A Good Death

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A Good Death

This topic area includes questions about values that should be advocated in end of life care and decision-making. It includes the ethics of euthanasia, but also the values we should use to think about our own and others' end of life decisions.

• Resource Needs:

• Definitions of Euthanasia
• Insights about Aging and End of Life Planning
• Specific arguments about personal and social (what the state should allow) approaches to end of life.
• Information about current approaches in Washington, Oregon and other states
• Research on how people actually approach end of life care decisions.
• Range of mainstream advice about end of life care.

• Research Advice:

• Many posts could benefit from a sentence or two describing a significant point made in the resource. This is especially true for video resources, which can be time consuming to watch.
• Try some philosophy encyclopedias like the Stanford Encyclopedia of Philosophy, [1], which will focus on arguments. Googling "philosophical arguments for ..." might get you somewhere as well.

• Highly Recommended: Stanford EOP on Voluntary Euthanasia -- I've add a pdf of this to your links on courses.alfino. Also linked below.

Information

As we discussed in our research group, when it comes to the right to your own body and having the right to die, where does it begin to cross the line? This article is about the right to die regarding mental illness and whether or not someone can have the right to die if they are suffering mentally, rather than suffering physically. http://www.medscape.com/viewarticle/848910 -Madeline Hummel

• Post summaries of something you learned about the topic that is important to thinking about it. Consult the resource needs list above for ideas. Use both Google searches leading to authoritative information and online databases, books, and articles linked through Foley Library.

• This web page gives information on all the different methods of euthanasia. [2] -Sidni Butler

• This discusses euthanasia and assisted suicide laws around the world. [3] -Sidni Butler

• This report outlines successes and failures of physician assisted suicide in the Nederlands from 1990-1995. Over this time it become more and more prevalent, despite it being illegal. [4] -Emma Delucchi

• Merriam Webster defines "Euthanasia" as: "the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy." (Posted By: John the Baptist)

• This link will take you to an interactive map of where Euthanasia is legal, illegal, and lacking statutes for or against it. [5] (Posted By: John the Baptist)

• Information on Washington state and death: The Washington Death with Dignity Act, Initiative 1000, codified as RCW 70.245, passed on November 4, 2008 and went into effect on March 5, 2009. This act allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live. (Citation: DOH. "Death with Dignity Act." Washington State Department of Health. Washington State Department of Health, 2008. Web. 8 Feb. 2016.) -Savanah Van Citters

• This page gives definitions for the different kinds of euthanasia such as the difference between voluntary euthanasia and assisted suicide. It also gives links to other websites and articles that may be helpful. [6] -Kate Pratschner

• The role of the physician in end of life decisions: Research shows that the physicians input has a large impact people's end of life decisions. Furthermore, the physicians are not objective in the decision making process. In fact their own set of social values plays a role in what information they give to or withhold from the patient in order to make their decisions. This means that the culture that they come from plays a role in how they make decisions and recommendations for their patients. For example, conservative and traditionally religious physicians tend to favor life prolonging treatments. (Citation: Cohen, Charles J; Chen, Yifet; Orbach, Heidi; Freier-Dror, Yossi; Auslander, Gail; Brwuer, Gabriel S. "Social values as an independent factor affecting end of life medical decision making." Medical Healthcare and Philosophy. 26 June 2014 18:71-80.) -Alex Neitz

• This article includes a video about a terminally ill woman who describes her reasons behind her decision to end her life through assisted suicide rather than succumb to her terminal brain cancer. This video also provides her family's testimony and why they chose to support this decision. Brittany Maynard decided to make this decision in order to "die with dignity". Additionally this article provides a small amount of debate on both sides of this issue. (Citation:Hirschhorn, D. (2014). Terminally Ill Woman Who Planned Assisted Suicide Dies. TIME. Retrieved February 8, 2016, from [7] - Austin Rompel
• significance: This video is a brief documentary regarding one terminally ill woman's choice to have a "good death" and the family's views on the issue.

