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From the Greek Means “Good Death”

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1 From the Greek Means “Good Death”
Euthanasia From the Greek Means “Good Death”

2 A Good Death? Are some deaths better than others?
Do we have a right to choose when to end our life? What if we are not suffering from a terminal illness?

3 X 5 Different Types Active Euthanasia Voluntary Euthanasia Active
Non-voluntary X Passive Euthanasia Involuntary Euthanasia

4 Active Euthanasia Something is done to the patient to hasten Death
Not legal in the United States Legal in Netherlands and Australia Examples: drugs are administered at lethal levels.

5 Passive Euthanasia Patient is allowed to die. Only medication help ease patient’s pain is administered. Examples: Turning off respirator, refusing chemotherapy.

6 Voluntary Euthanasia Patient request treatment to be stopped.
Examples: chemotherapy or dialysis.

7 Non- Voluntary Patient cannot decide from themselves.
Someone makes the decision for them. Examples: children, comatose patients, or individuals not mentally competent

8 Involuntary Patient is refused a life sustaining treatment.
Examples: Drugs are too costly, limited supply of organs. About 13,000 patients are on waiting list in the US.

9 Heath Care Surrogate You can appoint someone, to act as your representative in the event you are mentally incapacitated. Terri Schiavo did not have a Heath Care Surrogate. If you do not have one, by default it is your spouse. If you are unmarried it is your parents, or next of kin.

10 Living Will A living will is a document that states what your wishes in the event you need life sustaining care.

11 History 400 B. C. - The earliest recorded reference to Euthanasia comes from Hippocrates, the father of medicine. He is quoted as saying “I will give no deadly medicine to any one if asked, nor suggest any such counsel” 673 – England prohibits suicide.

12 History Cont. 1647 – the Providence Plantations (Rhode Island) declared that if an individual committed suicide his/her possessions would become the property of the King of England. 1800s – Laws of Connecticut essentially states that any person who aids another individual in committing suicide is guilty of murder if the advisee actually goes through with suicide.

13 History Cont. 1828 – “The earliest American statute explicitly to outlaw assisted suicide was enacted in New York….Between 1857 and 1865, a New York commission drafted a criminal code that prohibited ‘aiding’ suicide and, specifically, ‘furnishing another person with any deadly weapon or poisonous drug, knowing that such person tends to use such weapon or drug in taking his own life.” 1850 – “The California legislature adopted the English common law, under which assisting suicide was… a crime.”

14 History Cont. 1920 – “The book "Permitting the Destruction of Life not Worthy of Life" was published. In this book, authors Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig, argued that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. This book helped support involuntary euthanasia by Nazi Germany.”

15 Nazi Germany 1939 – In “Nazi Germany…Hitler ordered widespread ‘mercy killing’ of the sick and disabled.” 1935 – “The Euthanasia Society of England was formed to promote euthanasia.”

16 History Cont. 1995 – Australia's Northern Territory approved the “Rights of the Terminally Ill Act . “ It went into effect in 1996 and was overturned by the Australian Parliament in 1997.”

17 Legalized in Oregon the Oregon Death with Dignity Act was passed, which legalized assisted suicides. Other states such as California, Michigan, Maine, Hawaii, Arizona, and Vermont have tried to pass similar bills. All attempts have been unsuccessful.

18 History Cont. 2002 – Euthanasia is legalized in Belgium
2005 – “Netherlands set to give the go-ahead to child euthanasia.”

19 Assisted Suicide When someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When a doctor helps another person to kill themselves it is called “physician assisted suicide”.

20 Oregon’s Death with Dignity
In 1994 voter in Oregon passed an Assisted Suicide law. According to the Oregon Death With Dignity Act, “An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner “

21 A long road to legalization
In 1994, the Death With Dignity Act was approved 51% to 49%

22 Supreme Court said Up to States
In 1997 Ballot Measure 51 was introduced to overturn the Death With Dignity Act. The people of Oregon turned down the measure by a vote of 60% to 40% Ballot Measure 51 came about due to two court cases in which the U.S. Supreme Court ruled in assisted suicide was not a Constitutional right. However, the Court instructed that the issue would be best addressed in the "laboratory of the states."

