MHA Week 10 Spring 2012 Denise Hill, JD, MPA

Bodies

incinerated stolen

http://www.nj.com/news/index.ssf/2009/01/missing_jersey_city_babys_body.html

Bodies

Bodies

lost See sample policies http://www.azumc.com/body.cfm?id=565

Balancing of individual interests v. societal interests

Prostitution Immunizations Drugs

Selling
Suicide

organs (reconsidered by the AMA).

For Education only-Not legal advice

Has to be consent Can be decedent, healthcare power of attorney, or family.

Law went into effect July 1, 2002. First Person Consent Bill (Senate File 2195) allows "a written statement attached to or imprinted or noted on a driver's license or non-operator's id card, an entry in a donor registry, a donor's will or any other written document used by a donor to make an anatomical gift. www.iowadonorregistry.org.
Is this consent informed?

For Education only-Not legal advice

Many Legal and Ethical Issues:

Who decides if donor card and

family disagrees? beating

When to Harvestnon-heart

Dont sell legally

Confidentiality Who should get the organs?

Priority?

Great article on legal and ethical issues re: organ allocation

http://bioethics.georgetown.edu/pcbe/backg round/davispaper.html
For Education only-Not legal advice

94 year old woman who has been on the list longest; 3 year old girl in NY; 38 year old celebrity in CA who promises to contribute 5 million to cancer; 41 year old scientist in Chicago who is on the cutting edge of finding a cure for Parkinson's; 50 year old Iowa alcoholic who has 2 prior livers destroyed by alcohol will die tomorrow if does not get it; Mexican teenager in NC where hospital made medical errorwrong blood type during prior transplant, urgently needs; or 3 year old Iowa Boy with Cerebral Palsy 2nd on the list.

For Education only-Not legal advice

Practice for the benefit of patients--do no harm

Hippocrates (a.k.a. Father of Medicine)Ancient Greece 400 BC May be considered harmful to die May be considered harmful to live Assumption that we all desire to live
For Education only-Not legal advice

PAS

is Generally a Crime
with physicians role as healer and cant regulate.

AMA CEJA unethicalinconsistent

National

survey of DOsoverwhelmingly opposecontrary to oath

For Education only-Not legal advice

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Vacco v. Quill & Washington v. Glucksberg (1997)

Parties: physicians & patients
Challenged states ban on physician-assisted suicide Claimed denied liberty to choose death

Supreme Court: (9-0 decision)

Right to suicide is not fundamental liberty interest (offensive) Ban rationally related to states interest in preserving life.

State authority to regulate suicide without violating the 14th amendmentPatients no right to suicide, but states can permit. Distinction between letting die (DNR) and making die (suicide).
For Education only-Not legal advice

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Natural Death Act

State Statute affirming terminally ill patients right to refuse treatment

Oregons Death with Dignity Act of 1997

Legalized Physicians ability to write lethal prescriptions for terminally ill patients Attorney General Ashcroft
For Education only-Not legal advice

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Patients Determination Act Slippery Slope Argument

Hippocratic Oath
For Education only-Not legal advice

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Autonomy
Authority for a competent individual to choose how they want to be treated Authority to choose how they want to die

Beneficence
Hippocratic Oath is outdated Protect the best interests of the patient

Justice
Equality of treatment Benefits from treatment and nontreatment
For Education only-Not legal advice

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Right to Refuse Treatment

Right to Advanced Directives

Withdrawing life sustaining technology Withholding life sustaining procedures
For Education only-Not legal advice

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Conflicts:
Prescriptions for lethal drugs
Physicians direct involvement in

states that prohibit Physicianassisted suicide Passive Inaction versus active euthanasia (i.e. Dr. Kovorkian)
For Education only-Not legal advice

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IF PAS is legalized, there might be vulnerable individuals who will fall victim to the euthanasia.

Beneficence versus Malfeasance

For Education only-Not legal advice

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How has medical technology impacted our view on end of life choices? Should the government decide how we choose to die?
For Education only-Not legal advice

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http://depts.washington.edu/bioethx/topics/pas.html

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Background:

In the Netherlands physician assisted (& administered) suicide is legal if meet requirements:
2nd Opinion Hopeless Suffering No prospect of Cure Patient repeated requests euthanasia Further life unacceptable to patient

For Education only-Not legal advice

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Patient

had ALSLou Gehrigs Disease talking & breathing pain/outbursts of crying

Semi

paralyzed

Difficulty

Uncontrollable

Controlled death a comforting thought because alternative is suffocation

For Education only-Not legal advice

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Follows physician through visits with patient and his spouse, going through the mandatory process & choosing/getting the lethal drugs. Highlights the patients (and spouses) physical suffering and depression and how potential euthanasia at time of his death at his control was liberating, yet difficult decision, he postponed several times. Provides personal insight in to the physicians ethical/spiritual quandary

For Education only-Not legal advice

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There are no easy answers!

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2005-Dutch law enforcement cracking down on any non-physician assisted suicide they find, sentencing an old man to six months imprisonment for helping a sick, old woman to die Assisted Suicide Around the World http://www.assistedsuicide.org/suicide_laws.html

For Education only-Not legal advice

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