• This study analyzes the perspective of many psychological professionals on the issue of assisted suicide. It explores their perspective in terms of several vignettes/ situations including on the basis of religion. (Citation:Levy, T. B., Azar, S., Huberfeld, R., Siegel, A. M., & Strous, R. D. (2012). Attitudes Towards Euthanasia And Assisted Suicide: A Comparison Between Psychiatrists And Other Physicians. Bioethics, 27(7), 402-408. Retrieved February 8, 2016, from [8] - Austin Rompel

• This article provides opinions about euthanasia and physician assisted suicide through the eyes of an alternative source, Veterinarians. Although these professionals work with animals and not humans, they are frequently confronted with Euthanasia and the ethical implications involved. [9] -Reilly Bealer

• This link leads to a video and short article covering the national decision in Canada to allow physician assisted suicide. The video also gives personal testimony from the court session along with some of the issues that may arise in the interpretation of the new legislation. (Citation: "Canadian Court OKs Doctor-assisted Suicide, but Who's Eligible?" PBS. PBS, 1 Apr. 2015. Web. 08 Feb. 2016. --- [10] - Sophie Oswald

• This article details a study done in both the US and Australia aiming to better understand how critical care nurses feel end of life care could be improved. A major theme brought up by the hundreds randomly sampled included ensuring "a good death" with dignity and peace. The article also details ways in which critical care nurses and physicians are limited in their abilities to provide "good deaths" and how they believe the situation could be improved. See: http://ajcc.aacnjournals.org/content/15/1/38.full.pdf+html -Megan Lantsberger

• This seems important to me. Shifting from ensuring health to preparing for death involves pretty much every aspect of a person's life. So it makes sense that a good death might involve preparation. -Alfino

• This link takes you to the abstract and simple conclusions of a paper that sought to analyze the role of psychiatry in voluntary euthanasia. It makes suggestions about how laws should be constructed about voluntary euthanasia (if laws are created at all). They conclude that a psychiatric evaluation must be conducted before the decision is legally accepted and a "cooling off period" should also be instated. http://anp.sagepub.com/content/29/4/580.short -Megan Lantsberger

• Gets at idea of consent.

• This article is helpful in looking at this from a religious perspective (a moral authority for some). It includes information about ordination and marriage that you have to sift through but on page 78 there is a good table looking at attitudes toward euthanasia across sex and religious categories. Another table compares attitudes across sex and education level. The article unpacks these results. (Three Current Religious Issues: Marriage of Priests, Intermarriage, and Euthenasia- John P. Alston). [11] -Maryclare O'Brien-Wilson

• Another thing to think about is not just the quality of life of one person as they reach the end but also of the people around them. I have many articles from my Psychology class on care-giver fatigue and deficits in relationships when one person cannot reciprocate the care. This brings up the discussion of putting loved ones in a nursing home- can this enhance quality of life? -Maryclare O'Brien-Wilson

• In 2008, Washington became only the second state to approve of assisted suicide, with Oregon being the first. In Washington, physicians are not listed on the patient’s death certificates, but instead the cause for the assisted suicide is reported as the underlying terminal disease. The death certificate also must not have the cause of death to be marked as “natural” and it must not mention that the Death with Dignity Act was used. (citation: "Washington State Issues 6th Official Report on Doctor-prescribed Suicide." Patients Rights Council. 6 Aug. 2015. Web. 8 Feb. 2016.) -Laura Moretti

• Definition: "End-of-life care is the term used to describe the support and medical care given during the time surrounding death." The following link also helps to give a description on how one actually goes about finding end of life care. It lists all of the different types, and how one might approach this subject, including mentioning who pays for what. https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/finding-care-end-life -Morgan Lancaster

