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That he can control the timing of his death medical

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that he can control the timing of his death
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Medical Indications • 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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that he can control the timing of his death Medical...

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