1. Death and Dying Christian Perspectives on the End of Life

2.  What comes to mind when you hear the words “death” and “dying”?  What is our normal approach to death?  Why?  Denying Suffering (Socrates) or Anxiously Accepting Suffering (Jesus)?  There are many Good Fridays still in this world  What do I mean?

3. Death  Is a normal process of life  However difficult that is to accept  What is the appropriate role of medical care in society?  Caring vs. Curing

4. Ethical Issues around Death  Care for elderly  Care for those nearing death (in hospitals, long term care facilities, etc.)  What are issues people in these situations experience?  Is life something completely in our control or is it a gift to cherish?

5. Ordinary vs. Extraordinary  Ordinary = Ethically Obligatory  Extraordinary = Ethically Optional  Optional for what reasons?  Too expensive  Unlikely to work  Associated with great suffering  Might save the patient’s life at too great a psychological, spiritual or interpersonal cost.

6. Types of “Life Support”  Ventilators  Feeding Tubes  Different Types  “Prolonging Life” vs. “Delaying Death”

7. Ethical Directives  Nutrition and Hydration  “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient” (#58).

8.  “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘overzealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected” (#2278).

9. “Advance Directives”  “Living Will” or “Durable Power of Attorney for Health Care”  The Patient as Person  A shift from Doctor to Patient (or Patient’s Proxy) to make decisions about health care  Why are they so important?  The Schiavo Case

10. Euthanasia  Literally “a good death”  “in the strict sense, an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering”  Voluntary vs. Involuntary  What’s the difference?

11. Distinctions in Euthanasia  Two methods  Active/direct (taking deliberate steps to end life)  Indirect (withholding minor treatments that will lead to death)  Both are ethically problematic  Allowing death vs. delaying death vs. euthanasia  PVS (Persistent Vegetative State)

12. Terri Schiavo  What are the issues involved?  Medical Issues  Legal Issues  Ethical Issues

13. The Schiavo Case  Factors involved in making decision  13 years plus of PVS  Unable to make decisions herself  Husband is implied legal representative  Parents want a say  Thought husband was untrustworthy  Level of Brain function

14. The Schiavo Case  Is withdrawal of artificial nutrition and hydration equivalent to starvation?  This is a case of “delaying death”  Remove the feeding tube  Are you intending death here?  “Quality of death”, extraordinary, burdensome, PVS  Power of Attorney goes to the husband  He should have exclusive right  No reasonable chance of recovery  Letting go is necessary

15. Burke vs. Schiavo  How is Leslie Burke’s situation similar and different from Terri Schiavo’s?  What are the ethical values at stake in the Burke situation?

16. Leslie Burke vs. Terri Schiavo  Differences  Schiavo couldn’t speak for herself  Schiavo’s PVS was not terminal whereas Burke’s disease is neurodegenerative  Burke hadn’t had a feeding tube yet inserted  The feeling of pain/suffering  Similarities  Both are/will be dependent on artificial hydration

17. Values at Stake?  Speeding up vs. Slowing Down Death Process  Putting the Price on the Human Person  The cost of medical care at the end of life  Doctors’ Opinions vs. Patient Opinion  Whose perspective should be favored?

18. Ending Life  Ought we be able to determine when life ought to end?