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End of Life
Lawrence M. Hinman
Send E-mail to Larry Hinman
Lawrence M. Hinman
http://ethics.sandiego.edu
Introduction
03/15/15
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03/15/15
Lawrence M. Hinman
http://ethics.sandiego.edu
03/15/15
Lawrence M. Hinman
http://ethics.sandiego.edu
An Increasing Interest in
End-of-life Issues
The Bill
Moyers series
on dying;
Sept. , 2000.
JAMA issues
on End-of-life
decisions
New England
Journal of
Medicine
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Part One.
Cases and Laws
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Cruzan
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Cruzan, 2
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Cruzan, 3
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Washington v. Glucksburg
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Vacco v. Quill
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Vacco v. Quill. 2
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Terri Schiavo
The Terri Schiavo
case is, so far,
the most
famous and
notorious endof-life case of
the twenty-first
century.
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Source: http://www.miami.edu/ethics2/schiavo_project.htm
1986
The couple move to St. Petersburg, where Ms. Schiavo's parents had retired.
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August 1992
Ms. Schiavo is awarded $250,000 in an out-of-court medical
malpractice settlement with one of her physicians.
November 1992
The jury in the medical malpractice trial against another of Ms.
Schiavo's physicians awards more than one million dollars. In the
end, after attorneys fees and other expenses, Michael Schiavo
received about $300,000 and about $750,000 was put in a trust fund
specifically for Ms. Schiavos medical care.
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March 1, 1994
First guardian ad litem, John H. Pecarek, submits his report. He states that
Michael Schiavo has acted appropriately and attentively toward Ms.
Schiavo.
May 1998
Michael Schiavo petitions the court to authorize the removal of Ms.
Schiavos PEG tube; the Schindlers oppose, saying that she would want to
remain alive. The court appoints Richard Pearse, Esq., to serve as the
second guardian ad litem for Ms. Schiavo.
December 20, 1998
The second guardian ad litem, Richard Pearse, Esq., issues his report in
which he concludes that Ms. Schiavo is in a persistent vegetative state
with no chance of improvement and that Michael Schiavos decisionmaking may be influenced by the potential to inherit the remainder of Ms.
Schiavos estate.
February 11, 2000
Judge Greer rules that Ms. Schiavo would have chosen to have the PEG
tube removed, and therefore he orders it removed, which, according to
doctors, will cause her death in approximately 7 to 14 days.
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The PEG tube is removed in mid-afternoon. This is the third time the tube has been
removed in accordance with court orders.
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For the public, great uncertainty about what the actual facts of the case
areethical responsibility of the media
For the family, uncertainty and disagreement about whether she was
still there or notethical responsibility of scienceespecially
neurosciencesto shed light on the connections between brain
conditions and personhood. We face two questions in cases such as
this:
Is Terri there?
Is a person there?
Central to these questions is the issue of how we define personal identity and
personhood.
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Schiavo Autopsy
The Schiavo autopsy, released June 15
2005, showed severe and irreversible
brain damage
Brain half its usual size
Damaged in almost all regions,
including that region which controls
vision
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http://www.oregon.gov/DHS/ph/pas/index.shtml
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Oregon
All physical symptoms (eg, pain, dyspnea, and fatigue) at the time
of the interview were rated as unimportant (median score, 1), but
concerns about physical symptoms in the future were rated at a
median score of 3 or higher.
Lack of social support and depressed mood were rated as
unimportant reasons for requesting PAD. :
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Part Two.
The Philosophical Issues
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Conceptual Clarity
Vague dividing line between active and
passive, depending on notion of
normal care
Principle of double effect
Moral Significance
Does passive euthanasia sometimes
cause more suffering?
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Active Euthanasia
Typical case for active euthanasia
there is no doubt that the patient will die
soon
the option of passive euthanasia causes
significantly more pain for the patient
(and often the family as well) than active
euthanasia and does nothing to
enhance the remaining life of the
patient, and
passive measures will not bring about
the death of the patient.
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Overview of Distinctions
Passive
Voluntary Currently legal;
often contained in
living wills
Active:
Not Assisted
Active:
Assisted
Equivalent to
suicide for the
patient
Equivalent to suicide
for the patient;
Possibly equivalent to
murder for the
assistant, except in
Oregon
Equivalent to either
suicide or being
murdered for the
patient;
Legally equivalent to
murder for the
assistant
Equivalent to being
murdered for the
patient;
Equivalent to murder
for assistant
Not possible
Nonnvoluntary: Sometimes legal,
Patient Not but only with court
Able to Choose permission
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Not possible
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Chinese orphanages
Special danger to undervalued groups in
our society
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The elderly
Minorities
Persons with disabilities
Groups that are typically discriminated against
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Two Models
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Main Tenets
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The Calculus
Morality becomes a
matter of
mathematics,
calculating and
weighing
consequences
Key insight:
consequences matter
The dream: bring
certainty to ethics
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Jeremy Bentham.
Hedonistic utilitarians:
a good death is a
painless death.
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Central insight:
people cannot be
treated like mere
things.
Key notions:
Autonomy &
Dignity
Respect
Rights
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Protecting Autonomy
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Kantians emphasize
the importance of a
patients right to
decide
Utilitarians look only
at consequences
In cases such as the
Siamese twins, they
see radically different
worlds.
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Types of Rights
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Conclusion
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Lawrence M. Hinman
Send E-mail to Larry Hinman
Lawrence M. Hinman
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53
Philosophy
Religious Studies
& Theology
Literature
Psychology
Sociology
Biology
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Economics
Political Science
Media Studies
Medicine
Art
Theater
Lawrence M. Hinman
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Euthanasia
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End-of-Life Decisions
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Psychology
The psychological
dimensions of end-of-life
decisions
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Art
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Art
Throughout the
ages, we have
sought to
understand death
through art.
Drer,
The Four Horsemen
of the Apocalypse
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Art--2
Jack Kevorkian
Nearer My God to Thee
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Music
Whether through
requiems or ragas,
we have always
expressed our
feelings about death
and end-of-life
decisions through
music.
Mahlers
Kindestotenlieder
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Literature
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Christian
Jewish
Buddhist
Muslim
Native American
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Economics
Consider economic factors that have
had an impact on end-of-life issues:
Increasing cost of health care
Greater social mobility
Percentage of health care dollars
spent in last few months of life
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Sociology
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Anthropology
Anthropologists
have long been
concerned with
death and the
rituals surrounding
it.
Celebrations of
Death: The
Anthropology of
Mortuary Rituals.
Edited by by Peter
Metcalf, Richard
Huntington
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