Right to die vs. right to live - page 3

the following posting is in reference to a class project regarding the topic of the right to live versus the right to die. our group of senior nursing students, at the university of west florida, will be presenting this topic for... Read More

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    1. I cannot see any possible way that a person in Nancy's case would want to continue to receive feeding from a tube in her situation. There comes a time when we need to just trust the professionals that have seen this scenario played out time and time again. When the best case scenario that comes from continued feedings is merely sustained life that excludes awareness, emotion, love, or any other part of life that we all enjoy, we are probably obligated to allow them to die. This sounds harsh, but when someone is in a PVS for whatever reason, we have to assume that the physicians taking care of these people know what they are talking about when they say there is no hope left. There is no evidence in Nancy's case that would suggest that she would have any desire to continue as she is. At the same time, there is no evidence that suggests the alternative either.
    2. I would suspect that for every person that was asked this question, you would have that many different answers. I think that Nancy would obviously be considered a person. To me, the definition of a person is the body of the human being. With that said, I maintain that she is a person, though she is a person that cannot take care of herself, cannot think for herself, and cannot make any decisions for herself. All of these things that she lacks is what would be applied to the attributes that define a conscious person.
    3. I certainly think that because of Nancy's inability to feel pain or embarrassment, the entire dilemma is in the hands of the family. The family members are the only ones invovled with a true emotional stake in this case.
    4. This is a tricky question because it goes back to the question of what defines death. There could be stark differences in what the state considers dead and what the family considers death to be. I don't believe that there would be any constitutional claim to going against their wishes. I think that if a patient has insurance or other financial means of paying for the treatment, then nobody should be able to tell them when they must stop. I don't think that the state should be involved unless there is a dispute within a family on whether or not to "unplug" a patient.
    5. I don't think there was any "symbolism" whatsoever. I think this is a vague question and I'm not really sure why it was asked.
    6. I feel that the end result is the same, death. Obviously, there would be no need for a ventilator if the patient was already breathing and just needed a feeding tube in place.
    7. I don't think the state has any right whatsoever to determine what state a patient receives treatment in, or lack thereof.
    8. I think that the decision for any individual to end their own lives rests within that individual alone. I am not a proponent of physician assisted suicide in the least, but if it becomes lawful, I think it must be reserved for those capable of making the decision on their own.
    9. I think that there is a difference that must be looked at. I believe that passive euthanasia is probably a more ethical tactic than active. Active euthanasia just takes on an air of murder in my opinion. Whenever you intentionally administer something to someone to cause death, i think you are committing murder. Withholding medications that may be keeping someone alive but not improving their prognosis doesn't seem to have such a negative connotation.

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    1. doctors examining nancy cruzan concluded that she was in a persistent vegetative state, had no awareness of her environment, and had no hope of ever having awareness of her environment. what reason is there to doubt that any person in nancy's circumstances would want--if they were capable of even wanting--feeding to be continued? was there any evidence at all suggesting nancy would want to continue to "live"? one could make the argument that only the very close family of nancy (for some patients that includes friends, etc) can answer that question for her. her health care professionals could only comment on this if nancy had ever directly communicated a specific wish to them.

    2. in what sense could nancy cruzan even be considered a "person"? what are the essential attributes of a person? [color="#ff0000"]spiritually or physically?"

    3. since nancy could feel neither embarrassment nor pain, isn't it really only the empathetic interests of the family at stake? [color="#ff0000"]i would suggest that we really don't have any idea what she "feels". although we have many methods of measuring the physical, we don't have good ways to measure the spiritual. having said that, whether or not she can feel embarrassed, she remains entitled to dignified care. her family should advocate for nancy in that way! further, i would offer the notion that the feelings of the family, and their care, should be a concern of the health care team.

