This material has been developed by and is presented by The Sandwich Generation (r)
END› OF› LIFE DECISIONS
by Carol Abaya, M.A.
Involuntary Active Euthanasia:› Euthanasia, translated literally, simply means a žgood death.Ó› Traditionally it has been referred to the hastening of a suffering personŪs death or žmercy killing.Ó› Involuntary euthanasia refers to an intervention that ends a patientŪs life without obtaining the informed consent of that patient.
Voluntary Active Euthanasia:› Voluntary active euthanasia involves an intervention requested by a competent individual that results in death.
Assisted Suicide:› Assisted suicide refers to the act of providing the means to commit suicide knowing that the recipient plans to use them to end his or her life.› Physician assisted suicide specifically refers to a physician providing medications or other interventions with the understanding that a patient plans to use them to commit suicide.
The Withdrawal or Withholding of Medical Treatment: ›An individual has a constitutional right to request the withdrawal or withholding of medical treatment, even if this will result in the personŪs death.› This right was further supported by the Federal Self-Determination Act (1991) and subsequent court cases.
An individualŪs right to refuse treatment is still valid when he or she becomes incompetent, if the person has recorded his or her wishes in an appropriate legal document.› The Living Will and the medical power of attorney are examples of these documents.
Many states also have enacted surrogate decision making laws that allow relatives to make medical decisions for incapacitated family members in the event that the patient does not have an advance directive.
Prognosis:› A physicianŪs opinion of outcome based on the existing medical conditions and signs.› A determination of future medical condition and projected žquality of life.Ó
Medical Futility:› Treatment that is given, but which will not change the prognosis or outcome and may be deemed inappropriate given the prognosis.
TO PULL THE PLUG?
žEach person has his or her own definition of what is tolerable.› The patient is the expert on his own circumstances.› The most frightening aspect of death for many is not physical pain but the prospect of losing control and independence and of dying in an undignified, unaesthetic, absurd and existentially unacceptable condition,Ó› according to Dr. Timothy E. Quill, a specialist in medicine and psychiatry at the University of Rochester School of Medicine and Dentistry.
This is the dilemma millions of families face each year in relation to the life and death of a loved one.› What and how much is žtolerable,Ó žacceptable?Ó› How does one arrive at a decision žto pull the plug?Ó
Quill told The Sandwich Generation, žWhen disintegration of a person means there is no other escape, then the want for death is logical.Ó
This may be true for many.› But for others, like actor Christopher Reeve, life itself is more important than quality.
So, weŪre taking the approach that itŪs ok to want to žliveÓ regardless.› And itŪs just as ok to say žlet me goÓ or žhelp me go.Ó
Many seniors and the elderly actively take things into their own hands,› when their life žgets too badÓ› or quality of life becomes žunacceptableÓ to them.
More than 6,500 Americans over 65 take their own lives each year.› This is 3 times the rate of those between 15 and 44.› 25% of all suicides are by people over 65.› And the white male rate is four times higher than the average.
These žsuicidesÓ including hanging, shooting, poison, suffocating, medicine overdose, and refusal to eat or take medicine.›
Those most at risk for wanting an earlier death are those who are ill and have impairments.› The illness coupled with low income financial status, no spouse, social isolation, loneliness, feeling unwanted and useless, unneeded and unloved increase the žwant to goÓ decision.
The elderly also fear the loss of control of their life and being left alone.
As medical wonders allow more people to live to a žripe old ageÓ in spite of chronic illnesses, the issues of death and dying do have to be faced by every family.
There are two key issues, and decisions are made in accordance with the individualŪs person and the familyŪs perspective of the first.
While the first question is critical, we will not deal with it here.› For each person, the answer will be different.› Quality of life seems to be peopleŪs major concern.› But the definition of žqualityÓ and the level of it means different things to different people.
Many would have difficulty having to be in a wheelchair and would find such a life as žunacceptable.Ó› While others have no problem with this.› Many like Reeve, can accept having to depend on others for all personal care.› Many cannot.
It also depends on family values.› Whether one looks at dying and helping to ease those last days as destruction of life or as an act of caring and control of self if the person has expressed wishes to die.
A key element in arriving at the family žcomfort levelÓ is to ask, žIs it more humane to end a painful life than to watch, over time, a protracted dying?Ó
There is no answer that is žrightÓ for everyone.
What is foremost in an end-of-life scenario is that the family fully understands the patientŪs values and acceptability level.› In other words, is life žtoo difficultÓ by the patientŪs standards?› Secondly, one must look at the prognosis and tie that in with the žacceptabilityÓ level of the patient.› Answering the following questions honestly can help families make critical and comfortable decisions.
If the illness is incurable, and irreversible, if there is a high pain level, and if projected quality of life is not acceptable by the patient, then, according to Quill, žthen death may not be a bad outcome.Ó
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