KAY 386: PUBLIC POLICY RIGHT TO DIE

A political, legal & medical debate about How and when to withdraw life support from patients who can not speak for themselves Alternatives: Living wills: Patients` advance directives (Patient’s clear and convincing wishes) Presumption in favor of life Is it a parental decision for infants and children? Is it a spousal decision for incapacitated persons?

CONTEXT PAST At home, among family and friends Suddenly or in a short time PRESENT In an institution From a terminal illness in a longer period of time New technologies that prolong life Most people die

More Issues Legalization of physician-assisted suicide for terminally ill patients Recognize and define the right to life support treatments Is it a right to refuse medical treatment? Assuring patient autonomy/choice

Religion and PP Church and State relations What is the position of the Catholic Church on all these issues? Quality of life concerns

Whose right to die? Who can be allowed to end their lives? Persistent vegetative state Mentally competent, terminally ill people

Who should decide to end one`s life? (Or to remove life support) Family members (Health-care proxy) Medical Personnel The person himself-herself (living will) Government State or Federal Government State Governor or the President The Congress

How to assist suicide? By not providing medical treatment By not providing nutrition By prescribing lethal medication (that ends life) Agreement of at least two doctors on the prognosis Mandatory pyschological counseling 15 day waiting period

CRITERIA COST ADMINISTRATIVE FEASIBILITY ETHICAL/RELIGIOUS VALUES RELIEF OF PATIENT FROM PAIN QUALITY OF PATIENT’S LIFE PATIENT’S LOSS OF AUTONOMY AND DIGNITY

Interest Groups and Public Policy Groups Right to die groups Right to life groups Disability rights groups Issues Is public opinion really important?

EXTERNALITIES & IMPLEMENTATION PROBLEMS Unknown and unknowable circumstances

ALTERNATIVES TO USE THE RIGHT TO DIE PAIN THERAPHY END-OF-LIFE CARE HOSPICE SERVICES