3 DEFINING TERMS Suicide Pulling the Plug Refusing Treatment Physician Assisted Suicide (PAS)EuthanasiaPassive EuthanasiaActive EuthanasiaVoluntary – Patient ConsentsNon-Voluntary – Patient Can’t ConsentInvoluntary – Patient refuses or can give consent but not asked1. Suicide - The act or an instance of intentionally killing oneself.2. “Pulling the Plug” - The act of discontinuing futile medical interventions that prolong suffering during the dying process. The disease kills the patient. Ex: Discontinuing ventilator in a dying patient.3. Refusing Treatment - The patient refuses treatment believing it will be to great a burden. It is considered assault to treat a rational and informed patient against their wishes. Ex: patient refuses dialysis or CPR options.4. Assisted Suicide - Helping a person to kill themselves. In physician assisted suicide (PAS) the doctor prescribes a lethal dose of one or more medications5. Euthanasia - Greek - eu = good + thanatos “death”; Definition - The act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection.6. Passive Euthanasia - withholding or withdrawing medical interventions without consent with the intent to cause death. The patient is not dying but the withdrawal will cause death. Ex:not giving insulin to a Type I diabetic. Many ethicist don’t like this term because it is confused with “pulling the plug.7. Active Euthanasia - a deliberate action to cause death to a “suffering” pt.A. Voluntary - pt. consents Ex. Doctor gives lethal injection with pt. consent.B. Non-voluntary - pt. consent not possible Ex: comatose or demented pt.C. Involuntary - pt. consent possible but not sought..
4 USUAL “SAFEGAURDS” Less than 6 months to live Second opinion Multiple requestsWaiting PeriodCan change mindConfidential reportNot requiredFamily notificationPsychiatric examOregon passed by referendum in 1994 and confirmed in Death with Dignity referendum passed 51% to 49% in Implemented 1998 after injunction, 9th Circuit Court ruling and US Supreme Court ruling (7/97).WA passed by referendum in 2009, VT in 2013.Criteria for OR and WAa. Patient must be terminally ill with less than a six months prognosisb. A second doctor must confirm the diagnosis and prognosis.c. The patient must give an oral request and then provide a written request/informed consent form. After 15 days, the request must be confirmed orally before a prescription or the pills can be dispensed.d. The patient can change their mind at any point in the process.e. The physician is required by law to submit a written form documenting all the steps in the process.f. The patients family cannot be notified without the patients explicit written authorization.g. No psychiatric or psychological exam is required.4. Considered in many other states - MI - referendum defeated 72%-28% 11/98. CA - passed legislative committee in 5/99 but never got to floor. Maine - referendum defeated 11/ % to 49%. CT defeated in 2013, expected to come up again. New Jersey debating it in 2013, could be the next state to legalize it.5. MONTANA - in the state of Montana, the Baxter v. Montana (2009) court decision created a defense for a physician who is prosecuted should he or she be charged in assisting a suicide. Prosecutions for assisted suicide remain possible in Montana and conviction remains possible in Montana6. VERMONT - Patients must have the ability to administer the life-ending medicine to themselves. They must be capable of making sound decisions. They must be 18 years old or more. They must have a doctor's diagnosis of a terminal illness with less than six months to live. They must make multiple requests with specific waiting times and be given the opportunity to rescind at any time. After three years, these requirements are void. Medical personnel are granted immunity for assisting terminally ill patients to die. There are no reports to the government at any time.Hospitals, doctors, and pharmacists may opt out of the program. However, all doctors are obliged to inform terminal patients of the program7. NEW MEXICO – New Mexico doctors can help terminal patients die according to a 2014 court decision; doctors could not be prosecuted under the state's assisted suicide law, which classifies helping with suicide as a fourth-degree felony. The plaintiffs in the case did not consider physicians aiding in dying a form of suicide. The New Mexico Attorney General's Office said it is discussing the possibility of an appeal but needs to fully analyze the judge's opinion before commenting further.8. SUPREME COURT - In 1997, in the cases of Washington v. Glucksberg and Vacco v. Quill, the U.S. Supreme Court ruled unanimously that there is no Constitutional right to assisted suicide, and that states therefore have the right to prohibit it. Advocates of assisted suicide saw this as opening the door for debate on the issue at the state level.
