Death and Dying PRINCIPLE OF GROWTH THROUGH HUMAN SUFFERING As bodily pleasure should be sought as the fruit of the

satisfaction of some basic need of the total human person, so suffering and even bodily death when endured with courage can and should be used to promote personal growth in both private and communal living. Why Should Life be preserved? Human life is sacred; it is a gift from God By the principle of stewardship, we are given a shared, not absolute dominion over life God alone is the author of life and he alone can determine when our life ends Truth We Should Accept in Caring for Dying Persons Sickness and death are natural parts of life Dying is a human process not a medical event Dying persons are living persons Goal of care should be to help them live well while dying Crucial fears of the terminally ill: 1. Fear of unbearable pain 2. Fear of excessively burdensome and futile treatment 3. Fear of loss of autonomy and personal dignity 4. Fear of dying alone in loneliness Phases of Dying - Denial - Anger - Bargaining Depression - Acceptance and Hope (E. Kubler Ross) CARE FOR THE DYING - Health care professionals must address their own beliefs, anxieties and fears about their personal mortality before they can care appropriately for patients who face their own dying - We must accept that the dying process can be aided by good medicine but can be perverted by medicine Goals of Care and Treatment in the Terminally Ill Well-being of the patient achieved through attention to the physical, mental, social and spiritual needs of the dying person Appropriate pain management is to relieve physical pain Skillful interventions to facilitate expression of emotions that accompany mental pain We have to accept that dying persons are living persons so we have to help them live well while dying Supportive services are to allay guilt and sadness over unfulfilled social commitments Dying with Dignity 2 perspectives: To some people dying with dignity means that one should be able to make the decision to die when dying will be better than to go on living with an incurable distressing illness To some people dying with dignity means facing pain and suffering. People who face the realities of life with courage die with dignity Withholding or Withdrawing of Life Support This may be compatible with beneficence, non-maleficence and autonomy Brain death is not a necessary requirement for withdrawal/withholding of life support Use of proportionate (morally obligatory) and disproportionate means (morally non-obligatory)

PRINCIPLE IN THE USE OF ORDINARY (proportionate) and EXTRAODINARY MEANS (disproportionate) Ordinary Means: Not only food, drink and rest, but all medicines, treatments and operations, which offer a reasonable hope of benefit for the patient and which can be obtained without excessive expense, pain or other inconveniences. PRINCIPLE IN THE USE OF ORDINARY (proportionate) and EXTRAODINARY MEANS (disproportionate) Extraordinary Means: When the means used do not offer reasonable hope of any notable benefit to the patient. When the burden or risks entailed in the procedure outweighs the benefits it promises PRINCIPLE IN THE USE OF ORDINARY (proportionate) and EXTRAODINARY MEANS (disproportionate) Medical treatment is extraordinary when it is futile and imposes grave burden on the patient and family involved and therefore, non- obligatory Pope Pius XIIDifference between Ordinary and Extraordinary Means Ordinary Standard, recognized, established medicine, procedures during that period at the level of medical practice Includes not only normal food, drinks and rest but also in terms of hospital practice, all medicines, treatments, procedures which offer reasonable hope of benefit. For the patient which can be obtained and used for excessive expense, pain or other inconvenience Extraordinary A medicine or procedure that may be fanciful, bizarre, experimental, incomplete and not recognized All medicines, treatments and operations which cannot be obtained or used due to excessive expense, pain or other inconvenience for the patient or for others, on which if used would not offer a reasonable hope for the patient Do not Resuscitate (DNR) It must be made for the best interest of the patient- not the family, health care provider, insurance company or society at large All involved parties should agree what a DNR means; i.e.; no CPR if heartbeat or breathing stops It must be treatment which is heroic or disproportionate, futile or excessively burdensome It must periodically evaluated Advance Directives Document in which a person either states choices for medical treatment or designates an individual who should make treatment choices if the patient should lose his decision making capacity It can also apply to oral statements from patients to the caregivers given at a time when the patient was decisionally capable Forms of Advance Directives Living will - Patient must be terminally ill - Must lack decision making capacity Durable Power of Attorney - document that designates a surrogate decision maker should the patient becomes incompetent. It does not require the patient be terminally ill

EUTHANASIA (Good death, pleasant death mercy-killing) - an act (medical) that renders a patient dead to end his suffering.- the intention is death for the purpose of eliminating pain Dysthanasia- unnecessary prolongation of the dying process by employing disproportionate means Orthothanasia- right death - allowed to die by withdrawal or withholding disproportionate means - Patient dies because of underlying pathology Suicide- killing oneself either by acts of commission or omission EUTHANASIA MORAL EVALUATION: IMMORAL - Intentional killing and opposes the natural inclination to preserve life - Maybe performed for self-interest or other consequences - Health care professionals may be tempted not to do their best to save the patient; a simple way out and to disregard any other alternative Allowing to Die A time comes when prolonging life may not contribute to the spiritual purpose of life (serving God and others) - This time might be used compose oneself and come into terms with death, deal spiritually with God and others - Not rejecting life but accepting what God has given him/her Moral Differences between Euthanasia and Allowing to Die Euthanasia - intention brings about death by performance or withholding an act - Death directly intended by the agent Allowing to Die - patient dies because of the fatal pathology - Death is an unwanted side effect of a good ethical action extraordinary or