SF #020
This material has been developed by and is presented by The Sandwich Generation (r)
ENDÝ OFÝ LIFE DECISIONS
DEFINITIONS
by Carol Abaya, M.A.
Involuntary
Active Euthanasia:Ý
Euthanasia, translated literally, simply means a ìgood death.îÝ Traditionally it has been referred to the
hastening of a suffering personís death or ìmercy killing.îÝ Involuntary euthanasia refers to an
intervention that ends a patientís life without obtaining the informed consent
of that patient.
Voluntary
Active Euthanasia:Ý
Voluntary active euthanasia involves an intervention requested by a
competent individual that results in death.
Assisted
Suicide:Ý 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.Ý
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: ÝAn individual has a constitutional right to
request the withdrawal or withholding of medical treatment, even if this will
result in the personís death.Ý This
right was further supported by the Federal Self-Determination Act (1991) and
subsequent court cases.
An individualís 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.Ý 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:Ý A physicianís opinion of outcome based on
the existing medical conditions and signs.Ý
A determination of future medical condition and projected ìquality of
life.î
Medical
Futility:Ý
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?
OR NOT...
ìEach person has his or her own definition of what is tolerable.Ý The patient is the expert on his own circumstances.Ý 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,îÝ 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.Ý What and how much is ìtolerable,î ìacceptable?îÝ How does one arrive at a decision ìto pull the plug?î
Quill told The Sandwich Generation, ìWhen disintegration of a person means there is no other escape, then the want for death is logical.î
This may be true for many.Ý But for others, like actor Christopher Reeve, life itself is more important than quality.
So, weíre taking the approach that itís ok to want to ìliveî regardless.Ý And itís just as ok to say ìlet me goî or ìhelp me go.î
Many seniors and the elderly actively take things into their own hands,Ý when their life ìgets too badîÝ or quality of life becomes ìunacceptableî to them.
More than 6,500 Americans over 65 take their own lives each year.Ý This is 3 times the rate of those between 15 and 44.Ý 25% of all suicides are by people over 65.Ý And the white male rate is four times higher than the average.
These ìsuicidesî including hanging, shooting, poison, suffocating, medicine overdose, and refusal to eat or take medicine.Ý
Those most at risk for wanting an earlier death are those who are ill and have impairments.Ý The illness coupled with low income financial status, no spouse, social isolation, loneliness, feeling unwanted and useless, unneeded and unloved increase the ìwant to goî decision.
The elderly also fear the loss of control of their life and being left alone.
Discussion Needed
As medical wonders allow more people to live to a ìripe old ageî 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 individualís person and the familyís perspective of the first.
While the first question is critical, we will not deal with it here.Ý For each person, the answer will be different.Ý Quality of life seems to be peopleís major concern.Ý But the definition of ìqualityî 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 ìunacceptable.îÝ While others have no problem with this.Ý Many like Reeve, can accept having to depend on others for all personal care.Ý Many cannot.
It also depends on family values.Ý 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 ìcomfort levelî is to ask, ìIs it more humane to end a painful life than to watch, over time, a protracted dying?î
There is no answer that is ìrightî for everyone.
Look At
What is foremost in an end-of-life scenario is that the family fully understands the patientís values and acceptability level.Ý In other words, is life ìtoo difficultî by the patientís standards?Ý Secondly, one must look at the prognosis and tie that in with the ìacceptabilityî level of the patient.Ý 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, ìthen death may not be a bad outcome.î
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