Final Exam Study Guide
Final Exam Study Guide PSYCH 2588
Popular in Attitudes Toward Death & Dying
Popular in Psychlogy
This 25 page Study Guide was uploaded by Maya Blair on Friday April 15, 2016. The Study Guide belongs to PSYCH 2588 at George Washington University taught by Pamela Woodruff in Winter 2016. Since its upload, it has received 137 views. For similar materials see Attitudes Toward Death & Dying in Psychlogy at George Washington University.
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If Maya isn't already a tutor, they should be. Haven't had any of this stuff explained to me as clearly as this was. I appreciate the help!
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Date Created: 04/15/16
SUICIDE Shneidman ● National expert in this this field ● National Definition:Suicide is the human act of self inflicted, self intention cessation ● We don’t want to recognize the fact for what it is ➢ One concern is religion, with the belief that eternal punishment/damnation/unforgivable act ➢ Then concern for the feelings of family members (tremendous stigma attached to this act) ➢ Life insurance (state insurance boards put pressure on insurance companies. At one time the beneficiaries could not receive a payout if there was a suicide, no matter how long the policy had been in effect. Today it varies by company) 4 Categories of Suicide 1. Committed dead 2. Attempted act did not succeed 3. Threatened verbalizing (“if you leave me, I’m going to kill myself”) 4. Ideation psychological (thoughts about suicide) Sociological model, Durkheim, L e Suicide (1897) ● French ● 1897 publishes Le Suicide ● In the 1950s it becomes translated into English Connectedness to society ○ Focuses on the relationship between the individual and society to understand suicide ■ What were the group dynamics that influenced suicide? ■ Suicide resulted when they were too integrated or not integrated at all in the society ● The culture itself can believe a high level of cohesiveness or solidarity or a low level ● Either in a society that is supportive and stable OR chaotic, no stable form of government (anarchy) Topology ○ Egoistic suicide ■ Person underintegrated ■ Little concern for the community ■ Not a good connection between individual and family or other social groups ■ Ex. Live on the fringe of society ○ Anomic suicide ■ Person underintegrated ■ Occurs when relationship between individual and society is suddenly ruptured (perhaps fired from a job) → Severe loss (maybe a death of a close friend) ■ Can be positive (winning money) → People with sudden wealth may not be able to cope 1 ○ Altruistic suicide ■ Overintegrated ■ Group values predominate over the individual ■ Two other names: “Suicide by Convention” or “The Great Death” ■ Ex. Suttee in India at one time if a woman was widowed she was expected to jump into the fire of her husband’s cremation ■ Ex. Japan leaders of war ripping open their abdomen after shame and defeat while wearing ceremonial robes ■ Ex. Japan Kamikaze pilots ■ Ex. Ship captains expected to stay on the ship when the ship is going down ■ Ex. Heavens Gate. 1997. Marshall Applewhite + 39 followers thought a comet was the end of the work but they thought they would be transposed to the comet and live on. Rented a house. Ate applesauce + pudding with seasonal mixed in. Took it, got into bed, and found a few days later ○ Fatalistic suicide ■ Suffer political and or religious oppression ■ A culture that stifles or oppresses their people ■ Individual sees all opportunities and prospect as blocked ■ Excessive control by the society ■ Slavery, child soldiers, women forced into prostitution, child labor Psychological model ● Focuses on the dynamics of a person’s life Freudpsychoanalytic ● Introject the love object ○ Object = person ○ We internalize this person who we love ○ Emotionally they dwell inside of us ○ Later we may have ambivalent feelings ○ Feelings may alternate between love and hate ○ The hate becomes so strong and we want to kill that person ○ By killing ourselves we kill the person whom we’ve introjected inside of us because emotionally they are inside of us ○ Inside of us → end up killing ourselves ● Eros and thanatos ○ Life and death ○ In the intrapsychic realm there are motivations that we are