physician assisted suicide final draft

PHYSICIAN ASSISTED SUICIDEAdan, Angilyn D.

Dela Cruz, Madelyn Joy N.Fabella, Maria Grazia C.

Ilano, Lon Daniel P.Matsuzawa, Meyuki L.

PHYSICIAN-ASSISTED SUICIDE

• The voluntary termination of one’s own life by administration of a lethal substance with the direct or indirect assistance of a physician.

• The practice of providing a competent patient with a prescription for medication for the patient to use with the primary intention of ending his or her own life.

PHYSICIAN-ASSISTED SUICIDE• Physician-assisted death did not begin with the 1993 government-

sanctioned process in the Netherlands, nor with the first such acknowledged action by the pathologist Jack Kevorkian in the United States. The practice of ending the life of a suffering patient was so well established by the fifth century B.C.E. that opponents were motivated to mount a strenuous counterattack.

• The Hippocratic oath offered a landmark definition of the physician's responsibilities. Included was the key statement: "I will give no deadly medicine to anyone if asked, nor suggest any such counsel."

• In modern times, this controversial practice has become most commonly known as physician-assisted suicide. Some forensic experts and prosecuting attorneys, however, classify these deaths as homicides. The neutral term, physician-assisted death, leaves the question of whether the practice is actually homicide open for consideration.

DIFFERENCE OF EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE

PHYSICIAN-ASSISTED SUICIDE• The physician provides the

necessary means or information.

• The patient performs the act.

EUTHANASIA• The physician performs the

intervention.

IMPORTANT FACTS ABOUT PHYSICIAN-ASSISTED SUICIDE

• Physician-assisted Suicide is not a new phenomenon.

• Most physicians receive a request.• Many alternatives to Physician-Assisted

Suicide exists.

LEGAL AND ETHICAL ISSUES• The ethics of physician aid-in-dying continue to be debated. Some argue

that PAS is ethically permissible. Often this is argued on the grounds that PAS may be a rational choice for a dying person who is choosing to escape unbearable suffering at the end of life. Furthermore, the physician's duty to alleviate suffering may, at times, justify providing aid-in-dying. These arguments rely a great deal on respect for individual autonomy, recognizing the right of competent people to choose the timing and manner of death in the face of a terminal illness.

• Others have argued that PAS is not ethically permissible because PAS runs directly counter to the traditional duty of the physician to preserve life and to do no harm. Furthermore, many argue if PAS were legal, abuses would take place, as the social forces that condone the practice are a slippery slope that could lead to euthanasia. For instance, the disabled, poor or elderly might be covertly pressured to choose PAS over more complex and expensive palliative care options.

LEGAL AND ETHICAL ISSUES• The debate about the legalization of active steps to intentionally end life

as a means to end suffering remains controversial • Modern history suggests that the topic comes up for intense attention

periodically • Because of the added risk of misunderstanding or overriding the patient’s

wishes, there is currently less support for euthanasia than for physician-assisted suicide. Nonetheless, both requests do occur and physicians need to know how to respond to either type of request

• As the current debate unfolds, there are 2 principles on which all of organized medicine agrees: – Physicians have an obligation to relieve pain and suffering and to promote

the dignity of dying patients in their care

– The principle of patient bodily integrity requires that physicians must respect patients’ competent decisions to forgo life-sustaining treatment

FACTORS WHEN P.A.S. IS ETHICALLY JUSTIFIABLE

• Respect for autonomy• Justice• Compassion• Individual liberty vs. state interest• Honesty & Transparency

FACTORS WHERE P.A.S. IS ETHICALLY IMPERMISSIBLE:

• Sanctity of life• Passive vs. Active distinction• Potential for abuse• Professional integrity• Fallibility of the profession

ELIGIBILITY FOR P.A.S.

• Decisionally competent• Limited life expectancy of 6 months or less• Voluntary decision• Suffering from excruciating pain• When all possible intervention has already been

given and still rendered incapable of alleviating pain

• Incurable diseases• Enduring wish to die

DRUGS OF CHOICE FOR P.A.S.

Sodium Thiopental• Brand Name: Sodium Pentothal• Lethal Dosage: 2-5 grams• Typical Dosage: 3-5 mg/kg• Ultra-short acting barbiturate• Normally used as anaesthesia

DRUGS OF CHOICE FOR P.A.S.

Pancuronium Bromide• Brand Name: Pavulon• Lethal Dosage: 100 mg• Non-depolarizing muscle

relaxant• From the plant Malouetia

bequaertiana

DRUGS OF CHOICE FOR P.A.S.

Potassium Chloride• Lethal Dosage: 100 mEq• Normal Dosage: 10-20mEq/hr IV

incorporated.• Normally given to patients

suffering from hypokalemia

COUNTRIES AND THEIR STAND ABOUT P.A.S.