• This article explores the idea of a "good death" for terminally ill or elderly people through a comprehensive look into the entirety of the dying experience. The authors cover a wide variety of topics ranging from physical to psychological considerations. They also make an interesting claim, in which they suggest euthanasia and assisted suicide "do not aim at modifiable dimensions of the patients experience" making their effect on a "good death" very limited. [12] - Jacob Beardemphl

• We all come from different backgrounds with different opinions that help shape what we think about ethical topics in the world. However the opinion you have on something may not match the opinion someone else has on something. Religion plays a large role in various perspectives on euthanasia. The article linked below has background for different religious views, what they practice, and their overall stance on euthanasia. http://www.bbc.co.uk/ethics/euthanasia/religion/religion.shtml - Austin Gabriel

• The Shadow Side of Assisted Suicide: This article has various opinions on Frontline's video the Suicide Plan (http://www.pbs.org/wgbh/frontline/film/suicide-plan/). While a very controversial topic, the article has professors, doctors and other acclaimed individuals discuss their opinion on the issue of assisted suicide. Many believe that it is that it is not important how a person wants to die, but why they are choosing to die. The article contains many interesting points on both sides, in response to the Frontline video. <http://www.pbs.org/wgbh/frontline/article/the-shadow-side-of-assisted-suicide/> - Julia George

• This article looks into the ethics of Buddhism in regards to end of life care and the implications of euthanasia as being morally wrong in Buddhist views. The article can be accessed through the following link. [13] - Kendall Clark

• Some details from Atul Gwande's Being Mortal: 21: "Given the opportunity, both parents and children saw separation as a form of freedom. Whenever the elderly have had the financial means, they have chosen what social scientists have called mtimacy at a distance." Whereas in early-twentieth-century America the 1960s the proportion had dropped to 25 percent. By 1975 it was below 15 percent. The pattern is a worldwide one. Just lo percent of Europeans over age eighty live with their children, and almost half live completely alone, without a spouse." And on the demographics age cohort groups: 35: "In 1950, children under the age of five w re 11 percent of the US population, adults aged forty-five to fortynine were 6 percent, and those over eighty were i percent. Today, we have as many fifty-year-olds as five-year-olds. In thirty years, there will be as many people over eighty as there are under five. The same pattern is emerging throughout the industrialized world. " Gwande's book is still a good candidate for some of you doing this topic for the paper. Some reporting to the wiki page would be useful as well-- Alfino

• Every year nearly 3,000 professionals gather to discuss the multitude of issues relating to our older adult population. [14] As Fernando Torres-Gil [15], says, it should not be a normal occurance that you get sick when you're old; you must continue to treat these problems and not let age be a factor. -Katie Karl

• End-of-Life care is important to begin at an early stage [16], but in the elderly, particularly in LGBT elderly, it is much more difficult to approach this subject. [17] Often times, elderly who do not have an end-of-life plan in action, are only taken care of by a legal guardian, a person appointed by court to make some/all personal and/or property decisions on behalf of the incapacitated individual. [18] In order to stop this, many national agencies have provided resources for LGBT communities and those without next of kin to assist in their next step planning. [19] -Katie Karl

• An interesting article that brings up a new aspect of end-of-life care, concerning newborns. [20] -Amanda Kiefer

• It's important to note the differences in euthanasia and their definitions. [21] -Katie Karl

• This study shows the different between cultural and religious aspects about end of life care. Instead of looking at specific religions, it analyzes the idea of how someone views God. Overall, people that tend to view God as something bigger and better than themselves use a lot of end-of-life care, while those who have a personal relationship to God and talk to him all the time tend to deny end-of life care. This study is also useful because it analyzes the different views between cultures, even juxtaposing how different doctors view euthanasia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249849/ -Morgan Lancaster

• An in depth look at death and end of life care. Also talks about the ethical issues and challenges different methods present. [22] -Macklin Ohnemus

• An article that examines the controversial issue of aging and dying prisoners and brings forth ethical arguments for efforts to improve end-of-live care in prisons. [23] -Amanda Kiefer

• This article classifies the different types of euthanasia, and is important to understand before forming an opinion for or against. http://www.medicalnewstoday.com/articles/182951.php- Faith Smith

• This article highlights arguments both for and against euthanasia, as well as presents different scenarios where it may be sought after. It also talks about end of life care and how this may be different in the case of euthanasia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612319/ -Camille Guerin

• Here is information on neonatal euthanasia.

