1. Controversy 7 Should People Have the Choice to End Their Lives?

2. Should People Have the Choice to End Their Lives? More than two-thirds of all deaths in the U.S. occur among people over age 65 Medical advances force us to make decisions unforeseen just a few decades ago

3. Should People Have the Choice to End Their Lives? (cont.) Euthanasia – from the ancient Greek meaning simply “good death” Active euthanasia – denotes some deliberate intervention to end the patient’s life, such as giving a fatal dose of painkilling medication Passive euthanasia – not doing something, such as withdrawing life-support therapy Assisted suicide – a doctor or family member actively provides the means or carries out the instructions required for an individual to end his or her life

4. Depression and Suicide Several common predictors of suicide include: Intolerable psychological pain and frustration A feeling of hopelessness or helplessness Communicating the intent to kill oneself Clinical depression – differs from the “down” state that is a common response to setbacks and is temporary Can be difficult to diagnose because it can manifest with a variety of symptoms Insomnia, fatigue, inability to concentrate, anxiety, and other physical or emotional comforts

5. Depression and Suicide (cont.) It can be difficult to determine whether an elderly patient’s rejection of lifesaving treatment is an informed choice or a sign of depression But depressed patients are more likely to refuse procedures in situations where the medical prognosis is actually good Doctors are committed to keeping patients alive at all costs But the attitude of “treatment at all costs” may not respect someone’s decision to end their life

6. The “Right to Die” Widespread public discussion of the ethics of death and dying began during the late 1960’s First major “right-to-die” case involved Karen Ann Quinlan in 1976 First important “right-to-die” law passed was the California Natural Death Act (1976) Under common law in the U.S., people have a basic right to accept or reject medical treatment, and therefore a right to refuse treatment

7. The “Right to Die” (cont.) Guardian at litem – a designated spokesperson who represents the interests of an incapacitated person and reports to the court Courts rely on two kinds of standards to determine when to withhold or withdraw treatment Standard of substituted judgment – asks “What would this patient have wanted under these circumstances?” Best-interest standard – asks “What is the balance of benefits and burdens that a “reasonable person” might want under these conditions

8. The “Right to Die” (cont.) Gerontocide – the killing of the old, a practice in some premodern societies facing conditions of extreme scarcity Advance directives – legal documents such as a living will or power of attorney for health care instructions In most jurisdictions in the U.S., assisting a suicide is a crime Americans lack a clear consensus about exactly how “dying well” might be defined At a minimum, ‘dying well’ typically refers to having the right to know one’s medical condition, and the choice to accept or reject life-prolonging treatment

9. Outlook for the Future The Netherlands has gone the furthest in legalizing euthanasia and physician-assisted suicide Critics of assisted suicide and euthanasia believe we should focus more on palliative care – such as hospice and better pain medication Patient Self-Determination Act (PSDA) – a 1991 law that requires hospitals, nursing homes, and other health care facilities to advise all patients at the point of admission about their right to accept or refuse medical treatment