5 Christian Beliefs Oppose PAS Human life is sacred because man is made in God’s image. - Genesis 1:26God alone is sovereign over life and deathDeut. 32:39 I put to death and I bring to life.David says in Psalm 139:16 All the days ordained for me were written in your book before one of them came to be.People’s bodies belong to God - 1 Cor. 6:19)Suicide is defined as self-killingExodus 20:13 Thou shall not killThe Bible teaches that human dignity is inherent and not based on capabilities or quality of life.
6 JEWISH BELIEFS ABOUT PAS We cannot sanction, favor or support the legalization of physician-assisted suicide.Central Conference of American Rabbis
7 A Doctor shall not take away life even when motivated by mercy A Doctor shall not take away life even when motivated by mercy. This is prohibited because this is not one of the legitimate indications for killing. Direct guidance in this respect is given by the Prophet's tradition: "In old times there was a man with an ailment that taxed his endurance. He cut his wrist with a knife and bled to death. God was displeased and said "My subject has hastened his end I deny him paradise.MUSLIM BELIEFS1. Mercy killing finds no support except in the atheistic way of thinking that believes that our life on earth is followed by a void.2. Islamic Code of Medical Ethics - Since we did not create ourselves, we don’t own our bodies. Justification of taking a life to escape suffering is not acceptable in Islam4. “Do not kill yourselves, for indeed Allah is most merciful to you” The Holy QuranThe Holy Quran
8 PHYSICIAN ASSISTED SUICIDE HAS BEEN PROHIBITED IN MEDICINE FOR OVER 2000 YEARSHistory of Hippocratic OathThe oath says the doctor “will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect”First “Do no harm”1. History of Hippocratic Oath - Before Hippocrates - “physician” could heal or kill. Patients didn’t know which he would do. If someone else paid the physician more than the patient, the doctor would kill for hire. Without trust, there was no foundation for the doctor/patient relationship. Hippocrates and other doctors realized that doctors could only be healers and never killers if patients were to trust their doctors. They came up with the Hippocratic oath which states that doctors will keep confidences, not abort babies nor take the lives of their patients. Patients then voted with their feet and soon Hippocratic medicine prospered. PAS is not a new idea. It has been tried and found to corrupt and destroy medicine.2. “This is the defining moment in medicine. If doctors are allowed to kill patients, the doctor-patient relationship will never be the same again. If killing you is an option, how can I expect you to trust me to all that I can to heal you?”Linda Emanuel M.D. VP for Ethic Standards, AMANY Times Magazine, July 21, 1996(http://www.nytimes.com/1996/07/21/magazine/the-next-pro-lifers.html?n=Top/Reference/Times%20Topics/People/H/Hendin,%20Herbert&pagewanted=8)3. Do No Harm - This is the “silver rule” that is the foundational moral principle of medicine. It reminds doctors that as they attempt to cure and relieve suffering, they should never do anything that harms the patient. Taking a patient’s life or assisting them in doing so is the greatest harm that can be done. It takes away the future and any hope of happiness on earth.4. Will medicine be a calling and a profession or will it be a occupation where medicine is a technique for the satisfaction of consumer wants.
