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March 12 - End of Life.docx

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Western University
Health Sciences
Health Sciences 2610F/G
Ken Kirkwood

HS 2610 End of Life March 12, 2014 Active vs. Passive Euthanasia • Active – roughly, involves killing a patient  This is often what people have in mind when they simply speak of euthanasia  Be careful to distinguish killing from murdering (‘wrongful killing’) – not all killings are murders  You do something to end the live – the thing you did killed them  Could be about your quest, could be accidental, but that is active – something you did ended someone’s life • Passive – roughly, involves letting a patient die (e.g., failing to revive a patient who has signed a DNR order  There are two kinds of passive euthanasia 1. Withholding of Treatment – e.g., not performing a needed surgery or not administering a needed drug – i.e., in cancer patients who choose not to undergo treatment or withholding things with relatively low and high success such as a blood transfusion 2. Cessation of Treatment – e.g., turning off a respirator – sometimes the physician decides that this person’s condition is futile and that no treatment will help them, so they aren’t going to pursue this aggressively – certain cancers at certain stages are not curable  When thinking of passive, think about someone who doesn’t act – someone who stands back – someone who doesn’t intervene to save a life, if they can save a life  i.e., if you get mugged, you can be one of two people – you can be the person who sees it happen and stands back or you could be the mugger – morally you have a clear distinction who is the most bad (the mugger – the person who is active) and we think of the other person who is doing nothing not bad Voluntary vs. Non-Voluntary Euthanasia • Voluntary – killing or letting die a competent person who has expressed a desire for this (usually over a sustained period of time) • Non-Voluntary – killing or letting die when the patient is unable to express such a desire; not capable of making that decision so other people are making that choice for you – often confused with involuntary • Note: 1. There is a difference between involuntary and non-voluntary 2. Involuntary euthanasia is not a seriously considered possibility Assisted Suicide • Not actually euthanasia, since the ‘patient’ ultimately kills himself or herself • The line between the two can, however, become very thin • E.g., Dr. Jack Kekokian’s ‘Mercitron’ • Saying that people can help someone out, but they are responsible for doing it themselves – i.e., a doctor sets up equipment for the act by making sure the right chemical is in an IV, and the person who wants to die actually does it themselves by pressing the button to kill themselves – this is different from euthanasia • What if you have Parkinson’s and you can’t do it for yourself? The Law in Canada Says the Following About Euthanasia 1. Voluntary passive euthanasia = legal (in fact, required) 2. Voluntary active euthanasia = illegal – Although see ‘the Doctrine of Double Effect’ 3. Non-voluntary passive euthanasia = legal under appropriate proxy decision 4. Non-voluntary active euthanasia = illegal – Although, again see ‘the Doctrine of Double Effect’ 5. Assisted suicide = illegal (see the Sue Rodriguez case) • Doctrine – physicians in the process of trying to save your life can accidently kill you • I.e., by accidently giving the patient an overdose of a chemical – most people think this is murder or negligence Section 14 of the Criminal Code Provides that: • “No person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given.” Under Section 241 of the Criminal Code: • “… it is an offence to counsel or to aid suicide, although suicide itself is no longer an offence.” • You cannot help someone to kill themselves even if they do say “help me” – it is still a crime – crime is a certain class of illegal offences that attaches to it a series of prison time Continuum of Incapacity • Coma – brain activity, but no consciousness or wakefulness • Persistent Vegetative State (PVS) – Wakefulness, but no awareness • Minimally Conscious State (MCS) – wakefulness and minimal awareness • Locked-In Syndrome – full consciousness, but extreme paralysis The Doctrine of Double Effect (DDE) • Suppose an action (e.g., giving a terminally ill cancer patient morphine) has some reasonably foreseeable outcome (e.g., overdose or quickening the patient’s death) and that it would be unacceptable to perform this action for the purpose of bringing this outcome about • The DDE claims that it may still be acceptable to perform this action, provided th
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