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1. Termination of life support (TLS): withdrawing or witholding medical treatment for a patient in order to allow the patient to die.
2. Physician-assisted suicide: typically where a physician provides medication by which the patient can take his/her own life.
3. Euthanasia: "good death," where a physician or medical professional has a direct hand in the killing of the patient (i.e. lethal injection).
Ordinary means of treatment: course of treatment for a disease that offers reasonable hope of benefit without being too difficult for the patient to handle, i.e. antibiotics to cure an infection.
Extraordinary means: courses of treatment that offer little hope of recovery for the patient and place extremely high or undue burdens on him/her.
Typically, ordinary means are seen as morally obligatory treatments and extraordinary means are not
Living will/advance directive: decisions a patient makes on treatment before becoming seriously ill. Typically, someone designated with power of attorney will make decisions on the basis of the living will when the patient is no longer able to.
Do Not Resuscitate (DNR): advance directive telling doctors not to resuscitate a patient in the case of a heart attack.
Competence: level of a patient's ability to understand treatment options and give informed consent to an option that is being chosen.
Karen Ann Quinlan (1975-76)
Nancy Cruzan (1990)
Washington v. Glucksberg (1997)
Journal #28
Case 8.1: Your Father's Living Will
Your elderly father has recently been diagnosed with terminal lung cancer. His doctors estimate that he has roughly a year left to live before the cancer will overtake him. He is wisely using this as an opportunity to think about what kinds of treatements he wants or wants to refuse as the cancer takes its course. He has seen a number of his friends die on life support in hospitals and wants to make sure that he doesn't die that way. He is asking you to be his medical decision maker should he lose the ability to make those decisions for himself. Specifically, he does not want to be put on ventilator support, especially if it looks like he cannot be weaned off of it. You realize that means that he may die sooner than if he were on such support, and you wonder if you can do that, given your strong view of the sanctity of life. It feels as if you would be killing your dad if you authorized the witholding or withdrawal of ventilator support.
Answer questions 1-3 on p. 243 in the textbook for this journal entry.
Each answer should be a minimum of 3 sentences.
In the discussion about ethics and the termination of life support, a distinction is often made between withdrawing and withholding treatments:
Removal/termination of life support should meet at least one of the following criteria:
1. A competent adult patient requests it in an advanced directive.
2. The treatment would be futile or of no benefit to patient.
3. The burden to the patient outweighs the benefit.
What do you think about removing food and water?
What kinds of arguments exist in favor of physician assisted suicide?
Write at least 5 sentences in response to the Dr. Kevorkian interview we watched in class. What do you think of Kevorkian? What arguments does he make and are you convinced at all by his arguments? How might you respond to some of his claims if you disagree? How does religion play into the interview? (You don't need to answer all these questions, they're just to get you thinking.)
The Argument from Mercy
The Argument from Utility
The Argument from Autonomy
Euthanasia doesn't violate the hippocratic oath
There is no significant moral difference between killing and allowing to die.
Euthanasia doesn't always involve killing a person.
Looking at pp. 224-234, summarize how Rae responds to each of the arguments in favor of euthanasia and physician-assisted suicide. After you've summarized Rae's response, write whether or not you find each argument sufficient. If you don't, explain why.
1. The argument from mercy (p. 225-227)
2. The argument from utility (p. 227)
3. The argument from autonomy (p. 227-229)
4. Euthanasia doesn't violate the hippocratic oath (p. 229-230)
5. There is no morally relevant difference between killing and allowing to die (p. 230-232)
6. Euthanasia doesn't always involve killing a person (p. 232-234)
Is there a morally relevant difference between killing someone and allowing someone to die?
"Even though the result is the same, the intent is critical in justifying the termination of life support and raising questions about the legitimacy of physician-assisted suicide/euthanasia. The intent in the termination of life-sustaining treatment is not necessarily that the patient dies...most patients who desire to stop such treatments do not want to die; they simply want to live out their remaining days without dependence on medical technoogy that will not change the downward course of their disease and may be more burdensome than beneficial. Although it is true that in many cases the patient will die soon after termination of life support, it is usually not the intent. By contrast, the intent in physician-assisted suicide/euthanasia is clearly to cause the patient to die." (Rae, 232)
What aspects of Christian ethics might a theology of death and dying include?