9 “PAS is fundamentally inconsistent with the physician’s professional role.” “The medical profession must redouble its efforts to provide optimal end of life care.”“Requests to physicians for PAS should signal the M.D. that the patient’s needs are unmet and further help is needed.”Opinion AMA’s statement on physician assisted suicidePhysician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide). It is understandable, though tragic, that some patients in extreme duress--such as those suffering from a terminal, painful, debilitating illness--may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication. (I, IV) Issued June 1994(http://www.ama-assn.org//ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page)
13 DESTROYED DESTROYS TRUST 1. Ideal Physician - Physicians get frustrated and tired with patients that are dying. It is tempting to solve your problem by doing away with the patient when you can’t do away with the disease. Doctor’s are not perfect moral beings. Moral boundaries are necessary in medicine. That is why it is called a profession. The doctor professes to enter into a covenant relationship with their patient and to put their needs and interests above their own. This creates a foundation of trust upon which the whole doctor/patient relationship is built.2. Holland Dataa. 60% of elderly in Holland are fearful that their lives will be ended against their will. J.H. Segers, Law and Medicine, 1988b. 93% of people living in nursing homes in Holland oppose euthanasia.3. Congressional Report on Physician Assisted Suicide in Holland p. 17Mrs.. P - She had congestive heart failure and was being treated with diuretics, digoxin and an after load reducer. Her activities were limited - she couldn’t clean or go up a flight of stairs but she could still get around and had a wonderful outgoing and pleasant personality. She was very diligent in following her doctor’s orders and suggestions.She didn’t show up for her appointment with her cardiologist. He called her primary physician who said that he had told Mrs. P that “this wasn’t going to get any better, her life was limited because she couldn’t clean her house and all those pills she had to take made “no sense.” She continued to follow her doctors suggestion. Three days later she killed herself with the pills her primary physician had given her. Richard Fenigsen, M.D., Ph.D., Physician-Assisted Death in the Netherlands: Impact onLong-Term Care, 11 ISSUES IN LAW & MED. 283, (1995).
14 KILL SKILL TO IT TAKES NO GREAT TAKES NO GREAT SKILL TO KILL 1. End of life care requires consummate skill. It is an art learned over many years of practice because doctors must not only provide good pain and symptom control but also give emotional, family, spiritual and other support. EX Medical School
15 EASIEST OPTION1. Dr. Jack Kevorkian a retired pathologist who didn’t provided patient care for almost 40 years knows nothing about pain control or depression. He wouldn’t know an SSRI antidepressant from a tricyclic. No one argued that he didn’t do an excellent job killing people in an efficient manner. As he said, “My specialty is death” 60 min May 16, 19962. Euthanasia, in its promise of “a good life, a good death,’ does not put an end to burdensome treatment; it puts an end to burdensome people.” Eric Chevlen, M.D. First Things, June/July, 1996, p. 18.
16 Gives Physicians Too Much Power Judge, Jury and Assistant executioner EX: Getting up in middle of the night.
19 DISSENSION People more self-centered Don’t have time to take care of family“This will cause a quagmire of litigation between family members and make it enormously difficult to know who has been coerced or even killed against their will.”NY Attorney General Vacco1. “The effects on families, especially those who are excluded from the decision by the patient or who disagree with the patient's decision, may be significant.”“Practical Issues in Physician-Assisted Suicide.” Annals of Internal Medicine, 15 January :
20 Interview with 84 year-old woman Interview with 84 year-old woman... when I started losing my hearing about three years ago, it irritated my daughter. She began to question me about financial matters and apparently feels I won’t leave much of an estate to her... She became very rude.... Then one evening (she said) she thought it was okay for older people to commit suicide... So I sit, day after day, knowing what I am expected to do.“Santa Rosa Press Democrat - September 14, 1993 Interview with 84 year-old woman... when I started losing my hearing about three years ago, it irritated my daughter. She began to question me about financial matters and apparently feels I won’t leave much of an estate to her... She became very rude.... Then one evening (she said) she thought it was okay for older people to commit suicide... So I sit, day after day, knowing what I am expected to do.ELDER ABUSE2. EX: George Delury was sentenced to six months in prison for helping his wife with multiple sclerosis kill herself even though she left a note stating that she made the decision. Two relatives said, “It was a betrayal,” and that she only wished to kill herself when she was in the depths of depression. They felt Delury just didn’t want to be burdened with her anymore.3. Non family members may be motivated to encourage suicide. EX: Richard and Helen Brown 79 & 76 y.o. committed suicide with carbon monoxide. Their former pastor, Charles Hueser stated, “They took the high road to death.” He is also the one who advised them to leave their $10 million dollar estate to his church’s mission program, which they did.4. Kevorkian helped Judith Curren, a nurse with chronic fatigue syndrome who had a husband accused of abusing her, kill herself.