[24] -Kyla Colliton

• Here are the legal position of some countries and euthanasia [25]

Abraham Lopez

• This article looks at the acceptability and extent of how physician assisted suicide should be used in the community centered/highly religious society of India [26]

Reilly Bealer

• This article looks the challenges and ethical implications for Pharmacists who are responsible for filling prescriptions that will be used for physician assisted suicide [27]

Reilly Bealer

• Here are a couple articles about pet euthanasia. Declining rates due to sterilization [28] and a general idea of how often pet euthanasia is done for monetary reasons [29]. -Fearecia Maddox

-We Live Through Institutions Good Society Intro.pdf (this link for euthanasia when thinking about mental illness and suicide as a social issue, because we are intimately impacted by institutions....how we are obligated as a society to those who are healthy and young and wanting euthanasia) Chelsey Hand

This website is a database of sorts providing further details about many of the issues regarding end of life care [30] -Bailey Essig

This is another database providing varying views on end of life care. Offers perspectives from patients, doctors, caregivers and so on [31] -Bailey Essig

This site may help a few of you for backing up your position http://euthanasia.procon.org/view.resource.php?resourceID=000126 -Nick Corigliano

This article provides ten statements about human euthanasia, and has good points to both sides of the arguement. Although it does not go into to much depth, I think it provides a good starting point to think about both sides of the debate, maybe inspiring other perspectives or viewpoints. http://euthanasia.procon.org/view.resource.php?resourceID=000126 -Alex Grass

This article is written from India's perspective, and how they view the topic there. It opens up a few arguements that I have not yet seen in the United States. Check it out! http://www.legalserviceindia.com/article/l118-Euthanasia-and-Human-Rights.html -Alex Grass

This article focuses on the ethical and moral dilemmas regarding end of life care [32] -Bailey Essig

Ryan Gaske: https://books.google.com/books?id=xUW3oYHh24IC&pg=PA397&lpg=PA397&dq=keenan+the+case+for+physician+assisted+suicide&source=bl&ots=fTSWcnw1w0&sig=TZen3LZVWR_sIaTesg7Mscco5W0&hl=en&sa=X&ved=0ahUKEwi9oIXmvuvKAhVW92MKHWHiAGsQ6AEIMjAE#v=onepage&q=keenan%20the%20case%20for%20physician%20assisted%20suicide&f=false This is a link to an online book. It tells about social inequality between men and women. It can be used to show that euthanasia could potentially be used to escape certain situations based on a persons social class. You could also make the argument that the USA could offer better services for people suffering from mental health issues.

Arguments

• Post arguments that you find or want to put forward on this topic. You can research arguments by doing a Google search, but also by consulting databases like Philosopher's Index, Academic Search Complete, and Proquest.

• [33] Link to statement released by the United States Conference of Catholic Bishops on why assisted suicide is not the best option. -Bella Spies

• This article argues for integrated palliative care, as opposed to just end of life, but the points still follow with end of life. It goes over ethics, finance, morals, and the general role of CAM. CAM stands for “complementary and alternative medicine. Their main argument is looking at a person as a whole, not just a body. A quote that nicely summarizes is, “We are moving beyond notions of the body as a separate entity and acknowledging its interdependent relationship to all aspects of self.” [34] - Alex Bourguignon

• This article provides information on the various types of euthanasia, whether it be voluntary, involuntary or non voluntary. It analyzes the role and importance of the patient. [Rethinking Voluntary Euthanasia] (Posted by St. Peregine Laziosi)

• Interesting take on how to approach "justification" -- kind of a meta-level argument, arguments about how to settle arguments - Alfino

