End life issues - case studies - tutorial 5(1) PDF

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End lif life e issues / euthanasia: Ri Rights ghts and/or Wrongs - Euthanasia ‘Good Death’ “An act of ending a person’s

life in a situation of intolerable suffering”

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Case study 1:

Mable is an 82 year old lady who has lung cancer. She was diagnosed 8 months ago and is extremely poorly. She has been suffering terrible pain for over a month, which is not relieved by high dose analgesia, she is struggling to breathe and is suffering various unpleasant symptoms. Mable has asked her doctor and the nursing staff repeatedly to be given an injection to end her life. She is adamant that she wants to die as she feels her quality of life is extremely poor and she has stated on several occasions that a dog wouldn’t be treated like this.

Questions for discussion 1. Identify possible legal issues from this case study? 

Lung cancer- poorly?? Struggling to breathe is this caused by the analgesia or Mable’s condition? Doctrine of double effect may kill the pain and the patient.

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Pain not relieved by high dose analgesia – one month

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Wants to die

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Quality of life poor

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Has requested an injection to end her life- illegal cannot kill if intent- murder. Euthanasia not legal in Australia, Assisted suicide would be conspiracy to murder in Australia. In Switzerland they have a legal euthanasia program.

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Capacity? Pain, level of coherence following high doses of pain relief

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Advance directive?? Living will in the presence of a lawyer-Not for resuscitation etc.

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Supreme Court to decide- short term pain, have they tried alternatives, quality of life poor will get worse

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Conditions for overriding the Prima Facia to treat:

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Pointless

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Death 1

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Irreversible dying

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Burdens outweigh the benefits

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Quality of life but if treatment reduced there will be a further reduction in the quality of life

2. Apply the ethical principles (Beneficence, non-maleficence, autonomy, justice) and objectively address any positives / negatives issues from the case study. Arguments for euthanasia Benefits- relief of suffering and distress Non-maleficence

Prolonging suffering can cause harm yet withdrawal of treatment as in pain relief would lead to more suffering in this woman. Yet withdrawing treatment would make things worse.

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Increasing the pain relief may kill the pain and the patient. Is palliation appropriate when they said she was poorly, they did not say that she was terminal. Were alternative types of pain relief available.

Autonomy an argument for euthanasia Justice- fair treatment for all equal benefits 3. How would the theory of utilitarianism view this?

4. How would the theory of deontology view this?

5. Does Mabel’s age impact on your approach to this case scenario? Is quality of life relevant here?

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Case study 2: Phil is a 42 year old man who suffers from Motor Neurone Disease, which is an extremely painful condition and results in loss of motor responses. Phil has been in a wheelchair for some time, he can no longer feed himself or indeed, carry out any activities of daily living. His speech is slurred and it is becoming more difficult to communicate with him. Phil is married with 2 adolescent children, his wife is his carer. However, he is very clear in his wish to die and has stated that if he was able to, he would end his own life. He has repeatedly requested an end to his suffering and wants the doctor to give him something that will stop his suffering.

Questions for discussion 1. Consider any relevant laws, any legal issues / implications. Withdrawal of treatment will lead to a slow and painful death – food withdrawal- possible as Phil’s condition will only get worse. Is passive euthanasia as the food is keeping Phil alivelegal It is legal to refuse life sustaining treatment – Atkins, 2017, 258. Euthanasia illegal in this country Cannot assist suicide intentions even though he is happy to die ? Capacity painful condition yet lucid Slurred speech Advanced care directive?? Courts can decide ? Palliative care Physician assisted deaths in the Netherlands, US 1984 Switzerland euthanasia is legal.

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1995 NT passed “Rights of the terminally ill act” legalised medically assisted voluntary euthanasia but overturned 1997 federally Euthanasia is a criminal offence and is punishable by imprisonment Atkins, 2017 Victoria 2016 considering an end of life framework which would enable the terminally ill with two medical practitioners to decide if end of life is appropriate. 2. Apply the ethical principles addressing both positive / negative view points / perspectives. Benefits withdrawal of care ?an end to suffering Non-maleficence may do harm starving to death, could try increased analgesia Autonomy – decision to withdraw care Justice -Resource allocation- cost of keeping Phil alive

3. How would deontology approach this from a health professional perspective?

4. How would the theory of utilitarianism be applied to this scenario?

5. Consider Phil’s capacity and competence. Pain Slurred speech May feel under pressure to end his life to reduce the pain and suffering of the family Depression? Can understand and weigh up the alternatives Drs decide on this.

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A question fo forr discussion

Question: If one terminal cancer patient refuses necessary life-sustaining treatment, and another terminal cancer patient purposefully takes a fatal dose of necessary painkillers for managing the pain of the cancer, are these two circumstances of death morally different?

Also consider: 

Patient autonomy and personal morals.

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Burden V Benefit

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Euthanasia (passive /active) = result the same?

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Terminally ill – both will die

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Resource allocation / justice / $$

Further reflections related to nursing responsibilities: Must not assist anyone to commit suicide or complete voluntary euthanasia. Remain within your competence and scope of practice Practice within the law Maintain a duty of care Assisted suicide would lead to the following: Could be taken to the civil court – negligence Breach of duty of care causing harm

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