22 The Right to Die The Duty to Die will become EX: Mom Dr. John Hartwig – ETSU and U. of TN ethicist duty to die by age 75The whole family is affected when a member’s care must be paid for or provided.Society must abandon patient centered bioethics and do what is best for all concerned.It is “wrong for a family member to choose what they want for themselves.”There are burdens that are too great to legitimately ask others to bear.Therefore, the patient has a duty to refuse life-prolonging medical treatment and to take their life, even in the absence of a terminal illness.Former GOVERNOR LAMM of Colorado said “groups in our society have a duty to die to get out of the way of younger generations.”
23 PRECLUDES RATIONAL DECISION MAKING 1. Term “rational suicide” is like stating you had a glass of “dry water”. Such a thing doesn’t exist. Most doctors admit never having seen a rational suicidal pt.2. Supreme Court ruling said - “competent terminally-ill person seeking suicide is largely fiction.”Donna White - “When Donna White first got sick, her pain cut so deep that she wished for pills, poison, starvation, Kevorkian, anything to end her torment. In bed at night, she would thumb through Final Exit memorizing the instructions about deadly drug dosages and how to avoid an autopsy. Instead, like 250,000 other terminally ill Americans each year, White found hospice care - and some entirely different solutions. She received a more effective combination of drugs and was taught how to titrate her dose herself. Says White, ‘Once they got my pain under control. I started thinking with my heart.’ Today Donna’s goal is to see her daughter, Carrie, graduate from high school.”US NEWS AND WORLD REPORT April 25, 1994Phone call on talk radio show from depressed man. - “I’m liberal on all social issues but I’m oppose to PAS. (Why?) I’ve tried to commit suicide five times and if it was legal for doctors to have helped me, I would be dead now.”PRECLUDESRATIONALDECISION MAKING
24 DEPRESSION1. Depression Most Common Reason - Chief Justice Rehnquist - persons attempting suicide “often suffer from depression or other mental disorder”, “95% of those who commit suicide had a major psychiatric illness at the time of death.” Supreme Court RulingChochinov HM, Wilson KG, Enns M, Mowchun N, Lander S, Levitt M, et al. Desire for death in the terminally ill. Am J Psychiatry. 1995;152:2. Doctors Miss Depression Diagnosis - Survey of Oregon Psychiatrists94% did not feel very confident that they could spot a psychiatric disorder which impaired judgment in just one consultation “Attitudes of Oregon Psychiatrists Toward PAS,” American Journal of Psychiatry, Nov. 1996, pp Owen C, Tennant C, Levi J, Jones M. Suicide and euthanasia: patient attitudes in the context of cancer. Psycho-oncology. 1992;1:79-88.Survey of Oregon Psychologists - 78% surveyed said they favor the law; 1/3 said a consultation for determining depression in PAS was outside their practice expertise. 50.3% were “not at all confident” that they could adequately access a patient in just one visit % somewhat confident % very confident. No consultation required.“Attitudes of Oregon Psychologist Toward PAS and the Oregon Death with Dignity Act,” Professional Psychology:Research and Practice June 1999, 235,244.3. Depression in the Terminally Ill can be Treated - “suicidal, terminally ill pts. Usually respond well to treatment for depressive illness and pain medication and are then grateful to be alive”. Herbert Hendin, “Seduced by Death:doctors, Pts and the Dutch Cure (1997)
25 Robert Woods Johnson Report ECONOMIC FACTORS1. Aging Population - baby boomers are “pig in python.” Not enough taxpayers - now 3.4 taxpayers per Medicare pt. going to 2. Why? 35 million taxpayers aborted.2. Healthcare Costs - Cost inflation decreased from 11% to 5% due to managed care in 90’s. Now going back up. Health care costs will rise from 13.4% of GNP to 19% of GNP in 2007.Robert Woods Johnson Report3. Medicare& Social Security - Over 65 y.o million; in million. Presently costs $215 billion a year. ?cut benefits vs. “spending caps” or “price controls.”4. Costly Terminal Care – 50% of Medicare cost in last six months of life.5. Greed & Insurers - “The least costly treatment of any illness is lethal medication”Acting Soliciter General Walter Delinger, Chicago Tribune, 1/14/97Managed care organizations are now offering incentives to doctors to use less monetary resources. PAS is the ultimate form of cost containment. Hippocratic doctors will be pressured because they spend more by not doing PAS.Oregon’s HMO’s already funding and encouraging PAS.Ethix Corp announced that “they welcomed broad coverage for assisted suicide in a medical economic system already burdened.”