unaware of ○ Under great stress the intrapsychic pressures can impel us towards self destruction where all of our defense mechanisms may overwhelm that ego and the aggression (thanatos) turns inwards ○ Death overwhelms the ego and suicide takes place Sociocultural factors ● Today in the mental health field Freud’s approaches have been modified ● Sociocultural factors have been added ● For example being part of a dysfunctional family or the stress to succeed academ cally 2 Kastenbaum Cultural meanings of suicide 1. Sinful morally wrong 2. Criminal in earlier times family wouldn’t be able to inherit anything. If you failed you would have a criminal record! 3. Weakness or madness cowardly or mentally ill 4. The Great Death goes back to suicide by convention or altruistic suicide; it’s the culturally approved forms of ritual suicide like in India with the Suttee 5. Rational alternative it’s a balance sheet and the person feels that their quality of life is worst than being death Individual meanings of suicide 1. Reunion a way to join the deceased 2. Rest and refuge a way out of a burdensome, depressing, all encompassing situation 3. Revenge a way of expressing resentment, getting back at being rejected or hurt, maybe for achievements that aren’t acknowledged 4. Penalty for failure a response to disappointment, a frustration of not meeting the expectations you’ve set for yourself or the expectations others have set of you 5. Mistake the attempt was made as a cry for help, it was not INTENDED to be fatal, but there was no rescue or intervention in time and so the outcome was death Order of lethality Lethality = how effective a suicide method is ● Most effective to least effective ○ #1 = gunshot (58% if suicides) ○ #2 = carbon monoxide ○ #3 = hanging (hemp/cotton rope the best...some do it by mistake while trying to masterbate) ○ #4 = drowning (but there’s a reflex to start paddling or swimming) ○ #5 = suffocation (usually a plastic bag tied around the neck...but there’s an urge to get it off. For this reason some people sedate themselves then put on the bag) ○ #6 = Impact (jumping) ○ #7 = self immolation (usually used as a form of protest) ○ #8 = poison (usually insecticide poisoning) ○ #9 = drugs (takes quite a bit if you don’t have an injectable) ○ #10 = gas (propane) ○ #11 = cutting (parallel or neck with a butcher knife) At Risk Groups War Veterans/Military ➢ Veterans and those still in combat → 18 suicides a day ➢ Male have 2x national rate, women have 3x the national rate ➢ Use gun ➢ Depression, PTSD, injuries, unemployment ➢ Living in violence, sees it as an acceptable way to solve problems ➢ IED might cause one to lose genitals 3 Native Americans ➢ Extreme poverty ➢ School dropout rate high ➢ Unemployment rate high ➢ Alcohol/drug abuse high ➢ Child/spouse abuse high ➢ Particularly high among adolescent Native Americans Childhood and Adolescent Suicide ➢ Rate of suicide, for many decades, was be a line that increased by age (the older you were the higher the suicide rate) ➢ In the 60s it started to change ➢ Although it’s called often referred to adolescent suicid it’s a misnomer since the age range is 1524 ➢ Often in the news ➢ Below age 9 ○ Young children do exhibit suicidal behavior and kill themselves ○ However you cannot apply the label if the child is under 9 years of age (because they won’t have a concept of death being permanent, universal, and individual) ➢ Between 914 that’s considered child suicide ○ 500 deaths per year ○ 12,000 attempts ➢ Between 1424 ○ About 4,000 deaths per year ○ Low self esteem ○ Lack of relationship with peers (teasing/bullying) ○ Overly high selfexpectations ○ Excessively high expectations by parents, coach, teacher, etc ○ Being gay, gender dysphoria ○ Not seeing alternatives ➢ Warning Signs ○ Withdrawal from family and friends ○ Decline in school work ○ Increased use of tobacco, alcohol, recreational drugs ○ Giving away prized possessions Suicide By Cop ● In 1983 it was defined and given a label ● A situation in which an individual cannot carry out the act of suicide himself or herself. So they have a real gun, toy gun, or hand in a pocket. They then threaten a police officer who shoots them. They die ● Some leave notes in their pockets saying that this was their wish to