23 Who requested assisted Suicide
37 individuals used the law in 2004 (a fraction of the approximately 31,000 deaths statewide) 60 prescriptions were written by 40 different physicians Most of the individuals were able to die at home 89% were enrolled in hospice care Men and women were equally likely to use the law, the median age was 64,

24 Ashcroft Directive In 2001 Attorney General John Ashcroft said “assisting suicide is not a "legitimate medical purpose" under federal drug-control law and that the Drug Enforcement Administration could strip the prescribing rights of any physician who authorized drugs to help someone die.”

25 Oregon v. Ashcroft On November 6, 2001, Attorney General John Ashcroft issued a Directive stating that a doctor could lose his or her federal registration to prescribe controlled substances if the  registration is used to prescribe federally controlled substances for assisted suicide.

26 Supreme Court Affirms Assisted Suicide
On November 9, 2004, the Justice Department petitioned the U.S. Supreme Court to hear the case and, on February 22, 2005, the U.S. Supreme Court announced that it would hear the case (now titled "Gonzales v. Oregon" No ) during its session that begins in October 2005. On January 17, 2006, the Supreme Court Ruled in Favor of Assisted Suicide in Oregon

27 The Terminally Ill and Hospice
Hospice- end of life care. The goal of Hospice is not to cure illness, but to alleviate your pain and minimize your suffering.

28 Dr. Jack Kevorkian

29 Kevorkian Chronology May 28, 1928 Kevorkian is born in Pontiac, Michigan, the son of Armenian immigrants. 1952 Graduates from University of Michigan medical school with a specialty in pathology. 1956 Publishes journal article, "The Fundus Oculi and the Determination of Death," discussing his efforts to photograph the eyes of dying patients, a practice that earned him the nickname "Doctor Death."

30 Kevorkian Chronology December 1958 Presents paper at meeting in Washington, D.C., advocating medical experimentation on consenting convicts during executions. Embarrassed, University of Michigan officials ask Kevorkian to leave his residency there.

31 Kevorkian Chronology 1961 Publishes article in The American Journal of Clinical Pathology detailing his experiments on transfusing blood from cadavers to live patients. 1970 Becomes chief pathologist at Saratoga General Hospital in Detroit. Late 1970s Quits pathology career, travels to California, and invests life savings in directing and producing a feature movie based on Handel's "Messiah." With no distributor, the movie flops.

32 Kevorkian Chronology 1980s Publishes numerous articles in the obscure German journal Medicine and Lawoutlining his ideas on euthanasia and ethics. 1987 Advertises in Detroit papers as a "physician consultant" for "death counseling." 1988 Kevorkian's article, "The Last Fearsome Taboo: Medical Aspects of Planned Death," is published in Medicine and Law. In it, he outlines his proposed system of planned deaths in suicide clinics, including medical experimentation on patients.

33 Kevorkian Chronology 1989 Using $30 worth of scrap parts scrounged from garage sales and hardware stores, Kevorkian builds his "suicide machine" at the kitchen table of his Royal Oak, Michigan, apartment. June 4, 1990 Kevorkian is present at the death of Janet Adkins, a 54-year-old Portland, Oregon, woman with Alzheimer's disease. Her death using the "suicide machine" occurs in Kevorkian's 1968 Volkswagen van in Groveland Oaks Park near Holly, Michigan.

