What is a common theme in physician assisted suicide laws in states that allow it?

1. Sprung CL, Truog RD, Curtis JR, et al. Seeking Worldwide Professional Consensus on the Principles of End-of-Life Care for the Critically Ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) Study. Am J Respir Crit Care Med. 2014;190:855–866. [PubMed] [Google Scholar]

2. Attaran A. Unanimity on death with dignity--legalizing physician-assisted dying in Canada. N Engl J Med. 2015;372:2080–2082. [PubMed] [Google Scholar]

3. Schafer A. Physician assisted suicide: the great Canadian euthanasia debate. Int J Law Psychiatry. 2013;36:522–531. [PubMed] [Google Scholar]

4. Vincent J-L, Schetz M, De Waele JJ, et al. “Piece” of mind: end of life in the intensive care unit statement of the Belgian Society of Intensive Care Medicine. J Crit Care. 2014;29:174–175. [PubMed] [Google Scholar]

5. Kompanje EJO, Epker JL, Bakker J. Hastening death due to administration of sedatives and opioids after withdrawal of life-sustaining measures: even in the absence of discomfort? J Crit Care. 2014;29:455–456. [PubMed] [Google Scholar]

6. Cohen S, Sprung C, Sjokvist P, et al. Communication of end-of-life decisions in European intensive care units. Intensive Care Medicine. 2005;31:1215–1221. [PubMed] [Google Scholar]

7. Sumner LW. Assisted Death. Oxford University Press; 2011. [Google Scholar]

8. Wilkinson D, Savulescu J. Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics. 2012;26:32–48. [PMC free article] [PubMed] [Google Scholar]

9. Loggers ET, Starks H, Shannon-Dudley M, et al. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013;368:1417–1424. [PubMed] [Google Scholar]

10. Jansen-van der Weide MC, Onwuteaka-Philipsen BD, van der Wal G. Granted, undecided, withdrawn, and refused requests for euthanasia and physician-assisted suicide. Archives of Internal Medicine. 2005;165:1698–1704. [PubMed] [Google Scholar]

11. Seale C. The role of doctors' religious faith and ethnicity in taking ethically controversial decisions during end-of-life care. J Med Ethics. 2010;36:677–682. [PubMed] [Google Scholar]

12. Alderson P. Absence of evidence is not evidence of absence. BMJ. 2004;328:476–477. [PMC free article] [PubMed] [Google Scholar]

13. Cook D, Swinton M, Toledo F, et al. Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study. Ann Intern Med. 2015;163:271–279. [PubMed] [Google Scholar]

14. Cohen SR, Boston P, Mount BM, et al. Changes in quality of life following admission to palliative care units. Palliat Med. 2001;15:363–371. [PubMed] [Google Scholar]

15. Mount BM, Boston PH, Cohen SR. Healing connections: on moving from suffering to a sense of well-being. Journal of Pain and Symptom Management. 2007;33:372–388. [PubMed] [Google Scholar]

16. Sprung CL, Cohen SL, Sjokvist P, et al. End-of-life practices in European intensive care units: the Ethicus Study. JAMA. 2003;290:790–797. [PubMed] [Google Scholar]

17. Cook D, Rocker G. Dying with dignity in the intensive care unit. N Engl J Med. 2014;370:2506–2514. [PubMed] [Google Scholar]

18. Cook D, Rocker G, Marshall J, et al. Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med. 2003;349:1123–1132. [PubMed] [Google Scholar]

19. Luce JM, ALPERS A. Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them. Am J Respir Crit Care Med. 2000;162:2029–2032. [PubMed] [Google Scholar]

20. Street K, Henderson J. Ethical debate: The distinction between withdrawing life sustaining treatment under the influence of paralysing agents and euthanasia. Are we treading a fine line? BMJ. 2001;323:388–389. [PMC free article] [PubMed] [Google Scholar]

21. Bosshard G, Fischer S, van der Heide A, et al. Intentionally hastening death by withholding or withdrawing treatment. Wien Klin Wochenschr. 2006;118:322–326. [PubMed] [Google Scholar]

22. Brock DW. Misconceived sources of opposition to physician-assisted suicide. Psychology, Public Policy, and Law. 2000;6:305–313. [PubMed] [Google Scholar]

23. Rachels J. Active and passive euthanasia. N Engl J Med. 1975;292:78–80. [PubMed] [Google Scholar]

24. Lampert R, Hayes DL, Annas GJ, et al. HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. 2010;7:1008–1026. [PubMed] [Google Scholar]

25. Bakker J, Jansen TC, Lima A, et al. Why opioids and sedatives may prolong life rather than hasten death after ventilator withdrawal in critically ill patients. Am J Hosp Palliat Care. 2008;25:152–154. [PubMed] [Google Scholar]