• This is a chapter from a from a book Called "Moral Issues and Christian Responses." This section of the book is "The Case for Physician Assisted Suicide" by James Keenan. Keenen argues that physician assisted suicide actually discriminates against the marginalized. Women, depressed, and the poor are far more likely to request PAS, as shown through cases and statistics. Keenan argues that the common PAS patient is not someone terminally ill and in pain, but someone that feels they have no other options because of their status in society. https://books.google.com/books?id=xUW3oYHh24IC&pg=PA397&lpg=PA397&dq=keenan+the+case+for+physician+assisted+suicide&source=bl&ots=fTSWcnw1w0&sig=TZen3LZVWR_sIaTesg7Mscco5W0&hl=en&sa=X&ved=0ahUKEwi9oIXmvuvKAhVW92MKHWHiAGsQ6AEIMjAE#v=onepage&q=keenan%20the%20case%20for%20physician%20assisted%20suicide&f=false (Meredith Coad)

• This page includes an introduction to approaching euthanasia ethically, moral cases regarding voluntary euthanasia, and objections to the permissibility of voluntary euthanasia. http://plato.stanford.edu/entries/euthanasia-voluntary/#AMo -Megan Lantsberger

• This article includes a pro-euthanasia stance: doctors or nurses have a duty to relieve suffering if they have the capability to do so. However, a patient must be aware and respectful of the medical personnel's moral and professional values. -St. Luke

• This article argues both in favor of and opposed to euthanasia. It analyzes the nurse's point of view and their opinions on the current state of euthanasia and how their training and the process can improve. [Nurses' Attitudes to Euthanasia] (Posted By St. Peregine Laziosi)

• This video (11:18 minutes) talked about the right to die in Belgium, which has the most liberal euthanasia laws in the world. The video talked about how doctors are given the right to inject a patient, which is a common method used in Belgium. It was interesting to me that the laws focus on the rights of the patient, and it can even be given to psychiatric patients when deemed they have a legitimate reason. Another thing to note is that Beligium's religion is mainly Roman Catholic, according to the video. [35] -Laura Moretti

• Pros and Cons on euthanasia and questions surrounding euthanasia. General information surrounding the topic. [36] (Kelsi Jackson)

• Both sides of argument for euthanasia, and requirements for it. [37] -Macklin Ohnemus

• Here people can vote on whether people have a right to die and explain their reasons [38] -Macklin Ohnemus

• I thought this had some great pros and cons from key figures. [39] - Pierce Baldocchi

• This here is a good article to read. Has good insight on the topic. http://www.medicalnewstoday.com/articles/182951.php -Nick Corigliano

• Section of Peter Singer's Practical Ethics 2nd Edition, regarding euthanasia. Outlines the different types of euthanasia and offers his view on the subject. [40] (Kelsi Jackson)

• This is an article by BBC about pro and con euthanasia arguments. [41] - Fearecia Maddox

Pro-Euthanasia

• States who have legalized euthanasia have strict regulations to control how these actions are performed. [42]
• All human beings have a right to die. [43] [44] Death is considered the most personal experience and the public does not have a right to infringe upon this. By restraining this, it takes away a person's right to die in the way that he or she chooses.
• Other rights include the right to die:

• The right to life includes the right to die. Death is neither good nor bad and the process of dying is in itself a part of life. Human beings have the right to make the best of the situations they are given. This includes the right to make death as pleasant as possible.
• The right not to be killed is sufficient enough to ensure that doctors don't kill their patients.
• The right to freedom and belief includes the right to determine how you die.

