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Is this an act of killing? For a third time his heart fibrillated and he was shocked
Did the doctor criminally assist in a suicide? back to consciousness. When the intern heard of the
Should the patient have a "right" to die in this incident, he ran to see him, and the patient asked, "Why
manner, such that the doctor who supplied have you done this to me? Why will you not let me die?"
the pills will not be charged with violating the
law? The intern asked the same from resident who last
resuscitated him, and he replied, "Because it would be
Case # 2 the same as killing not to do everything possible to keep
A patient with heart failure stays alive with medicines a patient alive." For them the issue was not the
and a pacemaker but dies slowly because his condition and wish of the patient, but the mode of dying.
weakened heart cannot supply his kidneys, liver, and
intestines with enough blood to function.
Extended Dying
Hippocratic Oath
Our modern dilemma is how to deal with the
….I will apply dietetic measures for the benefit of the vastly increased numbers of patients with fatal
sick according to my ability and judgment; I will keep conditions who are dying with more intense
them from harm and injustice….. suffering and debility over longer periods.
For good purpose, physicians help patients In the years to come, patients and their
extend life for as long as technologically physicians will face more and more decisions
possible, but the unanticipated results of life about therapies that carry some possibility for
extension are new conditions of extended the reasonable extension of life but which also
dying that Hippocrates never imagined carry risk of failure and extension of dying with
additional suffering.
Looking back…
Case # 4
In the ancient myth, when Aesculapius, the first A newborn baby with a complicated and fatal
physician, transgressed against the godly powers malformation such as a hypoplastic left ventricle is
over life and death by raising a man from the dead, being kept alive on a ventilator. Surgery to correct the
Zeus slew him with a thunderbolt. defect has a 10 to 20 percent chance of long-term
success, but it also carries a substantial risk of
What was the meaning of the myth? permanent brain damage or lingering dying over months
or years if the operation is only partially successful.
The meaning of the myth was clear: Control over life
and death is the exclusive domain of the gods. After weighing the odds, the parents may decide that
Yet with the advent of resuscitation, physicians buried the chance of success is too slim and the probability of
the myth and entered into very direct involvement in prolonged suffering too great, and so they opt to let the
deciding when patients die. baby die, a medically and morally acceptable position.
The house staff used electrical shock to restore his A QUICK OVERVIEW
scarred heart to regular beating. His medicines were
increased, but the same thing happened again that
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I. The Value of KNOWING about Palliative
and Hospice Care
II. The Value of APPLYING Palliative and
Hospice Care
III. The Value of Palliative and Hospice Care
NOT ONLY for the medically inclined but
for EVERY INDIVIDUAL
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