34 Kevorkian’s Definition of Death With Dignity
“Well, let's take what people think is a dignified death. Christ was that a dignified death? Do you think it's dignified to hang from wood with nails through your hands and feet bleeding, hang for three or four days slowly dying, with people jabbing spears into your side, and people jeering you? Do you think that's dignified? Not by a long shot. Had Christ died in my van with people around Him who loved Him, the way it was, it would be far more dignified. In my rusty van.” - Jack Kevorkian; National Press Club - July 29, 1996

35 First 5 Assisted Suicide
1. Janet Adkins 1990 F 54 Alzheimer's Disease 2. Sherry Miller 1991 F 43 MS 3. Marjorie Wantz 1991 F 58 Abdominal and Pelvic Pain 4. Susan William 1992 F 52 MS 5. Lois F. Hawes 1992 F 52 Lung cancer

36 Less than 1/2 Less than ½ of all of Dr. Kevorkian’s Assisted Suicides were of patients that were terminally ill.

37 Why suicide? 36 had expressed fear of becoming dependent on others
34 were in chronic or cancer pain At least 15 had been diagnosed with less than six months to live 13 had rejected any further medical treatment At least 10 had tried suicide before

38 93 known Deaths… Kevorkian assisted in 93 reported deaths, but his lawyers says there are many more where the person wished to remain anonymous.

39 “60 minutes” Interview November 22, 1998 CBS's "60 Minutes" airs a videotape showing Kevorkian giving a lethal injection to Thomas Youk, 52, who suffered from Lou Gehrig's disease. The broadcast triggers an intense debate within medical, legal and media circles.

40 Convicted in 1999 April 13, 1999 Convicted of second-degree murder and delivery of a controlled substance in the death of Youk, a Michigan judge sentences Kevorkian to years in prison.

41 International Laws Assisted Suicide Active Euthanasia
Passive Euthanasia Are legal in several countries including: Japan, Belgium and the Netherlands

42 Japan In 1995 a Japaneselegalized "Active euthanasia" when four criteria are satisfied: unbearable pain, proximate death, no other way to relieve pain; and clear consent. Passive euthanasia, without consent, is also allowed if relatives consent.

43 Japan Surgeon Accused Japanese police are investigating a surgeon who has killed seven patients over the last five or six years by removing them from their respirators. The 50-year-old head of the surgery department at Imizu City Hospital, 260km northwest of Tokyo, allegedly wanted to allow his patients to die with dignity. According to hospital authorities, he consulted his decision with relatives first, but he never discussed the matter with the hospital ethics committee. Four men and three women -- all between the ages of 50 and are said to have been killed. Five had cancer.

44 Did he have consent? The case only came to light when the head nurse of the medical ward overheard the doctor instructing a staff member to remove an artificial respirator from a 78-year-old stroke patient. Hospital staff had been cooperating in the deaths. "In the surgery ward, the staff works in teams and no one could refuse his orders," the director of the hospital, Hidetsugu Asanoi, told the media. "I believe he made the decisions taking full responsibility and with faith in his own way [of doing things]." However, a relative of the stroke patient denied that the doctor had asked for consent. "We had not demanded that the respirator be removed. The surgeon did not obtain our consent," he said.

45 International Laws Belgium and The Netherlands have legalized Euthanasia In 1995, with the passage of the "Rights of the Terminally Ill (ROTI) Act," Australia’s Northern Territory became the only jurisdiction in the world with both legalized assisted suicide and euthanasia. The law went into effect in July It was repealed on March 25, 1997.

46 History in Netherlands
Started in 1973 became legal until 2002 The Dutch situation between 1973 and 2002 was an outgrowth of a series of court decisions and medical association guidelines, beginning with a 1973 District Court case in which Geertruida Postma, a Dutch physician, was convicted of the crime of euthanasia after she ended the life of her seriously ill mother.

47 Netherlands, continued.
The conditions under which the elderly woman died might have never come to the attention of authorities had it not been for Dr. Postma’s insistence that her actions be made public. While finding Dr. Postma guilty of the crime of mercy killing that was punishable by imprisonment for a maximum of 12 years, the court imposed a one-week suspended sentence and a week’s probation.

48 Euthanize Children! The Dutch government has decided to endorse guidelines for Nonvoluntary euthanasia of infants. Under the so- called Groningen protocol, euthanasia will be allowed when a child is terminally ill with no hope of recovery and suffering great pain, when two doctors agree that the case is hopeless and when the parents consent.

