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WHEN MAY I DIE AND WHEN AM I DEAD?
•Ethical frameworks•Medical ethics•Science, Medicine and Demographics•Issues and Implications
A THOUGHT WITH WHICH TO BEGIN
• There are two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.
Albert Einstein
ETHICAL FRAMEWORKS
• Deontology (Duty-based; Kantian Ethics)
• Consequentialism (Results-based)• Virtue (Character-based -Aristotle,
Aquinas)• [Natural Law – Aristotle, Aquinas]
• Communitarian Aspects – Michael Sandel, Stanley Hauerwas
MEDICAL ETHICS Beneficence, Do good Non-malificence Don’t do harm Justice Treat people fairly Autonomy Respect individual rights
Beauchamp & Childress, Principles of Biomedical Ethics
What type of ethical system is this? What about wisdom and
compassion?
LIFE EXPECTANCY• Life-spans are increasing each day by an
average of two hours.• Great Britain, averages• 1930, Men – 60• 1970, Men – 68, Women - 71• 2012, Men – 79, Women – 83
• But note huge differences, even within one city, eg Glasgow
Country Average life expectancy, years
Monaco 89.7Singapore 83.8Switzerland 81.2Denmark 78.8USA 78.5Sri Lanka 75.9Jamaica 73.4India 67.1Kenya 63.1Botswana 55.7Zambia 52.6Swaziland 49.4Republic of South Africa
49.4
Note:In Africa, averages are lowered by childhood deaths and by HIV/AIDS
Data from CIA World Fact Book
THE DOWNSIDE
• Frequencies of dementia in the UK, 2012
• Age 40–64 1 in 1400• Age 65-69 1 in 100• Age 70-79 1 in 25• Over 80 1 in 6
HEART
LUNGS BRAIN
It used to be easy: when the heart had stoppedbeating and breathing had ceased, the person had died. Since 1976 in the UK, cessation of brain stem function has also been taken as an indication of death. However, with our increased understanding of the relationship between heart, lung and brain function and our technological ability to provide replacements for at least some of those functions, defining death has become more difficult and this has led in turn to cases in which deciding about continuing or stopping treatment is very problematic.
THE ISSUES
• Voluntary euthanasia• Involuntary euthanasia• Assisted suicide• Withdrawing or withholding
treatment
IMPORTANT QUESTIONS
• Can euthanasia ever be justified?• Can killing ever be caring?• When should medical treatment be
withdrawn or withheld?• Is there a difference between killing a
person and letting them die?• Is there a moral difference between
euthanasia and assisted suicide?
IMPORTANT QUESTIONS
• Why shouldn’t I decide when I want to die?
• Isn’t it my right to make decisions about my own life?
IMPORTANT QUESTIONS
• What about the doctor’s part in all this?
• How does euthanasia / assisted suicide relate to the commandment ‘You shall not kill’?
• Is there a ‘Christian view’?
LEGAL EUTHANASIA
• Belgium•Netherlands•Luxembourg
• In Belgium and Netherlands, teenagers as young as 13-years old may opt for euthanasia
OTHER LEGAL ASPECTS
• Assisted suicide is legal in Switzerland, and in three US states
• But withdrawing or with-holding treatment, where further treatment is deemed ‘futile’, is legal in most countries. Some call this ‘passive euthanasia.’
MEDICAL ETHICS
Beneficence, Do good Non-malificence Don’t do harm Justice Treat people fairly Autonomy Respect individual
rights
What about wisdom and compassion?
HOW DO WE APPLY MEDICAL ETHICS?
• Compassion – ‘condemned to life’ (does beneficence exclude ‘mercy killing’?)
• Autonomy – it’s my life• Openness – it happens anyway• But ...• Is ending someone’s life the only way
to show compassion?• Does my exercise of autonomy affect
other people?