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Death and Dying

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Transcript of Death and Dying

End of Life Options
Death and Dying
End-of-Life Decision Making
Decision Making
Heart Disease
Lung Cancer
A New England Journal of Medicine poll questioned readers about a hypothetical near-death case and received more than 2,000 valid responses. Roughly two-thirds worldwide -- including 67 percent of replies from the United States -- said they disapprove of physician-assisted suicide.
End of Life Care
Ways to Define Death
Causes of
In the spring of 2014, 29-year-old Brittany Maynard learned that she had terminal brain cancer, glioblastoma multiforme. She and her family decided to move from their San Francisco Bay Area home to Oregon.
Brittany approached Compassion & Choices, the nation’s leading end-of-life choice advocacy organization, and asked how she could help advocate for more options for terminally ill Americans.
Brittany agreed to be interviewed on film regarding death with dignity because of her strong belief in the ethics of this basic healthcare and human rights.
“I decided to share my story. And it wasn’t an easy choice to make. But I decided to share it because I felt this is issue of death with dignity is misunderstood by many people in our community and culture”

-Brittany Maynard
“The freedom of death with dignity, it exist because this is a choice. I chose this for myself. But my question is… who thinks that they can sit there and tell me that I don’t deserve this choice.”

-Brittany Maynard
Most readers of the journal are
. Some said assisting a suicide violates a physician's oath to
do no harm
and might lead to euthanasia -- intentional killing to relieve suffering and pain.
Internationally, physician-assisted suicide is legal in five countries: Belgium, Germany, Luxembourg, the Netherlands and Switzerland. In the United States, Montana, Oregon, Vermont and Washington allow physician-assisted suicide.
”When high-quality palliative care is provided, people are comfortable, they live longer, they spend time with their families and the worries that drive somebody to say 'I would like assisted death' typically vanish."

- Dr. R. Sean Morrison
President of American Academy of Hospice and Palliative Medicine
5 Leading
Death in Men
Dementia & Alzheimer's
Heart Disease
Dementia & Alzheimer's
Causes of
5 Leading
Death in Women
Flu & Pneumonia
Lung Cancer
“Who has the right to tell me that I don't deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?”

-Brittany Maynard
Death-with-dignity laws authorize the medical practice of aid in dying, which offers mentally competent, terminally ill adults with less than six months to live the option to request a prescription for medication they can self-administer to end their dying process if it becomes unbearable.
Recent Legislation
California Gov. Jerry Brown (D) signed California’s right-to-die bill into law Monday October 5th, 2015, allowing terminally ill residents of the nation’s most populous state to end their own lives with the aid of their physician.
The law will allow terminally ill patients to seek medical aid in ending their lives as long as they have been given six months or less to live by two doctors, provided a written request and two oral requests at least 15 days apart and are deemed mentally capable of making decisions about their own health.
The California bill was inspired by Brittany Maynard, the 29-year-old San Francisco Bay Area resident who gained national attention for her decision to move to Oregon to take advantage of the state’s longstanding aid-in-dying law.
The legislation started out as SB 128, a bill introduced in January. That bill cleared the California Senate, but ultimately stalled in the state Assembly in July. The authors then introduced a similar bill in August, during a special legislative session called by Brown in summer of 2015.
• Brain functions are irreversibly lost
• Heart and lung function cease
• Careful diagnosis of total brain failure
The goal of care for people who are dying focuses on helping them enjoy as good a quality of life as possible. This may include relieving suffering; helping people stay as well as they can; and helping them achieve goals that are important to them before they die.
Formerly Competent Patients
• Autonomy
• Continuing life support
• Care of the hopelessly ill
Futility Judgements
• Physiological futility
• Normative futility
Tension between judgments
Substituted Judgment Test
Best Interest Test
• Who should the surrogate
decision-maker be?
• How much discretion should they have?
Beneficence – use beneficence to guide decisions regarding the patient’s best interest.

Justice – values of the medical profession versus personal/family values.
Application in the ANA
Provision 1:
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
P. 1.1:
Respect for Human Dignity
P. 1.3:
The Nature of Health
P. 1.4:
The Right to Self-Determination
Provision 2:
The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population.
P. 2.1:
Primacy of the Patient’s Interest
Provision 6.2:
The Environment and Ethical Obligation
Application in the ICN
Nurses have four fundamental responsibilities.
Element 1: Nurses and People
In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.

Christian Perspectives
on Death
Shelley and Miller (2006) explained that regardless of how much we love and trust God, most individuals fear death. In the Christian perspective, death presents a paradox of terror and hope.
Shelley and Miller (2006) elaborated that death is both the hope of eternal life and the fear of the unknown - a joyous expectation of seeing God and the fear of His wrath.
Apostle John (1 Jn 4:8, 1:5 as cited in Sire, 2009) stated that “God is love - in Him there is no darkness at all” (p. 212).
No natural force or spiritual being can overcome God - He is our refuge because God wanted to (Sire, 2009).
American Nurses Association (2015). Code of ethics with interpretive
statements. Silver Spring, MD. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

Beauchamp, T. L., & Childress, J. F. (2014). Principles of Biomedical Ethics. New
York: Oxford University Press.

Fry, S. T., Veatch, R. M., & Taylor, C. (2011). Case studies in nursing ethics (4th ed.).
Sudbury, MA: Jones & Bartlett Learning.

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for
nursing. Downers Grove, IL: InterVarsity Press. Sire, J. W. (2009). The universe next door. Downers Grove, IL: InterVarsity Press.

The ICN code of ethics for nurses. (2012). Geneva: Switzerland: ICN-
International Council of Nurses. Retrieved from http://www.icn.ch/about-icn/code-of-ethics-for-nurses/

Thank You!
Full transcript