Ethical Issues on Aging & Dying

Carla Staton and Heather Mutchie

Questions?How old is old?When have you lived a full life?What is bioethics and why has it become so

important?What is the difference between active and passive

euthanasia?How does having the option of euthanasia effect

people?How hard should we work to keep an old person

alive? Vs. keeping a young adult or child alive?

BioethicsBecause of increased medical technology,

Bioethics has become more prominent Bioethics is the study of the interface between

human values and technological advances in health and life sciencesWhich means, balancing between respecting a

person’s freedoms and wishes and recognizing that it is impossible to to establish one solid version of the moral decision

Example: the decision to turn off life support for a family member.

EuthanasiaEuthanasia is the practice of ending life

based on mercyEuthanasia is arguably the most important

issue in bioethics today and very controversial

The considerations that must be made when considering euthanasia are the value and quality of a human life

Most common situations where this arises are terminal illnesses and when life is sustained only by a medical machine

Euthanasia

Active vs. Passive EuthanasiaEuthanasia can be practiced either actively

or passivelyActive euthanasia is deliberately and

intentionally ending a person’s lifeIf the patient is unresponsive the wishes of

their proxy or surrogate are considered in this matter.

Passive euthanasia is the type of euthanasia that involves letting someone dieExample: not preforming a surgical procedure

Active EuthanasiaActive Euthanasia is also commonly referred

to as assisted suicideExamples are administering a drug overdose

or disconnecting life supportThough most Americans support actions like

disconnecting life support, there is still strong moral opposition for many reasons, commonly religion

Many studies have been conducted in European countries as well on this issue and found that mixed feelings are widespread

Cont.A Swedish study (Valverius, Nilstun, &

Nilsson, 2000) showed that increasing the education on pain relief methods decreased the amount of requests for assisted suicide

Cultural InfluencesA person’s culture has a tremendous effect on

how they view suicideCatholics view suicide as the ultimate sin Japanese believe that suicide is an honorable

way to dieAsian Americans have the highest rate of

suicide in America and generally feel that being a burden on their families is justification

Less than a third of Americans in most Ethnic groups oppose physician-assisted suicide

Cultural Influences

CriteriaMany people accept physician-assisted suicide if a certain

number of criteria are metThe Oregon law makes it legal to request a lethal dose of

medicine, however there are strict guidelines The Dutch Supreme Court ruled that physicians cannot

be prosecuted for assisted suicide if criteria are metOregon law is more restrictive but fundamentally similar.

It requires that patient be informed that they terminally ill and of all the alternatives, the patient must be mentally competent and make a total of 2 oral requests and a written request with 15 days in between each request

Impacts of Oregon Law341 deaths in the first 10 yearsPsychological benefits for the patients

Knowing the option is available for them to use is comforting

Passive EuthanasiaWithholding treatment from an already dying

person is generally acceptedTreating cancer in a dementia patientThe moral justification is that treatment would only

prolong death and extend the pain of the patientWithholding nourishment, such as food, is generally

opposed by most people, even when the patient is terminally ill.U.S. Supreme Court ruled in the Nancy Cruzan case

that a living will or health care power of attorney must indicate the desire to stop nourishment and that no third party has the right to do so.

Passive EuthanasiaTerri Schiavo Case also dealt with the form of

passive euthanasia that ended nourishment through forced feeding.This case illuminated all of the moral, medical,

and legal issues surrounding the topic of passive euthanasia

The argument between her parents and husband showed how emotional passive euthanasia and the belief in “death with dignity” can be.

End-of-Life IntentionsSome of the controversy and argument around euthanasia

can be avoided by making one’s intentions clearly knownEnd-of-life intentions are generally made known through a

living will. In the living will, feelings about certain treatments, diseases and life support are written down and a durable power of attorney for health care is appointed.

Living wills come into importance when the person is not competent or unconscious.

Living wills bring up issues that many people do not want to think about or deal with so many people avoid taking this step, making the ethics surrounding euthanasia more and more complex

Passive EuthanasiaPassive Euthanasia has become a controversy

in more ways that oneEuthanasia itself is highly debated but

passive euthanasia seems to be contradictory The argument is any form of euthanasia still

ends a life, which is an active processPassive Euthanasia can be accomplished two

ways: withholding treatment and withholding nourishment; However, these two methods are met with differing levels of approval

How old is old?Life Expectancy: age at which 50% of the

population dies as of this Century: 85 years old

Lifespan: maximum potential; longest lived of a population

As of this Century: 120 years old

Arking, R, Biology of Aging

All of these are great for caring for sweet old ladies BUT…Callahan’s “On Setting Limits” 1968What is the social role of the old that we are

keeping around? Being used for the effects that come with aging

rather than for the unique quality of being aged Social responsibilities

Theories of Aging: Disengagement and ActiveTHEREFORE: Is it right to use public funds to prolong

their lives?

Public funding for the AgedACTIVE - The Advanced Cognitive Training for Independent and Vital

Elderly

REACH-Resources for Enhancing Alzheimer’s Caregiver Health

Medicare – gov’t funding for medical expenses

Hospice – end of life care (not exclusive to elderly)

Graph from Dr. Rodney Guttmann

Cont’d

Resource Allocation-Society as a Cell

When have you lived a ‘full’ life?Measurements of quality of life

How to quantify? How could we declare a cut-off point? When can we say a life is ‘worth’ living?