DEATH AND DYING

ADDITIONAL NOTES

PRINCIPLE OF GROWTH THROUGH HUMAN SUFFERING

As bodily pleasure should be sought as the fruit of the satisfaction of some

basic need of the total human person, so suffering and even bodily death
when endured with courage can and should be used to promote personal
growth in both private and communal living.

WHY SHOULD LIFE BE PRESEVED?

Human life is sacred; it is a gift from God

By the principle of stewardship, we are given a shared, not absolute
dominion over life
God alone is the author of life and he alone can determine when our life ends

TRUTH WE SHOULD ACCEPT IN CARING FOR DYING PERSONS

Sickness and death are natural parts of life

Dying is a human process not a medical event
Dying persons are living persons
Goal of care should be to help them live well while dying

CRUCIAL FEARS OF THE TERMINALLY ILL PATIENTS

1. Fear of unbearable pain LEUD

2. Fear of excessively burdensome and futile/useless treatment
3. Fear of loss of autonomy and personal dignity (advance directives)
4. Fear of dying alone in loneliness

PHASES OF DYING (Kubler Ross)

Denial
Anger
Bargaining
Depression
Acceptance and Hope

CARE FOR THE DYING

Health care professionals must address their own beliefs, anxieties and fears
about their personal mortality before they can care appropriately for
patients who face their own dying
We must accept that the dying process can be aided by good medicine but
can be perverted by medicine
GOALS OF CARE AND TREATMENT IN THE TERMINALLY ILL
Well-being of the patient achieved through attention to the physical, mental,
social and spiritual needs of the dying person
Appropriate pain management is to relieve physical pain
Skillful interventions to facilitate expression of emotions that accompany
mental pain
We have to accept that dying persons are living persons so we have to help
them live well while dying
Supportive services are to allay guilt and sadness over unfulfilled social
commitments

DYING WITH DIGNITY

Two perspectives:

1. To some people dying with dignity means that one should be able to
make the decision to die when dying will be better than to go on living
with an incurable distressing illness.
2. To some people dying with dignity means facing pain and suffering.
People who face the realities of life with courage die with dignity

When there is pain, there is always glory

WITHHOLDING OR WITHDRAWING OF LIFE SUPPORT

This may be compatible with beneficence, non-maleficence and autonomy

Brain death is not a necessary requirement for withdrawal/withholding of
life support
Use of proportionate (morally obligatory) and disproportionate means
(morally non-obligatory)

PRINCIPLE IN THE USE OF ORDINARY AND EXTRAORDINARY MEANS

ORDINARY MEANS
-Basic needs, not only food, drink and rest, but all medicines, treatments and
operations, which offer a reasonable hope of benefit for the patient and which
can be obtained without excessive expense, pain or other inconveniences.

EXTRAORDINARY MEANS
- When the means used do not offer reasonable hope of any notable benefit
to the patient. When the burden or risks entailed in the procedure
outweighs the benefits it promises
 PRINCIPLE
One is not obliged normally bound to use extraordinary means based on the
duty of always avoiding evil and that of doing good as much as it is possible in the
situation.

Ordinary
- Standard, recognized, established medicine, procedures during that
period at the level of medical practice
- Includes not only normal food, drinks and rest but also in terms of
hospital practice, all medicines, treatments, procedures that offer
reasonable hope of benefit. For the patient which can be obtained and
used for excessive expense, pain or other inconvenience.

Extraordinary
- A medicine or procedure that may be fanciful, bizarre, experimental,
incomplete and not recognized
- All medicines, treatments and operations which cannot be obtained or
used due to excessive expense, pain or other inconvenience for the
patient or for others, on which if used would not offer a reasonable hope
for the patient.

DO NOT RESUSCITATE (DNR) / END OF LIFE CARE PLAN

- It must be made for the best interest of the patient, not the family, health
care provider, insurance company or society at large
- All involved parties should agree what a DNR means; i.e.; no CPR if
heartbeat or breathing stops
- It must be treatment which is heroic or disproportionate, futile or
excessively burdensome
- It must periodically evaluated
- Changed every 24 hours

ADVANCE DIRECTIVES
- Document in which a person either states choices for medical treatment
or designates an individual who should make treatment choices if the
patient should lose his decision making capacity
- Needs lawyers for notarization
- -effective only when patients are not effective in making decisions for
themselves
- It can also apply to oral statements from patients to the caregivers given
at a time when the patient was decisionallly capable
FORMS OF ADVANCE DIRECTIVES
- LIVING WILL
o Patient must be terminally ill
o Must lack decision making capacity
- Durable Power of Attorney/ Special power of Attorney
o Assigns a surrogate to make decision
o Document that designates a surrogate decision maker should the
patient becomes incompetent. It does not require the patient to be
terminally ill

EUTHANASIA (Good death, pleasant death, mercy killing) ALWAYS ILLICIT

- An act (medical) that renders a patient dead to end his suffering- the
intention is death for the purpose of eliminating pain

MORAL EVALUATIONL: IMMORAL

- Intentional killing and opposes the natural inclination to preserve life
- Maybe performed for self-interest or other consequences
- Health care professionals may be tempted not to do their best to save the
patient; a simple way out and to disregard any other alternative

Two kinds:
1. Active commission of an act (administration or overdose of drugs;
patient-assisted suicide, etc.)
2. Passive omission of an act (denial of nutrition, respiration or hydration,
etc.)

DYSTHANASIA unnecessary prolongation of the dying process by employing

disproportionate means
ORTHITHANASIA right death; allowed to die by withdrawal or withholding
extraordinary or disproportionate means; patient dies because of underlying
pathology

ALLOWING TO DIE
- A time comes when prolonging life may not contribute to the spiritual
purpose of life (serving God and others)
- This time might be used compose oneself and come into terms with
death, deal spiritually with God and others
- Not rejecting life but accepting what God has given him/her

SUICIDE killing oneself either by acts of commission or omission

MORAL DIFFERENCES BETWEEN EUTHANASIA AND ALLOWING TO DIE
EUTHANASIA intention brings about death by performance or withholding
an act; death directly intended by the agent

ALLOWING TO DIE patient dies because of the fateal pathology; death is an

unwanted side effect of a good ethical action

REMINDER!!!!!!!!!!
JUSTICE AND DEATH & DYING QUIZ NEXT WEEK MAY 15, 16