die and it wasn’t the police officer’s responsibility 4 Bereaved survivorssurvivor victims ● Special needs ● As a family member or close friend you may feel rejected, deserted abandoned, guilty, shame, relief ● The search for meaning ● The grief: very likely to be incomplete ● Increases their own risk of suicide Shneidman’s name for these people are survivorsvictims ➢ Feels this is mental health issue ➢ Should be offered counselling ➢ He calls this postvention (doing it after the fact) EUTHANASIA The right to die ● 6 minute film of Brittany Maynard ○ Foreshortened her life ○ Late 20s, brain cancer, married, lived in California, had to move to Oregon to die ○ Left a legacy: California passed a bill that now allows doctor assisted death ● Donald C. ○ Not a PVS Euthanasia ● Greek word for “good death, happy death, painless death, easy death, OR mercy killing” ● Original meaning was to foreshorten the life of someone who was terminally ill ● About 75% of adults in the US approve of assisted dying ● Every act of euthanasia has qualifying words with it Voluntary or Involuntary Voluntary ➢ A competent, rational person decides to die Involuntary ➢ The decision is not made by the patient (parents or someone else) Active or Passive Active ➢ A direct action is taken to end the life of an individual ➢ Ex. injecting morphine, taking a large amount of a barbiturate, etc Passive ➢ Two options ➢ You don’t start something ○ Either a treatment has not started (ex. person has pneumonia and you don’t treat it) ➢ You end something ○ If a treatment is in place already, then it could be withdrawn (ex. disconnecting a ventilator that breaths for a person, or no hydration and nutrition) FOUR OPTIONS IN TOTAL: 5 1. Voluntary active 2. Voluntary passive 3. Involuntary active 4. Involuntary passive History of suicide/euthanasia 1. Greeks: Socrates, Plato, Aristotle ○ Supported euthanasia ○ Defected children should be allowed to die ○ Also endorsed the right to an easy death 2. Romans: Seneca ○ Similar view to Greeks ○ “If I can choose between a death of torture and one that is simple and easy, why should I not select the latter?” 3. JudoChristian: no condemnation ○ 6 examples of suicide: none of which are condemned 4. St. Augustine ○ 4th century CE view changes ○ Suicide is a detestable and damnable wickedness 1. First, violation of 6 of the 10 commandments (“you are not to kill”) 2. Second, deprives a person the opportunity to pent 3. Third, an individual should endure suffering, to avoid suffering by suicide is an act of cowardice 5. St. Thomas Aquinas ○ 13th century ○ One of the greatest thinkers that the Catholic church has ever had ○ Agreed completely with Augustine ○ Suicide is a sin against self, neighbor, and God ○ Suicide is the most fatal of sins because it can not be repented ○ God should decide when we die 6. Sir Thomas More ○ Devout Catholic ○ Henry VIII broke from the Catholic church and established himself as the head of the church of England. Henry VIII respected Sir Thomas More and sent him out on diplomatic missions. However, he had him beheaded over an issue having to do with church and state. ○ Did not change his view to be in line with Henry VIII. However he fully supported euthanasia, something his church does not support ○ He dies holding onto his Catholic beliefs about divorce and the church, and yet, he’s going to say, going completely against his church, that those who are very sick and cannot be cured, should be allowed to die or even helped to die 7. David Hume ○ Wrote a piece called “Essay on Suicide” ○ A man who retires from life does no harm for society ○ Says it’s praiseworthy to “resign from life” ○ 1790 France legalized suicide 8. 1872 word euthanasia used 6 ○ The word “suicide” was not used until the 1600s ○ 1872 “euthanasia” was first used in a publishing of a book ○ Euthanasia = good death, happy death, painless death, easy death Organizations working to legalize euthanasia ● Most well known. Started off being called the hemlock society. Got concerned with the name and so a few years they changed it to Compassion and Choices. Arguments by opponents to legalization 1. First argument that is usually given is that it goes against the hippocratic oath ○ Says I will not go against the law, but if the law allows it, then it’s alright 2. 