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MHA Week 10Spring 2012
Denise Hill, JD, MPA
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Bodies incineratedhttp://www.nj.com/news/index.ssf/2009/01/missing_jersey_city_babys_body.html
Bodies stolen
Bodies lostSee sample policieshttp://www.azumc.com/body.cfm?id=565
http://www.nj.com/news/index.ssf/2009/01/missing_jersey_city_babys_body.htmlhttp://www.azumc.com/body.cfm?id=565http://www.azumc.com/body.cfm?id=565http://www.azumc.com/body.cfm?id=565http://www.azumc.com/body.cfm?id=565http://www.azumc.com/body.cfm?id=565http://www.nj.com/news/index.ssf/2009/01/missing_jersey_city_babys_body.html8/2/2019 Bodies Organs Suicide 2012
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Balancing of individual interestsv. societal interests
ProstitutionImmunizations
DrugsSelling organs (reconsidered by the AMA).Suicide
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Has to be consent Can be decedent, healthcare power of attorney, or family.
Law went into effect July 1, 2002. First Person Consent Bill (Senate File 2195)allows "a written statement attached to or imprinted or noted on a driver's licenseor non-operator's id card, an entry in a donor registry, a donor's will or any otherwritten document used by a donor to make an anatomical gift.www.iowadonorregistry.org.
Is this consent informed?
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http://www.iowadonorregistry.org/http://www.iowadonorregistry.org/http://www.iowadonorregistry.org/http://www.iowadonorregistry.org/http://www.iowadonorregistry.org/http://www.iowadonorregistry.org/8/2/2019 Bodies Organs Suicide 2012
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Many Legal and Ethical Issues:
Who decides if donor card andfamily disagrees?
When to Harvestnon-heartbeating
Dont sell legally
Confidentiality
Who should get the organs?Priority?
Great article on legal and ethicalissues re: organ allocation
http://bioethics.georgetown.edu/pcbe/backg
round/davispaper.html
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http://bioethics.georgetown.edu/pcbe/background/davispaper.htmlhttp://bioethics.georgetown.edu/pcbe/background/davispaper.htmlhttp://bioethics.georgetown.edu/pcbe/background/davispaper.htmlhttp://bioethics.georgetown.edu/pcbe/background/davispaper.htmlhttp://bioethics.georgetown.edu/pcbe/background/davispaper.html8/2/2019 Bodies Organs Suicide 2012
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94 year old woman who has been on the list longest; 3 year old girl in NY; 38 year old celebrity in CA who promises to contribute 5 million to
cancer; 41 year old scientist in Chicago who is on the cutting edge of finding
a cure for Parkinson's;
50 year old Iowa alcoholic who has 2 prior livers destroyed byalcohol will die tomorrow if does not get it;
Mexican teenager in NC where hospital made medical errorwrongblood type during prior transplant, urgently needs; or
3 year old Iowa Boy with Cerebral Palsy 2nd on the list.
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Practice for the benefit ofpatients--do no harm
Hippocrates (a.k.a. Father of Medicine)Ancient Greece 400 BC
May be considered harmful to die
May be considered harmful to live
Assumption that we all desire to live
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PAS is Generally a Crime
AMA CEJA unethicalinconsistent with physicians role as healer and cant regulate.
National survey of DOsoverwhelmingly opposecontrary to oath
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Vacco v. Quill & Washington v. Glucksberg(1997)
Parties: physicians & patients
Challenged states ban on physician-assisted suicide
Claimed denied liberty to choose death
Supreme Court: (9-0 decision)
Right to suicide is not fundamental liberty interest (offensive)
Ban rationally related to states interest in preserving life.
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State authority to regulate suicide withoutviolating the 14thamendmentPatients noright to suicide, but states can permit.
Distinction between letting die (DNR) andmaking die (suicide).
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Natural Death ActState Statute affirming terminally ill patients right torefuse treatment
Oregons Death with Dignity Act of 1997Legalized Physicians ability to write lethal prescriptionsfor terminally ill patients
Attorney General Ashcroft
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Patients Determination Act
Slippery Slope Argument
Hippocratic Oath
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AutonomyAuthority for a competent individual to choose how they want tobe treatedAuthority to choose how they want to die
BeneficenceHippocratic Oath is outdated
Protect the best interests of the patient
JusticeEquality of treatmentBenefits from treatment and nontreatment
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Right to Refuse Treatment
Right to Advanced DirectivesWithdrawing life sustaining technology
Withholding life sustaining procedures
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Conflicts:Prescriptions for lethal drugs
Physicians direct involvement in
states that prohibit Physician-assisted suicide
Passive Inaction versus activeeuthanasia (i.e. Dr. Kovorkian)
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IF PAS is legalized, there might bevulnerable individuals who will fall victim tothe euthanasia.
Beneficence versus Malfeasance
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How has medical technology impacted ourview on end of life choices?
Should the government decide how wechoose to die?
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http://depts.washington.edu/bioethx/topics/pas.html
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Background:
In the Netherlands physician assisted (& administered) suicideis legal if meet requirements:
2nd OpinionHopeless Suffering
No prospect of CurePatient repeated requests euthanasiaFurther life unacceptable to patient
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Patient had ALSLou Gehrigs Disease
Semi paralyzed
Difficulty talking & breathing
Uncontrollable pain/outbursts of crying
Controlled death a comforting thought because alternative is suffocation
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Follows physician through visits with patient and his spouse,
going through the mandatory process & choosing/getting thelethal drugs.
Highlights the patients (and spouses) physical suffering anddepression and how potential euthanasia at time of his deathat his control was liberating, yet difficult decision, he
postponed several times.Provides personal insight in to the physicians ethical/spiritualquandary
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There are no easy answers!
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2005-Dutch law enforcement cracking down on anynon-physician assisted suicide they find, sentencingan old man to six months imprisonment for helpinga sick, old woman to die
Assisted Suicide Around the Worldhttp://www.assistedsuicide.org/suicide_laws.html
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http://www.assistedsuicide.org/suicide_laws.htmlhttp://www.assistedsuicide.org/suicide_laws.html