End of Life Decisions and Pros of Euthanasia Assignment see the powerpoint and the following questions in the world documentations and answer them clearly.

End of Life Decisions and Pros of Euthanasia Assignment see the powerpoint and the following questions in the world documentations and answer them clearly.

feel free to ask when it is not clear.

thanks Chapter 16
Relationships in the Later Years
Chapter Outline
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Age and Ageism
Caregiving for the Frail Elderly—The “Sandwich
Generation”
Issues Confronting the Elderly
Successful Aging
Relationships and the Elderly
Grandparenthood
The End of One’s Life
The Concept of Age
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A person’s age may be defined:
? Chronologically
? Physiologically
? Psychologically
? Sociologically
? Culturally
Ageism
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Every society has some form of ageism—the
systematic persecution and degradation of people
because they are old.
Theories of Aging
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Disengagement
Activity
Conflict
Age Stratification
Modernization
Symbolic
Continuity
The “Sandwich Generation”
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The number of individuals in the sandwich
generation will increase for the following reasons:
? Longevity
? Chronic
disease
? Fewer siblings to help
? Commitment to parental care
? Lack of support for the caregiver
Issues Confronting the Elderly
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Income
Housing
Physical health
Mental health
Retirement
Sexuality
Relationships at Age 85 and Beyond
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Relationship with Spouse
Relationship with Siblings
Relationship with One’s Own Children
Grandparenthood
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Grandchildren report enormous benefits from
having a close relationship with grandparents.
Divorced grandparents have less contact with
grandchildren and participate in fewer shared
activities with them.
Preparing for One’s Own Death
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Thoughts in the last year of life
Behaviors the last year of life
The end comes to us all.
End of Life
This assignment connects the last chapter (16) with the first chapter of the Knox text.
The underlining theme of this text is choices and decision-making. As we address the final
leg of our journey, one issue currently debated is the end of life process. Is there a choice
in determining how and when to end a life?
The attached document provides both sides of the issue of euthanasia. Read the pros and
cons. Select three of each and respond with your thoughts. Are the comments valid?
Justified? How do they impact the family/the family member?
Summarize with your stance on this issue.
1. Right to Die
“The right of a competent, terminally ill
person to avoid excruciating pain and
embrace a timely and dignified death bears
the sanction of history and is implicit in the
concept of ordered liberty. The exercise of
this right is as central to personal autonomy
and bodily integrity as rights safeguarded
by this Court’s decisions relating to
marriage, family relationships, procreation,
contraception, child rearing and the refusal
or termination of life-saving medical
treatment. In particular, this Court’s recent
decisions concerning the right to refuse
medical treatment and the right to abortion
instruct that a mentally competent,
terminally ill person has a protected liberty
interest in choosing to end intolerable
suffering by bringing about his or her own
death.
“The history of the law’s treatment of
assisted suicide in this country has been and
continues to be one of the rejection of
nearly all efforts to permit it. That being the
case, our decisions lead us to conclude that
the asserted ‘right’ to assistance in
committing suicide is not a fundamental
liberty interest protected by the Due Process
Clause.”
Washington v. Glucksberg
US Supreme Court Majority Opinion
June 26, 1997
A state’s categorical ban on physician
assistance to suicide — as applied to
competent, terminally ill patients who wish
to avoid unendurable pain and hasten
inevitable death — substantially interferes
with this protected liberty interest and
cannot be sustained.”
ACLU Amicus Brief in Vacco v. Quill
American Civil Liberties Union (ACLU)
Dec. 10, 1996
2. Patient Suffering at End-of-Life
“At the Hemlock Society we get calls daily
from desperate people who are looking for
someone like Jack Kevorkian to end their
lives which have lost all quality…
Americans should enjoy a right guaranteed
in the European Declaration of Human
Rights — the right not to be forced to suffer.
It should be considered as much of a crime
to make someone live who with justification
does not wish to continue as it is to take life
without consent.”
Faye Girsh, EdD
Senior Adviser, Final Exit Network,
“How Shall We Die,” Free Inquiry
Winter 2001
“Activists often claim that laws against
euthanasia and assisted suicide are
government mandated suffering. But this
claim would be similar to saying that laws
against selling contaminated food are
government mandated starvation.
Laws against euthanasia and assisted
suicide are in place to prevent abuse and to
protect people from unscrupulous doctors
and others. They are not, and never have
been, intended to make anyone suffer.”
