JEAN A. LINZAU M.D.

INTRODUCTION:

"America is in a state of crisis regarding the manner in which we care for people who are dying. Study after study documents that medical care for the dying is poorly planned and frequently ignores the treatment preferences of the patient and family. Pain is commonly undertreated…"Byock:Potent Quotes.http:/www.dyingwell.com/dwquotes.htm

ETHICAL PRINCIPLES

AUTONOMY

NON-MALEFICENCE

BENEFICENCE

JUSTICE

DYING WELL IS DYING WITHOUT AVOIDABLE DISTRESS AND SUFFERING FOR THE PATIENT AND FAMILY; IN GENERAL ACCORD WITH THE PATIENT’S AND FAMILY’S WISHES AND CONSISTENT WITH CLINICAL, CULTURAL AND ETHICAL STANDARDS.APPROCHING DEATH N.A.P.

A BAD DEATH IS CHARACTERIZED BY NEEDLESS SUFFERING, DISHONORING OF PATIENT AND FAMILY’S WISHES OR VALUES AND A SENSE AMONG PARTICIPANTS OR OBSERVERS THAT NORMS OF DECENCY HAVE BEEN OFFENDED.ID

"NOTHING IS QUITE SO ISOLATING AS THE KNOWLEDGE THAT WHEN ONE HURTS, NOBODY ELSE FEELS THE PAIN; THAT WHEN ONE SICKENS, THE MALAISE IS A PRIVATE AFFAIR AND THAT WHEN ONE DIES, THE WORLD CONTINUES WITHOUT A RIPPLE…"QUOTED BY J.M. BERNARDI LCSW, Ph.D. PSYCHOSOCIAL CARE OF THE DYING

The act of either permitting a person to die or intentionally ending a person’s life generally rooted in motives of mercy, beneficence, or respect for patient dignity. Etymologically, euthanasia means easy or gentle death.

DOUBLE EFFECT
BENEFICENCE

DOUBLE EFFECT IS A DOCTRINE THAT HOLDS THAT AN EVIL EFFECT IS MORALLY ACCEPTABLE PROVIDED THAT THE ACTION WAS INTENDED TO PROVIDE A... GOOD EFFECT.

PHYSICIAN ASSISTED SUICIDE: THE ACT OF PROVIDING INFORMATION, MEANS, AND /OR ASSISTANCE FOR AN EFFECTIVE SUICIDE.

"WHEN THE PHYSICIAN AND THE PATIENT TOGETHER KILL THE PATIENT" THIS IS A JOINT ACTION.

 

"..further intervention is often described as futile…,"when "..it may become apparent that further intervention will only prolong the final stages of the dying process." JAMA, March 10, 1999-Vol. 281,No10 937

A value laden controversial concept

Conflict of professional autonomy and family’s autonomy

FUTILITY

WITHOLDING THERAPEUTIC INTERVENTIONS

WITHOLDING ARTIFICIAL FEEDING OR HYDRATION

WITHOLDING FOOD AND/OR WATER.

 

 

ADVANCE DIRECTIVES, A STATEMENT USUALLY IN WRITING, THAT DELINEATES AN INDIVIDUALS PREFERENCES AND VALUES FOR END OF LIFE CARE IN ADVANCE OF THE TIME WHEN HE OR SHE IS NO LONGER ABLE TO COMMUNICATE SUCH PREFERENCES.

LIVING WILL: ALSO CALLED HEALTH CARE DIRECTIVE, IS A WRITTEN STATEMENT…THAT EXPRESSES GENERAL WILLINGNESS TO ACCEPT CERTAIN FORMS OF TREATMENTS, OR TO DIE WITHOUT THE USE OF ARTIFICIAL INTERVENTION.

DURABLE POWER OF ATTORNEY, ALSO KNOWN AS A PROXY DESIGNATION , DELEGATES THE DECISION MAKING AUTHORITY TO ANOTHER INDIVIDUAL.

SURROGATES SUCH AS A SPOUSE, ADULT CHILD, A PARENT CAN BE STATUTORY DECISION -MAKERS

· integrates the psychological and spiritual aspects of patient care,

· offers a support system to help patients live as actively as possible until death,

· offers a support system to help the family cope during the patient's illness and in their own bereavement

HOSPITAL(20-50%) 1994-95

NURSING HOME(15-20%)

HOME (20%)

OTHERS (6-10%)

QUESTION: WHAT IS THE BEST PREDICTOR OF WHERE PEOPLE DIE?

QUESTIONS?