USA 1997, the U.S. Supreme Court ruled that the right to refuse treatment is based on a right to maintain one’s bodily integrity, not on a right to hasten death Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Physician-Assisted Suicide: USA (continued) Supreme Court also affirmed that states can draft policy concerning physician-assisted suicide Currently, Oregon is the only U.S. state where physician-assisted suicide is legally permitted Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland The Concept of “Double Effect” An intended “good effect” can have a potential “bad effect” Medication to relieve pain may be given to a patient even though a dose that is sufficient to relieve pain also hastens the patient’s death This practice is sometimes termed “terminal sedation” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Measures to Add Dignity to the Dying Process Greater use of hospice and palliative care More aggressive pain management Timely diagnosis of a terminal illness Make right to refuse treatment universally available to patients Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Measures to Add Dignity to the Dying Process (continued) Expand use of DNR orders to avoid unnecessary care Provide universal access to appropriate combination of care options (home, hospice, etc.) Institute health insurance system that ensures adequate and appropriate care for everyone Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Advance Directives : Living Will Living will provides instructions about the kind of medical care you wish to receive if you become unable to participate in treatment decisions Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Advance Directives : Health Care Proxy Health care proxy appoints a surrogate to make decisions about medical treatment if you become unable to do so. Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Wills and Inheritance A will is a legal declaration expressing a person’s intentions and wishes for the disposition of his or her estate -money, property, and other possessions -- after death Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Wills and Inheritance (continued) The issues and legalities associated with wills and inheritance can have either a beneficial or an adverse effect on survivors Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Wills and Inheritance (continued) Estate planning can help ensure peace of mind for both the bereaved and the person putting his or her affairs in order. Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Insurance and Death Benefits Psychological and emotional value Viatical settlement Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Considering Ethical Issues Analysis and theory versus “morality of ordinary practice” and “what genuinely moves people to act” Ethical choices involve both personal and cultural values Every human encounter is an ethical encounter Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland ...
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