• Libertarians argue euthanasia promotes the best interests of everyone involved and violates no one's rights and therefore is morally acceptable.
• Those in the medical field argue that euthanasia let's the patient receive what they desire and free resources that would otherwise be used for those who need the resources direly.
• Euthanasia happens anyways so why not regulate it and control how it is administered?
• Is death a bad thing? Should a human's automatic fear of death stop anyone who isn't needlessly suffering from wanting to die? -Katie Karl [45]

• Dax Cowart[46] is an example of a person who wanted to commit physician assisted suicide due to a almost fatal injury and the mentally anguishing recovery from that injury. He calls it "the right to die". He asked the doctors to not treat his life-threatening injuries and let him die, but they refused because they felt like they had the duty as doctors to treat him. Here[47] is an link to a paper written about him. Here [48] is a link to a video about this. -Emma Delucchi

• Cost and resources to keep the person alive who wants to die is a waste of money and time- Austin Gabriel
• Argument of living and seeing the world with experiences versus sitting in a bed knowing you will die. Are you really living at this point or just surviving?- Austin Gabriel

• In some cases without the option of assisted suicide the suffering of the patient is prolonged until it is unbearable. I do not advocate the right to persons of mental illness, but for those who suffer from terminal ailments. People have the capacity to decide whether a particular choice is right for them. It is not up to a third party to decide the morals of another. - St. Catherine of Sienna

• This is a great article because it interviews certain people who are going through terminal diseases. The first one is interviewing a woman in the UK where this was illegal (not sure if it still is). She wishes she was in another country but she is planning killing herself and she will hide it from her family so they won't be persecuted for assisted suicide. Shows that this is a decision that will happen anyways, but this is more controlled, better for the family, and it helps have the patient be in control of their own lives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563356/ -Elizabeth Cieri

Anti-Euthanasia

• Against the will of God as suffering is a right that God has granted us.
• The sanctity of life as it is a gift from God and therefore every life is sacred and is an ultimate Good.
• The slippery slope that if voluntary euthanasia is legalized, soon involuntary euthanasia will be legalized leading to the genocide of many.
• Euthanasia is subtext saying that it would be better to be dead than to be sick or disabled.
• The patient's best interests could be at stake. The doctor could be wrong or the patient could be crying for help. The rights of the loved ones should also be considered.
• Euthanasia would discourage more palliative care. It's important to continue to look at patients as human beings rather than a list of symptoms and illnesses.
• How can Euthanasia be regulated morally and effectively.
• Doctors should not be able to play God. This includes determining if someone is ready to die or not.
• Weak patients could be put under pressure to take their lives. -Katie Karl [49]
• This talks about how some euthanasia methods don’t always work the way that they are wanted to. [50] –Sidni Butler
• Legalization of euthanasia could lead to an undermining of the sanctity and inviolability of life.

Gives reasons why euthanasia is practically, ethically, religiously, and historically wrong. http://www.bbc.co.uk/ethics/euthanasia/against/against_1.shtml -Jordan Batres

• Statements against euthanasia with arguments to back the reasons. Points out some good arguments that can be used to justify anti euthanasia argument. Offers good insight for the pro euthanasia argument, to see the other side of that argument. [51] (Kelsi Jackson)

• This paper critiques physician assisted suicide as being wrong due to the argument that this decision actually limits or even removes patient autonomy. [52] - Reilly Bealer

• This analysis critiques physician assisted suicide as breaking the oath of "do no harm", however, it looks at the alternative of continuous deep sedation until death. [53] - Reilly Bealer

Ryan Gaske- This link gives an overall overview of arguments both for and against euthanasia. From the main page there are links to more detailed arguments both for and against. http://www.bbc.co.uk/ethics/euthanasia/against/against_1.shtml

Insights

• Post here under your name (or login anonymously and either use your saint name (if you want me to know who you are) or make up your own. Post a brief statement of your views as they are evolving on the topic. What arguments, values, and facts are central (or gaining prominence) in your thinking?

Ryan Gaske- It is important to understand that people in society may come from different cultural backgrounds. This is important as it helps explain peoples attitudes towards certain things such as death. For example, in our society, we view death as a bad thing that should be avoided. However, other societies may view it as a cause for celebration. Death ceremonies are used to recognize the persons achievements.