49 Belgium- not to be outdone…
The Belgian act legalizing euthanasia was passed on May 28, 2002 and went into effect on September 23, 2002. It limited euthanasia to competent adults and emancipated minors. Just recently, the government announced it intends to extend its euthanasia law to newborns and children Approximately 2,000 people have used the law

50 Australia “Death by Laptop” Performed by Dr. Philip Nitschke
Used the law to assist four people with their suicides. Hooked up IV to patient which was connected to laptop.

51 Australia (cont.) Dr. Philip Nitschke

52 Australia (cont.) Death by Laptop

53 Australia (cont.) Computer asked three questions:
Are you aware that if you go ahead to the last screen and press the ‘yes’ button, you will be given a lethal dose of medicine and die? Yes / No Are you certain you understand that if you proceed and press the ‘yes’ button on the next screen, you will die? Yes / No In 15 seconds you will be given a lethal injection. Yes / No Nitschke still researching ways to help people kill themselves

54 Canada Current bill being considered that would legalize euthanasia
Bill C-407 legalizes both euthanasia and assisted suicide. For people with chronic suffering and mental pain. Person does not need to try to find other ways of helping ease pain, they may refuse and just choose euthanasia Anyone can help euthanize a person, does not need to be a physician, but need “confirmation”

55 International Organizations
Council of Europe has rejected bills that would legalize euthanasia UN is against euthanasia However, wording of new draft for rights of people with disabilities seems to leave the door open: The text makes illegal all "medical or related interventions," possibly including life-saving nutrition and hydration, carried out without the "free and informed consent" of the person concerned or his legal representative. Needless to say, Catholic church is strongly opposed to euthanasia

56 Durable Power of Attorney for Health Care
Also called Protective Medical Decisions Document (PMDD) This is a signed, witnessed (or notarized) document in which the signer designates an agent to make health care decisions if the signer is temporarily or permanently unable to make such decisions The difference between the power of attorney and a living will is that this does not require the signor to have a terminal condition Agent must be willing to execute the wishes of the signor and these should be thoroughly discussed before signing This has an advantage over the court appointed guardian who is unfamiliar with the values of the patient Allowed in every state, but some states require you file one specifically in that state Limitations The agent does not have authority to approve the direct and intentional ending or your life This includes giving lethal injections, removing feeding tubes, etc.

57 Case Studies Karen Ann Quinlan 2 tales from Katrina Terri Schiavo
Baby MB

58 Karen Ann Quinlan  In 1975 a 21-year-old woman named Karen Ann Quinlan suffered a respiratory arrest that resulted in severe and irreversible brain damage and left her in a coma. Several months later, after doctors informed them that their daughter's recovery was extremely unlikely, Quinlan's parents requested that artificial means of life support be removed. The hospital refused this request.

59 Court sided with Family
After a lengthy legal battle, in 1976 the Quinlans obtained a court order allowing them to remove the artificial respirator that was thought to be keeping their daughter alive. The New Jersey Supreme Court ruled that the Quinlans could disconnect the device so that the patient could "die with dignity."

60 Turned off respirator This decision spawned increased discussion of the scope of patients' rights to control their death. Although the respirator was removed in 1976, Quinlan began to breathe on her own. She lived until 1985 without ever regaining consciousness.

61 The Tale of Two Choices…
Hurricane Katrina Hospital case Assisted Living Case

62 Katrina Track…

63 Louisiana probes 215 deaths
A state investigation into whether critically ill patients were left to die or were euthanized at a New Orleans hospital during the chaotic aftermath of Hurricane Katrina is part of a probe into an estimated 215 deaths at nursing homes and hospitals across the area, according to the Louisiana Department of Health and Hospitals. As Reported 10/17/05

64 Tough Decisions at Hospital
Staff doctors in a New Orleans hospital may have euthanased critically ill patients with massive doses of morphine in the chaotic aftermath of Hurricane Katrina. According to the London's Mail on Sunday, the doctors say that the patients would have died anyway and some were in great pain. They were unable to care for them properly when the power failed and looters and rapists were roaming the wards.