Rita Marker, JD
Executive Director
Kathi Hamlon
Policy Analyst
International Task Force on Euthanasia and Assisted
Suicide
“Euthanasia and Assisted Suicide: Frequently Asked
Questions,” www.internationaltaskforce.org
Jan. 2010
3. Slippery Slope to Legalized Murder
“Especially with regard to taking life,
slippery slope arguments have long been a
feature of the ethical landscape, used to
question the moral permissibility of all
kinds of acts… The situation is not unlike
that of a doomsday cult that predicts time
and again the end of the world, only for
followers to discover the next day that
things are pretty much as they were…
We need the evidence that shows that
horrible slope consequences are likely to
occur. The mere possibility that such
“In a society as obsessed with the costs of
health care and the principle of utility, the
dangers of the slippery slope… are far from
fantasy…
Assisted suicide is a half-way house, a stop
on the way to other forms of direct
euthanasia, for example, for incompetent
patients by advance directive or suicide in
the elderly. So, too, is voluntary euthanasia
a half-way house to involuntary and
nonvoluntary euthanasia. If terminating life
is a benefit, the reasoning goes, why should
euthanasia be limited only to those who can
consequences might occur, as noted earlier, give consent? Why need we ask for
does not constitute such evidence.”
consent?”
R.G. Frey, DPhil
Edmund D. Pelligrino, MD
Professor of Philosophy, Bowling Green State
Professor Emeritus of Medicine and Medical Ethics,
University
Georgetown University
“The Fear of a Slippery Slope,” Euthanasia and “The False Promise of Beneficent Killing,” Regulating
Physician-Assisted Suicide: For and Against How We Die: The Ethical, Medical, and Legal Issues
1998
Surrounding Physician-Assisted Suicide
1998
4. Hippocratic Oath and Prohibition of Killing
“Over time the Hippocratic Oath has been
modified on a number of occasions as some
of its tenets became less and less
acceptable. References to women not
studying medicine and doctors not breaking
the skin have been deleted. The muchquoted reference to ‘do no harm’ is also in
need of explanation. Does not doing harm
mean that we should prolong a life that the
patient sees as a painful burden? Surely, the
‘harm’ in this instance is done when we
prolong the life, and ‘doing no harm’ means
that we should help the patient die. Killing
the patient–technically, yes. Is it a good
thing–sometimes, yes. Is it consistent with
good medical end-of-life care: absolutely
yes.”
Philip Nitschke, MD
Director and Founder, Exit International
“Euthanasia Sets Sail,” National Review Online
June 5, 2001
“The prohibition against killing patients…
stands as the first promise of self-restraint
sworn to in the Hippocratic Oath, as
medicine’s primary taboo: ‘I will neither
give a deadly drug to anybody if asked for
it, nor will I make a suggestion to this
effect’… In forswearing the giving of poison
when asked for it, the Hippocratic physician
rejects the view that the patient’s choice for
death can make killing him right. For the
physician, at least, human life in living
bodies commands respect and reverence–by
its very nature. As its respectability does not
depend upon human agreement or patient
consent, revocation of one’s consent to live
does not deprive one’s living body of
respectability. The deepest ethical principle
restraining the physician’s power is not the
autonomy or freedom of the patient; neither
is it his own compassion or good intention.
Rather, it is the dignity and mysterious
power of human life itself, and therefore,
also what the Oath calls the purity and
holiness of life and art to which he has
sworn devotion.”
Leon Kass, MD, PhD
Addie Clark Harding Professor, Committee on Social
Thought and the College, University of Chicago
“Neither for Love nor Money,” Public Interest
Winter 1989
5. Government Involvement in End-of-Life Decisions
“We’ll all die. But in an age of increased
longevity and medical advances, death can
be suspended, sometimes indefinitely, and
no longer slips in according to its own
immutable timetable.
“Cases like Schiavo’s touch on basic
constitutional rights, such as the right to live
and the right to due process, and
consequently there could very well be a
legitimate role for the federal government to
play. There’s a precedent–as a result of the
So, for both patients and their loved ones, highly publicized deaths of infants with
real decisions are demanded: When do we disabilities in the 1980s, the federal
stop doing all that we can do? When do we government enacted ‘Baby Doe Legislation,’
withhold which therapies and allow nature which would withhold federal funds from
to take its course? When are we, through
hospitals that withhold lifesaving treatment
our own indecision and fears of mortality, from newborns based on the expectation of
allowing wondrous medical methods to
disability. The medical community has to
perversely prolong the dying rather than the have restrictions on what it may do to
living?
people with disabilities – we’ve already seen
what some members of that community are
These intensely personal and socially
willing to do when no restrictions are in
expensive decisions should not be left to
place.”
governments, judges or legislators better
Stephen Drake. MS
attuned to highway funding.”
