Jodie_Haselkorn_ Lecture Slides

Progressive multiple sclerosis dependent on others

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Progressive Multiple Sclerosis Dependent on others for mobility Catheter for bladder control Needs assistance with bowel management Absent sensation, except neurogenic pain Depression, treated Beginning to loose high level cognition
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Preferences He wants prescription to control his own death before he looses insight and judgment • Adult Advance Care Directive
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Quality of Life • He and has tolerated the loss of mobility He cannot tolerate cognitive loss Pain is a background issue and while bothersome isn t a major factor in his decision making
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Contextual Features • Catholic He is a retired mental health professional His family is supportive of decision; 2 young children Compassion in Dying is supportive and advocates for assistance He is retired military with life-time pension He also has a life insurance policy It is illegal to prescribe medication to end a life in this situation in the US
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Case #2 Ethical Issues Is this assistance with death? Is it different from withholding or withdrawing treatment? Does it matter?
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Ethical Arguments Autonomy Do no harm Legality
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Case #3 57 year old male falls from a tree and at the scene is thought to have high quadriplegia CPR stated by neighbors; EMTs intubate He is admitted to the hospital intensive care unit He requests withdrawal of life support
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Case #3 He was weaned from the ventilator and transferred to SCI He requests that his physician administer a lethal dose of medication
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Medical Indications C5 motor sensory complete quadriplegia He has no sensation below the neck Movement is restricted to the level of the wrist extensors He needs a catheter for bladder control and assistance with bowel care He needs full assistance for mobility and self-care
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Preferences He had made repeated requests to be withdrawn from ventilator He is angry that this choice is no longer available He does not have an Advance Care Directive
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Quality of Life He cannot tolerate the loss of mobility He cannot tolerate need for assistance He sees no future in looking at the stars
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Contextual Features • Catholic His wife supportive; No children He is retired military with full medical benefits Wife and veteran perceive a care burden He would need physical assistance to administer the medication which is illegal in Washington and in a Federal Institution
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Ethical Issues How is this different than Case #2? What ethical arguments can you make for and against administering the medication?
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Some Arguments for Assistance with Death Beneficent—Good death • Autonomy— define one s own concept of existence of meaning, of the universe, and of the mystery of human life. Casey All arguments against providing assistance to an individual in intolerable pain/suffering are based on religious, political, or other beliefs and this is prohibited by the Constitution
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