COLUMBIA• Jose Euripedes Parra Parra

brought a lawsuit with the intention of deleting all references to euthanasia and PAS in Columbian Law. The lawsuit backfired.

• On May 20, 1997, the Constitutional Court legalized euthanasia and PAS for terminally ill patients who have clearly given their consent.

JAPANFour Conditions when merciful

death is permitted:• The patient is suffering

unbearable physical pain.• Death is inevitable and

imminent.• All possible measures have

been taken to eliminate the pain with no option left open.

• The patient has clearly expressed his/her will to approve the shortening of his/her own life.

COUNTRIES AND THEIR STAND ABOUT P.A.S.

SOUTH AFRICA• 1997 Apr 15: The South African Law

Commission released a 100 page discussion paper entitled “Euthanasia and the Artificial Preservation of Life.” It included a Draft Bill on the Rights of the Terminally Ill.

• 1999 Mar 9: The South African Medical Association asked that the proposed legislation be put on hold.

• 1999 Mar 10: a group of doctors opposed the choice of abortion and PAS appealed to the government to keep the status quo.

• 1999 Oct: the bill was under active discussion in Parliament.

• 1999 Oct 8&9: A law was proposed to prohibit involuntary euthanasia and allow PAS only if the patient has requested it.

SOUTH KOREA• 2009 May 21: South Korea’s

supreme court upheld a lower court decision and authorized the removal of a respirator from a 76 yr old woman who was declared brain-dead last Feb. She has previously told her family her refusal to be kept alive by artificial means if her hospital treatment ended badly. The Supreme Court ruled that maintaining a brain-dead state damaged “human dignity” when there’s no chance of recovery.

COUNTRIES AND THEIR STAND ABOUT P.A.S.

UNITED STATES• Between 1994 and 2006,

there were76 legislative bills to legalize PAS in 21 states and all of them failed.

• Currently, PAS is legal in 3 states: Oregon, Montana and Washington.

CANADA• Physician-assisted suicide is

still illegal but euthanasia is allowed under strict defined regulations.

COUNTRIES AND THEIR STAND ABOUT P.A.S.

THE NETHERLANDS• Physician-assisted suicide is

legal under strict circumstances.

• The right to choose physician-assisted suicide remains highly favored.

UNITED KINGDOM• Physician-assisted suicide is

illegal.• The current movement

there is to focus on palliative care, not euthanasia or PAS.

“DOCTOR DEATH”

LANDMARK CASE

JACOB “JACK” KEVORKIAN

JACOB “JACK” KEVORKIAN• an Armenian-American pathologist and a right-

to-die activist.• best known for publicly championing a terminal

patient’s right to die via PAS; he claims to have assisted at least 130 patients to that end.

• “Dying is not a crime.“• Beginning in 1999 Kevorkian served eight years of

a 10-to-25-year prison sentence for second-degree murder and was released on parole in June 1, 2007 on the condition that he would not offer suicide advice to any other person.

JACOB “JACK” KEVORKIAN• Was tried in court numerous time for assisting suicides.• 1991: His medical license got revoked.• On the November 22, 1998, broadcast of 60 Minutes,

Kevorkian allowed the airing of a videotape he had made on September 17, 1998, which depicted the voluntary euthanasia of Thomas Youk, 52, who was in the final stages of Amyotrophic Lateral Sclerosis.

• On March 26, 1999, Kevorkian was charged with second-degree murder and the delivery of a controlled substance (administering a lethal injection to Thomas Youk).

JACK KEVORKIAN’S DEATH MACHINE

JACK KEVORKIAN DEATH MACHINE(INTERPRETATION)

JACK KEVORKIAN CARBON MONOXIDE DEATH MACHINE

JACOB “JACK” KEVORKIANAlthough Kevorkian claimed to be an advocate for the terminally ill, by the estimation of the investigative reporters at the Detroit Free Press, at least 60% of the people who committed suicide with Kevorkian's help were not terminally ill. Furthermore, the reporters found that:

• Kevorkian's counseling was often limited to phone calls and brief meetings that included family members and friends.

• There was no psychiatric exam in at least 19 Kevorkian suicides, including several in which friends or family had responded that the patient was despondent over matters other than health.

JACOB “JACK” KEVORKIAN• In at least 17 assisted suicides in which people complained

of chronic pain, Kevorkian did not refer the patients to a pain specialist.

• Kevorkian's access to medical records varied widely; in some instances, he received only a brief summary of the attending physician's prognosis.

• Autopsies of at least three Kevorkian suicides revealed no anatomical evidence of disease.

• At least 19 patients died less than 24 hours after meeting Kevorkian for the first time.

However, the accuracy of these findings is disputed by Kevorkian and his supporters.

Video of Jack Kevorkian administering carbon monoxide to

one of his patients.