65 These extraordinary claims have not been reported in the US press and should probably be treated with some caution. However reporters Caroline Graham and Jo Knowsley interviewed a doctor who had killed several patients and assert that a hospital orderly and local government officials had corroborated her story.

66 "I didn't know if I was doing the right thing," the doctor reportedly said. "But I did not have time. I had to make snap decisions, under the most appalling circumstances, and I did what I thought was right. I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul." The doctor, who eventually fled the hospital in fear of being killed by armed looters, denied that she was a murderer. "This was not murder, this was compassion. They would have been dead within hours, if not days," she said.

67 What we did was give comfort to the end
What we did was give comfort to the end. I had cancer patients who were in agony. In some cases the drugs may have speeded up the death process. We divided the hospital's patients into three categories: Those who were traumatised but medically fit enough to survive, those who needed urgent care, and the dying. People would find it impossible to understand the situation. I had to make life-or-death decisions in a split second.

68 It came down to giving people the basic human right to die with dignity. There were patients with 'do not resuscitate' signs. Under normal circumstances some could have lasted several days. But when the power went out, we had nothing. Some of the very sick became distressed. We tried to make them as comfortable as possible. The pharmacy was under lockdown because gangs of armed looters were roaming around looking for their fix. You have to understand these people were going to die anyway."

69 The British paper Scotland on Sunday related yet another hospital mercy killing. A female manager ordered that a 380 pound man be put down because the staff could not evacuate him. A weeping doctor told reporter Jacqui Goddard: "We had minutes to get out, and I asked, 'What are we going to do about this guy, because he's a big man. It was going to be tough getting him down those stairs -- the elevators weren't working. That woman turned to me and said straight out, 'We're going to help him to heaven'. It makes me want to break down, how that man's life was taken away." ~ Mail on Sunday (London), Sept 11   

70 Nursing-home owners charged with negligent homicide
"Salvador & Mabel Mangano

71 Refused assistance The husband-and-wife owners of a New Orleans-area nursing home where 34 people died in Hurricane Katrina's floodwaters were charged Tuesday with negligent homicide. The case represents the first major prosecution to come out of the disaster in New Orleans. The owners of St. Rita's Nursing Home in the town of Chalmette "were asked if they wanted to move (the patients). They did not. They were warned repeatedly that this storm was coming. In effect, their inaction resulted in the deaths of these patients," Louisiana Attorney General Charles Foti said.

72 Salvador A. Mangano and his wife, Mable, surrendered and were jailed on 34 counts of negligent homicide. Each count carries up to five years in prison. The attorney general said he is also investigating the discovery of more than 40 corpses at flooded-out Memorial Medical Center, in New Orleans' Uptown section. The Manganos had an evacuation plan as required under state law and a contract with an ambulance service to evacuate the patients, but they did not call the company, Foti said. They also turned down an offer from St. Bernard Parish officials who asked if the nursing home wanted help evacuating, he said. Foti said the bodies have not all been identified and he was not sure how many of the victims were patients or staff.

73 Nursing Homes May be Responsible in Hurricane Katrina Deaths
At least 140 nursing home patients died in the recent Hurricane Katrina and her aftermath, prompting criminal investigations by the government.  The Louisiana Attorney General’s Office reported that they are leading a series of investigations to see whether or not the nursing homes were negligent in the deaths.  Arrests and charges are likely to occur, as are related personal injury lawsuits.

74 Terri Schiavo In the early 1990s Schiavo had a heart attack and collapsed incurring massive brain damage and slipping into a coma. She remained in this coma and after 3 years was in a persistent vegetative state. (PVS)

75 Terri’s Loving Husband
Beginning in 1998, Schiavo’s husband began petitioning the courts to remove the feeding tube that kept her alive claiming that she would not want to be kept on a machine with no hope for recovery. Her parents claimed that Schiavo was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration .

76 Michael Schiavo Vs. The Schindler Family

77 Persistent Vegetative State
The scan on the left is that of a healthy 25 year old. The light grey areas are healthy, functioning brain tissue. The scan on the right is that of Terri Schiavo after her accident. The black areas are non-functional areas of the brain that have permanently atrophied. An EEG on Schiavo showed that she had no measurable brain activity.

