Реферат: The Business Of Dying Essay Research Paper

The Due Process Clause does not require a State to accept the “substituted judgment” of close family members in the absence of substantial proof that their views reflect the patient’s. Without proof of ones wishes the question of constitutionally-protected liberty and interest in determining the time and manner of ones death will continue to be an issue. CHAPTER 3

Legislation and the Health Care Stand

As Congress looks for ways to curb rising Medicare costs, health care providers and dietetic professions are raising their concerns. Within these institutions, the idea of an ethics committee is being considered. The committees would carry out defined written guidelines for care of the permanent unconscious. In addition, dietitians would be required to be a members of or consultant to such committees and would serve an integral role in development of institutional policy. The dietetics community is involved in the legislative arena at the state and local level to promote the use of advanced directives and to effect legislative and societal changes that result in appropriate care for patients in a prolonged vegetative state.

The Multi-Society Task Force on Prolonged Vegetative States has already established guidelines for feeding a patient in a prolonged vegetative state and within individual institutions. Usually, the nutritional notion of “when in doubt, feed” is considered essential for the patient’s rights.

Considering patients who are permanently unconscious, with respect for personal autonomy, various ethical principals may be in conflict of the “when in doubt” idea. If care providers decide that there is an obligation to feed a permanently unconscious patient, does that obligation ever stop? As yet, there is no official consensus among physicians that treating a patient in a persistent vegetative state is inappropriate or that prolonging life is not an independent and overriding goal of medicine. The possibility of positive outcome should be assumed until the patient has not shown progress over time. According to the position of those in the medical profession, a consensus on the issue of prolonged care and prolonging life may be long in coming. They add that such a consensus may not be desirable. If physicians agreed, society might be foolish enough to give the health care provider unilateral say over what is best for the patient.

The Hippocratic Corpus encourages physicians to recognize when medicine has reached its limit of usefulness. A common method of distinguishing between obligatory and optional is to consider the effects, both benefits and burdens. Nutrition and hydration can be effective to maintain life, but alone they cannot restore consciousness. The Corpus goes on to state, “because the ultimate goal of any medical intervention should be improvement of the patient’s prognosis, comfort, well-being, or general state of health; therefore, nutrition may be futile as a medical treatment.”

The Hippocratic Oath has been the guiding ethical code for physicians since ancient Greece. Medical professionals still take the oath upon their indoctrination. It states in part, “I will maintain the utmost respect for human life from the time of conception; even under threat I will not use my medical knowledge contrary to the laws of humanity.” It is unclear just what mandates the exact laws of humanity. While natural law provides that we use moral and ethical principles inherent in human nature and our natural intelligence, we still must consider what our natural rights may be regarding the evolution of society. A broad definition of the law consists of enforceable rules governing relationships between individuals and between individuals and their society. In today’s society we can joke about death and we can view death on television and in the media, but we still don’t want to think about planning for our own death or the death of those we love. We certainly do not look forward to preparing a documented account of what we would want in an emergency or prolonged life situation. The issues of justice and the right to die with dignity may be growing in intensity, but each individual approaches that universal, common end called death with different religious, philosophical and personal attitudes and values. The legislation passed to protect these rights only made a meager attempt to protect the individual’s rights to prepare for their own death.

The Patient Self-Determination Act, which took effect on December 1, 1991, requires all Medicare/Medicaid health care providers to inform patients of their right to prepare an advance directive and to refuse treatment. The Act is based on principle, which was affirmed in a 1891 case, that “No right is held more sacred, or is more carefully guarded by the common law, than the right of every individual to the possession and control of his person, free from all restraint or interference of others, unless by clear and unquestionable authority of the law”

The act was established to ensure that patients, not the family or institutions, make their decisions about their medical treatment. In cases where there is no documented evidence of the individuals wishes, the courts are left to decide them on a case by case basis. Certainly not all cases and patient situations are not the same. Some interesting points to deliberate may be what considerations we should make for children verses older adults, or pregnant women. With respect to patients in a persistent vegetative state, the evolution legislation and social changes may be the solution. As time passes and our society evolves, further legislation is likely to be passed, thus molding what defines the future right to die issues. If through the evolution, the definition of death were changed to be the death of higher brain functions, a patient in a persistent vegetative state would be considered dead.