Los Angeles Times
“Planning for Worse Than Taxes,” Opinion
Mar. 22, 2005
Research Analyst, Not Dead Yet
“End of Life Planning: Q & A with Disabilities
Advocate,” Reno Gazette-Journal
Nov. 22, 2003
6. Palliative (End-of-Life) Care
“Assisting death in no way precludes giving
the best palliative care possible but rather
integrates compassionate care and respect
for the patient’s autonomy and ultimately
makes death with dignity a real option…
“Studies show that hospice-style palliative
care ‘is virtually unknown in the
Netherlands [where euthanasia is legal].’
There are very few hospice facilities, very
little in the way of organized hospice
activity, and few specialists in palliative
The evidence for the emotional impact of
care, although some efforts are now under
assisted dying on physicians shows that
way to try and jump-start the hospice
euthanasia and assisted suicide are a far cry movement in that country…
from being ‘easier options for the caregiver’
than palliative care, as some critics of Dutch The widespread availability of euthanasia in
practice have suggested. We wish to take a the Netherlands may be another reason for
strong stand against the separation and
the stunted growth of the Dutch hospice
opposition between euthanasia and assisted movement. As one Dutch doctor is reported
suicide, on the one hand, and palliative care, to have said, ‘Why should I worry about
on the other, that such critics have implied. palliation when I have euthanasia?'”
There is no ‘either-or’ with respect to these
Wesley J. Smith, JD
options. Every appropriate palliative option
Senior Fellow in Human Rights and Bioethics,
available must be discussed with the patient
Discovery Institute
and, if reasonable, tried before a request for
Forced Exit
1997
assisted death can be accepted…
Opposing euthanasia to palliative care…
neither reflects the Dutch reality that
palliative medicine is incorporated within
end-of-life care nor the place of the option
of assisted death at the request of a patient
within the overall spectrum of end-of-life
care.”
Gerrit Kimsma, MD, MPh
Associate Professor in Medical Philosophy
Evert van Leeuwen, PhD
Professor in Philosophy and Medical Ethics
Center for Ethics and Philosophy at Free University in
Amsterdam (Amsterdam, Netherlands)
“Assisted Death in the Netherlands: Physician at the
Bedside When Help Is Requested”
Physician-Assisted Dying: The Case for Palliative
Care & Patient Choice
2004
7. Healthcare Spending Implications
“Even though the various elements that
make up the American healthcare system
are becoming more circumspect in ensuring
that money is not wasted, the cap that marks
a zero-sum healthcare system is largely
absent in the United States… Considering
the way we finance healthcare in the United
States, it would be hard to make a case that
there is a financial imperative compelling us
to adopt physician-assisted suicide in an
effort to save money so that others could
benefit…”
“Savings to governments could become a
consideration. Drugs for assisted suicide
cost about $35 to $45, making them far less
expensive than providing medical care. This
could fill the void from cutbacks for
treatment and care with the ‘treatment’ of
death.”
International Task Force on Euthanasia and Assisted
Suicide
“Frequently Asked Questions,”
www.internationaltaskforce.org
(accessed May 27, 2010)
Merrill Matthews, Jr., PhD
Director, Council for Affordable Health Insurance
“Would Physician-Assisted Suicide Save the
Healthcare System Money?,” Physician Assisted
Suicide: Expanding the Debate
1998
8. Social Groups at Risk of Abuse
“One concern has been that disadvantaged
populations would be disproportionately
represented among patients who chose
assisted suicide. Experience in Oregon
suggests this has not been the case. In the
United States, socially disadvantaged
groups have variably included ethnic
minorities, the poor, women, and the
elderly. Compared with all Oregon residents
who died between January 1998 and
December 2002, those who died by
physician-assisted suicide were more likely
“It must be recognized that assisted suicide
and euthanasia will be practiced through the
prism of social inequality and prejudice that
characterizes the delivery of services in all
segments of society, including health care.
Those who will be most vulnerable to
abuse, error, or indifference are the poor,
minorities, and those who are least educated
and least empowered. This risk does not
reflect a judgment that physicians are more
prejudiced or influenced by race and class
than the rest of society – only that they are
to be college graduates, more likely to be
Asian, somewhat younger, more likely to be
divorced, and more likely to have cancer or
amytrophic lateral sclerosis… Moreover,
although 2.6 percent of Oregonians are
African American, no African American
patients have chosen assisted suicide.”
