DEATH AND DYING

Jerbies E. Llames, RN
• OBJECTIVES: Students should be able to
1. Understand the meaning and cases of euthanasia
2. Understand issues involving death of the dying patient
3. Understand issues about organ donation
4. Apply ethical principles related to death and dying.
• EUTHANASIA
means EASY DEATH (Greek word eu means easy, and thanatos means death)
painless and peaceful death- mercy killing
person from a marked deformity and unbearable and distresssing disease
affirms an individual’s right to die in a painless and peaceful manne

CASES OF EUTHANASIA
SELF- ADMINISTERED- voluntary and deliberate
OTHER ADMINISTERED-
CASES OF EUTHANASIA
SELF- ADMINISTERED
1. ACTIVE AND VOLUNTARY
2. PASSIVE AND VOLUNTARY
3. ACTIVE AND NON-VOLUNTARY
4. PASSIVE AND NON-VOLUNTARY
PROBLEM OF HUMAN DIGNITY
moral issue about the preservation of human dignity in death
positive: preserve human dignity until death
negative: erodes human dignity
DIFFERENT VIEWS
T. GARRY WILLIAMS- moral wrong
JAMES RACHELS- humane
PHILIPPA FOOT- endorsed active and passsive euthanasia
RICHARD BRANDT- prima facie duty
• INVIOLABILITY OF HUMAN LIFE
• principle of implied protection regarding aspects of life that are said to
be holy , sacred, or otherwise of such value that are not to be violated
• DYSTHANASIA- is the term for futile or useless treatment, which does
not benefit a terminal patient. It is a process through which one merely
extends the dying process and not life per se. Consequently, patients
have a prolonged and slow death, frequently accompanied by suffering,
pain and anguish. Patient is kept alive artificially , in a condition,
otherwise they cannot survive
• ORTHOTHANASIA- derives from the Greek orthos, which means
“correct,” and thanatos, meaning “death.” In other words, death at the
appropriate time with due respect to the limits of life 24-26. A normal or
natural manner of death and dying
• ADMINISTRATION OF DRUGS TO THE DYING
in medicine, end of life care-palliative sedation is the
practice of relieving distress in a terminally ill person in the
last hours or days of a dying patient, usually by means of a
continous IV or SUBCU infusion of sedative drugs , or
specialized catheter to provide a comfortable and discreet
administration of ongoing medications
PASSIVE SEDATION - is an option of last resort for pts
whose symptoms can’t be controlled by any other means.
it is not a form a euthanasia- since it’s goal is to control
symptoms not to shorten pt’s life
• PALLIATIVE CARE- specialized medical care for people living
with a serious illness, such as cancer or heart failure. Patients
in palliative care may receive medical care for their
symptoms, or palliative care, along with treatment intended
to cure their serious illness.
• CPR DECISIONS
• Resuscitation efforts are used to reverse the clinical sign of
death (loss of spontaneous respiration, loss of cardiac
function & unconsciousness).
• Ethical questions arise on use of CPR & emergency cardiac
care.
• A DO NOT RESUSCITATE (DNR) order is generally written
when the client or proxy has expressed the wish for no
resuscitation in the event of a respiratory or cardiac arrest.
• WITHHOLDING/WITHDRAWING OF LIFE SUPPORT
• Withholding” refers to never initiating a treatment, whereas
“withdrawing” refers to stopping a treatment once started.
• The distinction between not starting a treatment & stopping
it is not itself of ethical significance; what is whether the
decision is consistent with the patient’s interests &
preferences.
• The nurse ensures that the patient/surrogate understands
the information by clarifying technical terms & helping the
patient weigh treatment options.
• The patient then considers his or her own values & wishes in
the context of prognoses & realistic options.
• The final decision reflection the patient’s wishes should be
supported by the nurse & other members of the health care
team.
 POINTS TO CONSIDER
• Withdrawal of life support is indicated if the patient has
Glasgow coma score is less than 5, absence of pupil &
motor response 3 days after arrest.
• Communicate frequently throughout the critical care stay,
not just when death is imminent.
• Provide consistent, honest information.
• Keep the discussion on withholding/withdrawing life support
based on patient wishes & the burden versus benefits of the
various options.
• Recognize that the patient & family are anticipatory grieving
& provide support.
• Most decisions regarding withdrawal/ withholding of life
support are not made in courts. It made based on open
communication with patient, family & surrogate as
appropriate.
• ORGAN DONATIONS
• The important ethical principles useful in decision making on
transplantation include respect for persons, autonomy,
beneficence, Nonmaleficence, justice & fidelity.
• The process when a person allows an organ of their own to
be removed and transplanted to another person, legally.
• The donation can be made by a provision in a will or by
signing a card-like form. This card is usually carried at all
times by the person who signed it.
• Coordinate with the Organ Donation unit
APPLICATION OF ETHICAL THEORIES
• NATURAL LAW- condemns mercy killing, implies direct and
deliberate killing of a person,hence it is murder ( PRINCIPLE
OF STEWARDSHIP AND INVIOLABILITY OF LIFE)
• PRINCIPLE OF DOUBLE EFFECT
• KANT- human dignity of an autonomous human being
• UTILITARIANISM- benefit of happiness for the majority
makes this legitimate
• PRAGMATIC theory- truth and good of euthanasia
• SITUATIONISM- justify and endorse euthanasia
APPLICATION OF ETHICAL THEORIES
• ROSS’S ETHICAL PRINCIPLE- prima facie duty
• RAWL’S CONCEPT- no amount of social good or welafre can
override the inviolabilty of human life