27 THERE IS A SLIPPERY SLOPE Dutch physician administered a fatal injection to her terminally ill mother. Court said it was a compassionate act so there was no penalty.Court laid down nine criteria for not only PAS but active voluntary euthanasia because doctors had found they needed to give lethal injection to 20% of PAS patients who didn’t die.Court decided patient did not have to be terminally ill - just chronically ill. Rational - if should eliminate suffering that would last only six months why not if will last years?Non-voluntary euthanasia tolerated. EX: A doctor was taken to court for killing several nursing home patients without their consent. The doctor was not only acquitted but given $150,000 for damage to his reputation.First lethal injection to a newborn baby with Down’s syndrome. Infanticide okayed.Court said it was okay to assist patient in suicide for mental sufferingThe case that decided it was - “50 year old social worker, divorced, abused by former husband, her son committed suicide in 1986 and she underwent psychiatric treatment for depression and suicidal intent. Her second son died in 1991 from cancer. She attempted suicide and failed. She objected to both bereavement therapy and anti-depressive medication so her doctor gave her a suicide prescription.” NYTimes June 22, 1994, p 10A64% of Holland's doctors think euthanasia can be an acceptable alternative forpatients suffering from a mental disorder in the absence of any physical disorder.A doctor was charged for not following rules for PAS. He did not get written consent. Did not observe waiting period. He did not report the death as PAS. He was given a suspended sentence. (Sachs, S 1997, Jan 6, Newsday p.A6.)Belgium Feb. 8, Belgium’s Parliament is expected to pass a controversial law permitting the voluntary euthanasia of children as early as next Thursday. The bill will allow minors to ask for a lethal injection if they are terminally ill, if they are in great pain and if there is no effective treatment.Parliarmentary Assembly of the Council of Europe passed a resolution saying - betrays some of the most vulnerable children in Belgium by accepting that their lives may no longer have any inherent value or worth and that they should die; mistakenly assumes that children are able to give appropriate informed consent to euthanasia and that they can understand the grave meaning and complex consequences associated with such a decision; promotes the unacceptable belief that a life can be unworthy of life which challenges the very basis of civilised society.
28 SAFEGUARDS DON’T WORK SIX MONTHS TO LIVE IMPOSSIBLE TO PREDICT Oregon Survey - Lee MA, Nelson HD, Tilden VP, Ganzini L, Schmidt TA, Tolle SW. Legalizing assisted suicide-views of physicians in Oregon. N Engl J Med. 1996;334:310-5.Cancer Patients - 40% of cancer patients who lived longer than six months were expected to die sooner. “Relative Accuracy of the Clinical Estimation of the Duration of Life for Patients with End of Life Cancer,” 86 Cancer 170-6SECOND OPINION RUBBER STAMP- Holland study “A problem with these consultation may be that the independence of the consultation with regard to the attending physician” Study showed 90% approval from “CONSULTING PAIRS” Medical Journal of Australia 170:OREGON’S FIRST PATIENT - doctor refused, second doctor said pt. was depressed. Pt. contacted Compassion in Dying who found doctor who did. Three sentences about alternatives and didn’t consult pt’s primary doctor.DOCTORS ALMOST IMMUNE FROM MALPRACTICEIn Oregon all that is required is to show “GOOD INTENT”- the lowest standard. Doctor can misdiagnose and botch PAS but can’t be charged. Same on legislation in Washington.State doesn’t even KNOW THE DOCTORS WHO DO PAS. Since 2001, doctors doesn’t’ give any identifying information.CLOAK OF SECRECYthis assures only supportive information published. In Oregon - doctor forbidden to record PAS on death certificate. NO review. All we know is doctors are filling out the forms correctly. No punishment if don’t. Original records destroyed.SUPREME COURT – EXTREMELY DIFFICULT TO POLICEa) KATE CHENEY, 84 year old cancer patient - daughter pushing to do it and she demented based on psychiatric exam. Doctor thought coercion and denied. Doctor shopped till found one