CHAPTER 4

Death a matter Ethics, Religion or Legal Realism

John Stuart Mill established the utilitarian model of ethics. He saw ethical decisions as those that produce the greatest positive balance of value over negative balance of value for all persons affected. To the novice this means that under utilitarian ethics, an action is morally correct or right when it produces the greatest amount of good for the greatest number and when the action affects the majority adversely it is morally wrong. His views focus on the consequences of an action, not on the nature of the action itself or on any set of preestablished moral values or religious beliefs. The deontological viewpoint of ethics, expressed by Immanuel Kant, states that some acts are wrong and other are right independent of their consequences. American society highly values tolerance of conflicting moral values. It also values the right to the individual to control or govern ones own reasoning and ethical values. While health care professionals have an inherent ethical obligation to respect the sanctity of life and to provide relief from suffering. Beneficence, autonomy, and justice are accepted moral principles governing the behavior of health care professional within society. With the technological advances in medicine come conflicts between application of moral principles and use of certain types of medical treatment. The decision of which moral principle takes precedence in what situation creates the conflict. The current guidelines written by health care providers and the American Dietetic Association do support the patient’s right to self-determination as the overriding principle. However, the basis for self-determination hang by the single thread that a living will or some sort of medical power of attorney exists.

Religion may be the only institution that comes close to a possessing consensus. While Orthodox Judaism does not accept the idea of “brain death” it does define death as the absence of respiration, cardiac function, and brain function. The Jewish belief supports that the decision to proved care should be based on a reasonable body of medical opinion that care is not required when a case is hopeless. Roman Catholics and some Protestant church authorities have rejected the notion of prolonging life despite quality. While both conclude that prolonging life by artificial means was distinct from euthanasia, they concur that the removal of life support was acceptable if being allowed to die would be better for the patient. In 1992, the National Conference of Catholic Bishops released a paper opposing all willful suicides but stating that Roman Catholics are not obliged to use extraordinary or proportionate means when there is no hope for recovery. In General most religions support the argument that if there is no benefit, the procedure cannot be obligatory. Just as religion holds that the holy scriptures were given by divine inspiration, so do they believe that life is a gift. While the methods of each church or religion differ, the predominate religions of the western hemisphere do not support prolonging life when their is no benefit to the individual and no hope of their recovery.

Conclusion

“An editorial of sorts”

Although there are several cases involving right to die issue, no clear cut definitions exist in law or legislation about what is considered right or wrong when it comes to the Health Care Provider taking means prolonged life support to a patient in a persistant vegetative state. The fact remains that if an individual does not have living will or some sort of advance directive in place, they are basically leaving the choices up to the hospitals the courts and lastly the family. In some cases the family did not even have the last say.

I have to wonder if it has not become an issue of money to some in the health care profession. When states are picking up the tab the hospitals and nursing homes seem to fight to continue in their quest to prolong life. Frankly I was appalled that the hospitals could even sue to continue care. If the family is fighting to end the care of the patient, what benefit other than money could the hospital or nursing home foresee?

Altogether I hold the same opinion or belief as the held by religion. If there is no hope of recovery, health care providers should not prolong life. I see no benefit to the greater good of society if health care providers are allowed to prolong the inevitable.

Bibliography

Blue Rivers Area Agency on Aging (BRAAA)

Larry Ossowski, Director

Gage County Courthouse, Room 24

Beatrice, NE 68310

World Federation of Right to die Societies Newsletter

Issue #29, November, 1996

ISSN 0742-535X

Choice in Dying Issues

http://www.choices.org/issues.htm#introduction

Legal and Ethical Issues

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