How much have you thought about death in your own life? Based on the Griffiths article, do you think you have thought about death in ways that are unhealthy or perhaps even un-Christian? How could you adjust your thoughts on death to better reflect a proper Christian response to death? How might this affect our perspective on physician-assisted suicide and euthanasia? (7 sentence minimum)
1. How does Griffiths propose that Christians should think about death? Do you agree or disagree with his main point?
2. What are the problems with “death-seeking” on one hand, and with “death-avoidance” on the other for Christians?
3. What are Griffiths’ four recommendations for Christian practices that will help them to think and prepare well for death?
"The pre-Transition life span unveils a creature: a being with limits, whose life belongs to God. The hard part of this reality is mortality--and inevitable dying is as hard today as ever. This is what the stark limitations on survival made clear but what today's death-marginalizing life expectancy has obscured: we are fundamentally limited creatures who depend on God, and that will never change. The converse of knowing this, however, is the inescapable quality of "miracle" that attaches to life: the miracle is love, which is about giving the self over in the face of limits and mortality. It is impossible to understand the cross of Christ apart from grasping this fact about ourselves. For only to creatures, existing as a divine gift, can the cross be given as the font of fruitfulness. Only mortal creatures can understand how birth and death constitute the place of generation."
- Ephraim Radner
"Death, the Catholic theologian Karl Rahner insisted, is a theological claim. He was thinking of the theoretical possibility that human beings might one day so advance their technologically driven extensions of the life span that "dying" would simply recede as a necessary part of human existence. To say that our deaths are "simply" or "purely" or "essentially" part of who we are is thus to claim something that goes beyond theoretical reason and actually engages our faith. (This is an important claim, since it points to the way that contemporary discussions about technological interventions in human life are in fact religious ones not simply utilitarian in nature.) There is something important here to grasp: part of our Christian vocation is to proclaim the reality of death itself. Nothing could be more revelatory of contemporary forgetfulness--or faithfulness--that the disappearance of this proclamation from Christian teachers and preachers as a central part of the gospel they announce. The tradition of memento mori--"remember that you must die"--was not merely a medieval invention. It stands as a central scriptural focus (e.g., Ps 39:6; Luke 12:20). For to proclaim death, at least in its central aspect of our existence, is to return always to the form of our being as creatures. To announce our creaturehood is to proclaim God."
-Ephraim Radner
Createdness and givenness
On Suffering
Jesus, Death, and Suffering
"The “craft of suffering,"...is the straightforward, steady learning to live with Jesus. Such a life will be filled with pain...At root, though, living just this inevitably painful life with this Jesus is to fashion a good life, ultimately a beautiful life. Yes: a painful life lived with Jesus is indeed “beautiful”; it is, after all, God’s life. Ultimately, it is all about knowing Christ: being taken to him, living with him, learning from him, dwelling within him, and being transformed by the gift of his self. Suffering and Christ — that is entry into God."
- Ephraim Radner
Suffering, Resurrection and Hope
Virtues to die well, (Ars moriendi)
1. Instead of losing faith, focus on the faith of Jesus.
2. Instead of despair, hope in the resurrection of the body and the life of the world to come.
3. Instead of impatience, charity, love, and patience.
4. Instead of pride in autonomy and independence, humility through dependency.
5. Instead of greed, generosity in letting go in peace.
6. Instead of cowardice, courage in the face of death.
"Precisely because death will not have the last word, we need not always resist it. And because the triumph over death is finally not a technological victory, but a divine victory, we will resist not only the commendation of death but also the medicalization of dying."
1. We are not meant to die alone--care and concern for the elderly
2. Visit the sick and dying, death and dying should be public acts
3. Make death more visible
4. Include symbols of death in Christian life
5. Funeral practices of celebration and lament
6. Be careful with language about death and dying
The more pragmatic case against physician-assisted suicide and euthanasia is comprised of one main argument and supplemented by four others:
The four supporting arguments are:
1. Assisting in the death of another is playing God.
2. For all we know, suffering may be redemptive in the life of the patient and others.
3. Misdiagnoses are possible and actual.
4. Deaths are likely to move from voluntary to involuntary euthanasia.