that would do it.b) OTHERS ADMINISTERING -1) PATRICK MCLENNY with ALS, difficulty swallowing, being assisted by his brother-in-law), If I hadn’t been there it would not have worked”) being assisted in taking the drugs, because they were not able to be self-administered.2)JENNIFER FEY - In the Washington Post (11/3/1999), staff writer Jennifer Frey “A Death in Oregon: One Doctor’s Story”, reported the PAS death of an Oregon woman with ALS (a non-cancer diagnosis). A cancer doctor in Salem opened 90 capsules and poured the powder into a bowl of chocolate pudding. He gave the mixture to two of the woman’s sons, one of whom helped spoon the pudding into his mother’s mouth, and the other son gave sips of water to wash it down.c) MOVING FROM OUT OF STATE ILLEGAL but - DAVID BRADLEY, 79 year old man with esophageal cancer moved from NM with help of C & Cd) COMMITTING EUTHANASIA ILLEGAL BUT - ｷ A case of illegal euthanasia occurred in Oregon in 1997, when Dr. Gallant of Corvallis euthanized a 78-year old comatose terminally ill woman. Even though it was illegal, he was not prosecuted. The Oregon Board of Medical Examiners only suspended his medical license for two months. (Erin Hoover, �Doctor may face homicide charges, The Oregonian, August 7, 1997).
29 IS SUBJECTIVE NO machine to measure pain or suffering. How do you say someone not Suffering enough to merit
30 Lives Not Worthy to be Lived? Once you say that are lives note worthy to be lived Someone begins to decide who those people are.
31 Oregon’s “Experiment” Isn’t Working th in hospice care (not #1 as claimed) eight states without PAS are better.PAIN MANAGEMENTPAIN MANAGEMENT HAS DETERIOTED in Oregon. After fours years of assisted suicide in Oregon (from June 2000 to March 2004), there were almost TWICE AS as many dying patients in moderate or severe pain or distress, as there had been prior to Oregon's assisted suicide law being used. [Fromme, Tilden, Drach, Tolle. Increased family reports of pain or distress in dying Oregonians: 1996 to JOURNAL OF PALLIATIVE MEDICINE 2004;7: ]2) Other states when they banned PAS morphine use in patients went up . In Oregon it has increased but no increase to dying patients.[Americans for Integrity in Palliative Care, Presentation to AMA House of Delegates Meeting, June 11, 2003]3)) Compassion and choices involved in 180 of 246 cases in Oregon “Why Oregon Patients Request Assisted Death: Family Member’s Views� by Linda Ganzini, Elizabeth R. Goy and Steven K Dobscha in the Feb issue of JOURNAL OF GENERAL INTERNAL MEDICINE 23 (2):5) : �Some Oregon clinicians have expressed surprise at the paucity of suffering at the time of the request among these patients�, referencing the paper �Oregon Physicians’ Responses to Requests for Assisted Suicide: a Qualitative Study� by Dobscha, Heintz and Ganzini in Journal PALLIATIVE MEDICINE ; 7: Most common reason6. Clinical Problems in Performing Euthanasia and PAS in the NetherlandsJ AMA Vol 342 No. 8 - Found Complications and problems in Netherlands in PAS 23% of time . In 16% of cases so severe that it required the doctor to lethally inject the patient. IN OREGON ALMOST NO COMPLICATIONS REPORTED AND NO EUTHANASIAFear of losing autonomy %Less able to engage in activities 87%making life enjoyableFear of loss of dignity 82%Fear of losing control of bodily functions 58%Fear of being burden on family, 39%friends, caregiversInadequate pain control %or concern about itOregon’s “Experiment” Isn’t Working
32 Supreme Court Ruling No Constitutional Right to PAS State Has Interest inPreserving Life – No Sliding ScalePreventing SuicideProtecting Integrity of Medical ProfessionProtecting Vulnerable from abuse, neglect, mistakesAvoiding likely slippery slopeDid not addressProtecting family members and loved onesProtecting people with disabilities1. FRAMING THE ISSUE - Ninth framed it as “whether a pt. Who is terminally ill has a constitutionally protected liberty interest in hastening what might other be a protracted, undignified and extremely painful death.” Saw as a “privacy right”, “right to define ones own choices.” It was so wide a definition that it encompassed active euthanasia.2. PRESERVING LIFE - “unqualified interest in the preservation of human life” “even for those who are near death ”view even individual cases through the wide-angle lens of public policy” no “sliding scale approach” “all person lives, from beginning to end, regardless of physical or mental condition, are under the full protection of the laws.”3. PREVENTING SUICIDE - “The state recognizes suicide as a manifestation of medical and psychological anguish.” 