Linda Ganzini, MD, MPH
Professor of Psychiatry and Medicine Senior Scholar,
Center for Ethics in Health Care at Oregon Health &
Science University
“The Oregon Experience,” Physician-Assisted Dying:
The Case for Palliative Care and Patient Choice
2004
not exempt from the prejudices manifest in
other areas of our collective life.
While our society aspires to eradicate
discrimination and the most punishing
effects of poverty in employment practices,
housing, education, and law enforcement,
we consistently fall short of our goals. The
costs of this failure with assisted suicide and
euthanasia would be extreme. Nor is there
any reason to believe that the practices,
whatever safeguards are erected, will be
unaffected by the broader social and
medical context in which they will be
operating. This assumption is naive and
unsupportable.”
New York State Task Force on Life and the Law
“When Death Is Sought: Assisted Suicide and
Euthanasia in the Medical Context,”
newyorkhealth.gov
1994
9. Religious Concerns
“Guided by our belief as Unitarian
Universalists that human life has inherent
dignity, which may be compromised when
life is extended beyond the will or ability of
a person to sustain that dignity; and
believing that it is every person’s inviolable
right to determine in advance the course of
action to be taken in the event that there is
no reasonable expectation of recovery from
extreme physical or mental disability…
“As Catholic leaders and moral teachers, we
believe that life is the most basic gift of a
loving God- a gift over which we have
stewardship but not absolute dominion. Our
tradition, declaring a moral obligation to
care for our own life and health and to seek
such care from others, recognizes that we
are not morally obligated to use all available
medical procedures in every set of
circumstances. But that tradition clearly and
strongly affirms that as a responsible
BE IT FURTHER RESOLVED: That
steward of life one must never directly
Unitarian Universalists advocate the right to intend to cause one’s own death, or the
self-determination in dying, and the release
from civil or criminal penalties of those
who, under proper safeguards, act to honor
the right of terminally ill patients to select
the time of their own deaths; and…
BE IT FINALLY RESOLVED: That
Unitarian Universalists, acting through their
congregations, memorial societies, and
appropriate organizations, inform and
petition legislators to support legislation
that will create legal protection for the right
to die with dignity, in accordance with one’s
own choice.
death of an innocent victim, by action or
omission…
We call on Catholics, and on all persons of
good will, to reject proposals to legalize
euthanasia.”
United States Conference of Catholic Bishops
“Statement on Euthanasia,” on www.usccb.org
Sep. 12, 1991
Unitarian Universalist Association: The Right to Die
With Dignity, 1988 General Resolution
Unitarian Universalist Association
1988
10. Living Wills
“Living wills can be used to refuse
extraordinary, life-prolonging care and are
effective in providing clear and convincing
evidence that may be necessary under state
statutes to refuse care after one becomes
terminally ill.
“Not only are we awash in evidence that the
prerequisites for a successful living wills
policy are unachievable, but there is direct
evidence that living wills regularly fail to
have their intended effect…
When we reviewed the five conditions for a
A recent Pennsylvania case shows the
successful program of living wills, we
power a living will can have. In that case, a encountered evidence that not one condition
Bucks County man was not given a feeding has been achieved or, we think, can be.
tube, even though his wife requested he
First, despite the millions of dollars lavished
receive one, because his living will,
on propaganda, most people do not have
executed seven years prior, clearly stated
living wills… Second, people who sign
that he did ‘not want tube feeding or any
living wills have generally not thought
other artificial invasive form of nutrition’… through its instructions in a way we should
want for life-and-death decisions… Third,
A living will provides clear and convincing drafters of living wills have failed to offer
evidence of one’s wishes regarding end-oflife care.”
people the means to articulate their
preferences accurately… Fourth, living wills
too often do not reach the people actually
making decisions for incompetent patients…
Fifth, living wills seem not to increase the
accuracy with which surrogates identify
patients’ preferences.”
Joseph Pozzuolo, JDProfessor, Neuman College
Lisa Lassoff, JD
Associate, Reed Smith
Jamie Valentine, JD
Associate, Pozzuolo & Perkiss
“Why Living Wills/Advance Directives Are an
Essential Part of Estate Planning,” Journal of Financial
Angela Fagerlin, PhD
Service Professionals Core Faculty Member, Robert Wood Johnson Clinical
Sep….
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