78 Terri’s Never had Treatment
Michael Schiavo had a girl friend and children, but he was still the legal guardian of Terri. He restricted access by her parents- they had to go to court to get visitation. He refused to give her any medical treatment or to ask for a second opinion.

79 Terri’s Law On October 15, 2003 Schiavo’s feeding tube was removed. Six days later Terri’s Law was passed and Gov. Bush sent armed men to take Schiavo to a hospital to have her feeding tube reinserted. A guardian ad litem was also appointed that was to report to Gov. Bush On May 5, 2004 Terri’s Law was found to be unconstitutional The Supreme Court Refused to hear the case and March 18, 2005 it was ordered that the feeding tube be removed again…

80 Dust in the Wind Terri was read her last rites on March 26, 2005 and died on March 31, 2005. Her “loving” husband refused to let here parents attend the funeral! He had the body cremated- and spread the ashes in a secret location!

81 Baby “MB” MB is a 19 month old baby boy.
MB has a condition called spinal muscular atrophy which leaves him almost totally paralysed. He requires a ventilator to breathe and cannot cry, chew or swallow.

82 Doctors- His life is not worth living!
All his doctors and the guardian appointed to represent the child's interest in court argued that the burdens of his existence outweighed the benefits.

83 His Parents want to let him live
The parents love their child and want to keep him alive. MB's mother told the High Court, in London, that the child was conscious. He responded to cartoon films such as Shrek and Finding Nemo, but did not appear to like the news or the TV soap Eastenders.

84 Justice Holman said… "It must be assumed that he processes all of those sights and sounds like any child of his age and gains pleasure from them," said Justice Holman. "No court has yet been asked to approve, against the will of parents, the withdrawal of life support with the inevitable and immediate death of a conscious child with sensory awareness and cognition, and no significant evidence of brain damage."

85 Do not resuscitate or medicate
The judge also said that if the child's heart stops, the hospital would not be required to resuscitate him or to give antibiotics if he develops serious infections. As reported by the BBC, Mar

86 Philosophical Views James Rachels James Sullivan Margaret Battin

87 James Rachels James Rachels- He argues that there is no moral difference between passive and active euthanasia. They are either both morally permissible or they are both wrong. He claims that they are both morally permissible. He think that there are times when the pain and suffering of an individual should lead us to help end their suffering.

88 Bishop James Sullivan-
Bishop James Sullivan- He argues that God has providence of matters of life and death. Further he claims that "intentional killing" is always wrong. He thinks both passive and active Euthanasia are wrong- yet he admits that there are cases- such as an infant that is suffering from a painful and incurable condition, where the doctor should make the baby feel good and withhold treatment- (Hence passive euthanasia) But it was okay because the goal was not intentional killing, just easing of pain…

89 Analysis of Sullivan Sullivan is inconsistent. Further his arguments are not very good. He employs the wedge principle- (Rachels "the slippery slope") The claim is that once we allow passive euthanasia, it will lead to active euthanasia and eventually people will be killing each other for the most trivial of reasons.

90 Rachels’ response Rachels gives a rebuttal where he points out the wedge principle follows neither logically or psychologically. Logically it does not follow that if we allow one form of euthanasia that we must also accept any other type of killing. Psychologically, it is not the case as a society that because we have allowed one form of Euthanasia that we have lost all social control and there is murder and mayhem in the streets.

91 Euthanize the old people
Margaret Battin- She argues that because of a scarcity of heath care resources medical treatment ought to be withheld from the elderly. This is in effect arguing for passive euthanasia, because you are withholding lifesaving treatment. She argues for this because she thinks that the resources will serve the community better if they are spent on the younger segment of the population.

92 It is important to note that such a situation, if it were instituted right now, would result in an injustice to elderly people today. Why? Because in point of fact, they have not benefited in their youth by such a system. Secondly such a system should not be adopted if there are enough resources in place. If we have enough medicine and enough doctors, then we should not withhold treatment from anyone.

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