26. Aulisio MP. In defense of the intention/foresight distinction. American Philosophical Quarterly. 1995;32:341–354. [Google Scholar]

27. Douglas CD, Kerridge IH, Ankeny RA. Narratives of “terminal sedation,” and the importance of the intention-foresight distinction in palliative care practice. Bioethics. 2013;27:1–11. [PubMed] [Google Scholar]

28. Crawshaw R, Rogers DE, Pellegrino ED, et al. Patient-physician covenant. JAMA. 1995;273:1553. [PubMed] [Google Scholar]

29. [Accessed on July 7, 2015]; //www.cma.ca/Assets/assets-library/document/en/advocacy/EOL/care-at-the-end-of-life-cma-framework-june2015-e.pdf. [Google Scholar]

30. Sulmasy D. Intelligence Squared Debates. Legalize Assisted Suicide. [Accessed July 7, 2015]; November 13, 2014: //intelligencesquaredus.org/debates/upcoming-debates/item/1160-legalize-assisted-suicide. [Google Scholar]

31. Pellegrino ED. Patient autonomy and the physician's ethics. Ann R Coll Physicians Surg Can. 1994;27:171–173. [PubMed] [Google Scholar]

32. Lewis-Newby M, Wicclair M, Pope T, et al. An Official American Thoracic Society Policy Statement: Managing Conscientious Objections in Intensive Care Medicine. Am J Respir Crit Care Med. 2015;191:219–227. [PubMed] [Google Scholar]

33. White DB, Brody B. Would accommodating some conscientious objections by physicians promote quality in? JAMA. 2011;305:1804–1805. [PubMed] [Google Scholar]

Page 2

Core ethical issues under discussion About Physician-Assisted Suicide/Euthanasia in Critical Care.

Core Ethical IssuePosition 1 (perspectives
supporting PAS/E*)Position 2 (perspectives opposing
PAS/E)
Are there patients for whom death is beneficial?Some patients may benefit from death
  • Quantity of life can be sacrificed in the interest of quality of life

  • Some suffering will only end with the death of the patient

The benefit of death is unknown and unknowable to medicine
  • For death to be beneficial, the condition of being dead must be superior to the condition of remaining alive

  • The medical profession (and the patient) has no empirical knowledge of the condition of being dead (i.e. whether there is life after death or what it is like to be dead)

  • Ending life early precludes potential opportunities for relational and spiritual healing at the end of life

Is physician-assisted suicide/euthanasia morally equivalent to withholding/withdrawing life support?There is no ethically meaningful difference between PAS/E and WWLST
  • The key considerations in PAS/E and WWLST are the same: respecting patient values and sacrificing quantity of life in the interest of quality of life

  • The overall intent in both PAS/E and WWLST is the same: provide comfort

  • The physician who performs WWLST that results in death has the same moral agency in that death as the physician who performs PAS/E

PAS/E and WWLST are ethically distinct because of differences in intent and mechanism of effect
  • WWLST is not carried out in order to deliberately end the patient’s life, although death is often a foreseen consequence of WWLST

  • The goals of WWLST (comfort, removal of burdensome therapies) are achieved irrespective of whether the patient dies following WWLST, whereas the goals of PAS/E are achieved only through the death of the patient

Is it morally acceptable for physicians to cause death intentionally?Intentionally causing death of patients may sometimes be morally acceptable
  • PAS/E is distinguished from murder by the presence of consent and a compassionate motivation

  • There is no reason to allow passive treatment plans that shorten life (i.e. WWLST) but not active ones

  • If death is certain and the possibility of suffering is significant, PAS/E can be defended on grounds of harm reduction

Intentionally causing death of patients is not morally acceptable
  • Human persons have an intrinsic and incalculable value that transcends circumstance and preference

  • Respect for persons necessarily entails that we cannot make a ‘somebody’ into a ‘nobody’

  • The duty to respect preferences stems from the intrinsic value of the person; honoring a preference for death necessarily takes aim at the very basis for respecting the patient’s preferences

What is a reasonable accommodation between the right of patient access to PAS/E and the right of conscientious objection?Consensus was reached on this issue
  • Conscientious objections should be accommodated without unduly obstructing patient’s access to medical interventions permitted by law

  • Physicians must discuss all legitimate options for treating suffering, and recognize the distinction between restricting their own actions and obstructing the patient’s right of access

  • Special constraints upon conscientious objection apply in the ICU because hospitalized patients often have little or no ability to choose their attending physician

  • In the ICU context, transferring care to an alternate attending physician upon the patient’s request because of conscientious objection does not constitute a referral for PAS/E and does not imply moral culpability if the patient subsequently undergoes PAS/E

Última postagem

Tag