1. ADJUSTING THE TIME AND MANNER OF DYING
TERMINAL CONDITION
ADJUSTING THE
TIME AND MANNER
OF DYING

2. TERMINAL ILLNESS/CONDITION DEFINITION
A CONDITION, BROUGHT ON BY DISEASE OR INJURY, WHICH IS PRESENT IN PATIENTS WHEN THEY EXPERIENCE KEY SYSTEM OR MULTIPLE SYSTEM FAILURE, WHICH IS PART OF AN IRREVERSIBLE AND/OR DETERIORATING PROCESS AND WHICH WILL RESULT IN DEATH AS AN INEVITABLE AND PREDICTABLE OUTCOME.
FINAL PHASE OF AN OTHERWISE CHRONIC CONDITION

3. SOME KEY ISSUES “TIME” DESIGNATION [ARBITRARY?]
ROLE OF NATURAL SELECTIVE FACTORS
DEATH AS FAILURE OF BODY SYSTEMS OR FAILURE OF TECHNOLOGY
TECHNOLOGY AS “HASTENING” DEATH OR “LENGTHENING” LIFE
QUALITY OF LIFE QUESTIONS AFTER DIAGNOSIS
PAIN CONTROL
PLEASURES
ACTIVITIES

4. ADJUSTING THE TIME AND MANNER OF DYING: THE CAUSAL CONNECTIONS IN THE DISEASE/INJURY NETWORK
PROGRESS OF DISEASE
SYMPTOMS
THERAPEUTIC RESPONSES
INITIATING TREATMENT
WITHHOLDING/WITHDRAWING TREATMENT
DECISIONS [INTENTIONS]
PATIENT [REFUSAL OF TREATMENT]
SURROGATE
CAREGIVER
PHYSICIAN’S DIRECT CAUSAL ACTIVITY ADDRESSING PATHOLOGICAL CONDITION
CAUSAL FACTORS EXTERNAL TO THE DISEASE NETWORK
MEDICATIONS --- ACTIONS --- INTENTIONS

5. RIGHT TO REFUSE TREATMENT
RIGHT TO PRIVACY
1,4,5,9,14 AMENDMENTS
QUINLAN (1976] ET AL..
CRUZAN (1990)
LIBERTY RIGHT (14TH AMENDMENT]
ENDORSED BY THE PATIENT SELF-DETERMINATION ACT (1990]
VACCO V. QUILL (1997)
“EVERYONE, REGARDLESS OF PHYSICIAL CONDITION, IS ENTITLED , IF COMPETENT, TO REFUSE UNWANTED LIFESAVING MEDICAL TREATMENT; NO ONE IS PERMITTED TO ASSIST A SUICIDE.”