    4. what if missouri defined nancy as dead and ordered her feeding discontinued against the wishes of her parents? would they have any constitutional claim? [color="#ff0000"]would the parents have the claim?, or the state? i think if the state is paying for the care, and the professionals are telling them that there is no hope of meaningful recovery as well as suggestion that nancy had other wishes they can make a case. i think there is case law that might address this issue

    5. was missouri using nancy as a symbol? as a symbol for what? [color="#ff0000"]

    6. should it matter whether the decision involved was to discontinue feeding rather than extraordinary treatment such as a ventilator? [color="#ff0000"]it very much matters. it is much easier for a family to see a ventilator and assign some level of suffering to that experience. family, by and large, do not associate provision of nutrition with suffering...even when there is evidence that it is causing more harm than good. every living thing lives while it eats, when it stops eating it dies. when dying patients begin to refuse food some family members become fixated upon food. imagine how difficult the choice to choose to remove nutrition from your loved one knowing that the very thing will cause the decline toward death.

    7. could missouri have prevented the cruzans from taking nancy to another state that would allow their wishes to be carried out? [color="#ff0000"]there would be no grounds for that action...where is the state's injury if she leaves? i seriously doubt the state would even consider spending money on that course of action.

    8. if there was a right to assisted suicide, as the 9th circuit found, why should the right be limited to terminally ill and competent adults? why would persons in great pain, or who are severely depressed, also have such a right? [color="#ff0000"]i do not believe in assisted suicide so i cannot really answer your first question other than to say, if it were a right why would a society not want it limited to those who are adult and mentally competent?...terminal is sometimes in the eye of the beholder. people who are in great pain first have a right to adequate pain control as part of the health care. i would suggest that if we provided better pain management for that person he/she might not be interested in assisted suicide. it would not make sense to allow a person with a diagnosed mental illness to make a life and death choice and, as a nurse, you could be held liable if you obtained informed consent from someone whom is known to have a poorly controlled mental illness.

    9. does the distinction between passive euthanasia (withdrawal of feeding tubes, for example) and active euthanasia (administration of lethal drugs, for example) make sense to you? [color="#ff0000"]as a hospice professional, the distinction is as clear as the blue sky over lake michigan on a brisk september morning! when the wishes of the patient are known, it is absolutely appropriate to withdraw supportive interventions. there is an enormous difference between removing intrusive medical intervention at the wish of the patient or dpoa vs. administering a lethal dose of a medication with the intent to cause death.

    10. what state interests supporting laws against physician-assisted suicide do you think are the strongest? [color="#ff0000"]sorry, i have no idea.[color="#ff0000"]
    Last edit by tewdles on Apr 9, '10
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    I found the questions at the end to be very thought provoking. The point still stands that the patientís autonomy is very important. Nancy Cruzan was initially not allowed to be shut off of the feeding tube, because she had not expressed this desire. The argument can also be made about weighing the difference between beneficence and nonmaleficence. I think that keeping Nancy Cruzan on the feeding tube is actually harming her. In her persistent vegetative state, she could be feeling pain we just donít know. I do not see the good on keeping her on the feeding tube, the doctors all agreed that she was beyond help. There is no justice in denying the right to die to Nancy Cruzan.
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    I believe Physician assisted suicide should be illegal. I look at physicians as someone who is supposed to help you live as long as you can. It can be hard as a health care professional to separate personal feelings and professional responsibilities. Doctors do have the right to refuse to participate in PAS though. Even if that is the law in your state, doctorís personal morals might not allow them to assist a patient in dying. But I also believe that there are exceptions for different circumstances. No one would enjoy living in a brain dead state. Nobody wants to be a ďvegetableĒ for the rest of their life. At that point, it is up to the patientís family. I honestly would not know what I would want if one of my family members were ever in that stage. Itís hard to say what you would do until you are actually in that situation. I know there are people that would want to be kept alive though. Patients can choose to discontinue treatment which for some could lead to death. That is legal and the choice of the patient. That would be the legal way to allow one to die although that might be more painful for the patient. It might even be harder on the family that way. I do not believe that a healthcare professional in the health care facility that the patient is admitted to, should be able to make a decision for the patient at all. Some people say that families are selfish if they keep the patient around for as long as they can. I can see where they are coming from but I also see that it is selfish of the family to not keep the patient around. Some family members might want the patient gone so they can have some of the money or estate. I would like to think that there arenít family members out there that are that selfish, but I know there are. For some patients though, letting them go would be the most peaceful way for them to die. If you take them off of medications or treatments, they could die a very painful death. It would be helpful though if patients had previously filled out an advanced directive while they can still make decisions for them. That saves the family a hard decision. Overall, I believe ultimately it should be the patientís decision.

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