95% of pts. have major psychiatric illness; Court concluded that legalization “could make it more difficult for the State to protect depressed or mentally ill person, or those who are suffering from untreated pain, from suicidal impulses.”3. PROTECITING THE MEDICAL PROFESSION - “PAS could, it is argued, undermine the trust that is essential to the doctor-patient relationship by blurring the time-honored line between healing and harming.”4. PROTECTING THE VULNERABLE - “the State has an interest in protecting vulnerable groups from abuse, neglect and mistakes” and there is a “real risk of coercion.”5. SLIPPER SLOPE -9th declared this risk was nonexistent. Supreme Court said that “any recognized right would “likely” be “a much broader license, which would prove extremely difficult to police and contain.” Courts should consider where individual steps might lead.6. Two other state interests not discussed by Supreme Court (A) Protecting family members and loved ones. (B) Protecting persons with disabilities from social stigma and erosion of respect.
33 Supreme Court RulingSaid , “Withdrawing treatment does not equal assisted suicide”Not similar groups - one connected to life-sustaining equip.Laws treated people alike - all were free to refuse treatment and none were free to assist suicide.Fundamental legal principle of causation“When pt. refuses treatment, pt. dies of underlying disease.”“When pt. ingests lethal medication, he is killed by that medication”Fundamental legal principle of intentMD withdrawing or not starting treatment intends to respect patient’s wishes.MD giving lethal medication intends to kill the patient.The doctrine of double effect does not equal assisted suicide.1. FRAMING THE ISSUE - Ninth framed it as “whether a pt. Who is terminally ill has a constitutionally protected liberty interest in hastening what might other be a protracted, undignified and extremely painful death.” Saw as a “privacy right”, “right to define ones own choices.” It was so wide a definition that it encompassed active euthanasia.2. PRESERVING LIFE - “unqualified interest in the preservation of human life” “even for those who are near death ”view even individual cases through the wide-angle lens of public policy” no “sliding scale approach” “all person lives, from beginning to end, regardless of physical or mental condition, are under the full protection of the laws.”3. PREVENTING SUICIDE - “The state recognizes suicide as a manifestation of medical and psychological anguish.” 95% of pts. have major psychiatric illness; Court concluded that legalization “could make it more difficult for the State to protect depressed or mentally ill person, or those who are suffering from untreated pain, from suicidal impulses.”3. PROTECITING THE MEDICAL PROFESSION - “PAS could, it is argued, undermine the trust that is essential to the doctor-patient relationship by blurring the time-honored line between healing and harming.”4. PROTECTING THE VULNERABLE - “the State has an interest in protecting vulnerable groups from abuse, neglect and mistakes” and there is a “real risk of coercion.”5. SLIPPER SLOPE -9th declared this risk was nonexistent. Supreme Court said that “any recognized right would “likely” be “a much broader license, which would prove extremely difficult to police and contain.” Courts should consider where individual steps might lead.6. Two other state interests not discussed by Supreme Court (A) Protecting family members and loved ones. (B) Protecting persons with disabilities from social stigma and erosion of respect.
36 Fight PASPain ManagementModify Narcotics LawMore HospiceDx and Rx DepressionHolistic CareInvolve the Church
37 RESOURCES Christian Medical Association: www.cmda.org Family Research Council:National Right to Life Committee:Life Issues Institute:Means to a Better End: A Report on Dying in America Today, November 2002:Life on Hold. Finding Hope in the Face of Serious Illness by Laurel Seller