6th commandment ○ Thou shalt not kill 3. Only the God has the right to determine when life will end ○ Human life is sacred, and us humans should not be playing God 4. There could be a mistake in diagnosis 5. Future discoveries might provide a cure 6. If we allow euthanasia, it will destroy a patient's confidence in the doctor because the doctor would be both the healer and executioners 7. It could be used in an abusive way ○ A family member might pressure a doctor to hasten death 8. Voluntary euthanasia is the beginning of a domino effect ○ Will there be state imposed euthanasia for the mentally ill, prisoners, the homeless, etc? 9. The patient who may feel that he or she has become a burden, might feel pressured to sacrifice their life (even though they might not want to die) Hippocratic Oath ● References abortion and euthanasia Rule of Double Effect page 299 ● Thousands of doctors around the world have done this ● Comes out of Catholic thinking ● But most people who practice it, don’t know where it comes from ● Key elements to it 1. The act, carried out usually by the doctor, must be good 2. The agent (the doctor) must intend the good effect (to relieve pain/suffering) and must not intend the evil effect (must not intend to kill the patient) 3. The evil effect must not be the means to the good effect 4. There must be a proportionately great reason to risk the evil effect Kastenbaum : level of viability (distinguishes between viability = life, and recovery) 1. Not viable even with life support you can not keep the person going 2. Conditional viability someone is in a vegetative state and requires this total life support 3. Physiological viability vegetative state but the person only needs to be kept warm and fed artificially (no active life support needed) 4. Recovery with significant impairment mental and motor loses 5. Recovery with minimal impairment loss of perhaps personality 7 The Harvard Ad Hoc Committee to Examine the Definition of Brain Death (1968) ● Established an operational criteria to legally say that someone is dead. And almost 50 years later, we are still using it, although many would like to see it modified ● 5 parts 1. Patient isunreceptive and unresponsive to even painful stimuli 2. No movement or breathing 3. No reflexes (ex. Light shines in the eyes and the pupils stay dilated instead of constricting & hitting the knee or elbow without jerking movement 4. EEG is flat (no electrical activity in the brain) 5. No circulation of blood within the brain ● Test must be repeated 24 hours later with the same physician who did it the first time ● 2 things we MUST check for ○ Check to make sure that the body temperature is normal (when the body is cold we go into a state of hibernation) ○ Second make sure that there is not a barbiturate in the system ○ These two things, individually or together that could mask brain death! Definitions 3 Definitions of being death: 2 are legal and one is not, but still used 1. Cardiopulmonary legal term ➢ The heart and the lungs are not functioning ➢ Not breathing and heart not beating ➢ Yet, this is true for people who get revived and who experience the NDE 2. Decerebrate legal ➢ Referring to your brain ➢ Nothing in the brain is functioning ➢ The Harvard criteria ➢ No reflexes, flat EEG, no circulation of blood to the brain 3. Neocortical ➢ Never been formalized in law but is often used ➢ Neocortex ➢ Says that the cerebral cortex is not functioning ➢ No consciousness or personhood ➢ No higher rational activity PVS persistent vegetative state ● Have only a functioning brain stem ○ Controls very basic functions like digestion ○ Sleep/wake cycle ○ Can’t see/swallow/smell/hear/talk ○ Some people would prefer that we use the term “Permanent Vegetative State” ○ Smack lips ○ Grind teeth ○ Stick tongue in and out (like a snake) ○ Chewing movements but you can’t feed them because they have no swallowing reflex → would choke them ○ Can yawn ○ Eyes can blink 8 ○ Pupil can go side to side ○ Even with physical therapy, some people’s limbs may contract: limbs pull up to body, nails go into palm of hand, look like a grasshopper or prymantis ○ 25,000 people in this country that we are keeping alive and the cost is about $200,000 Minimally Conscious State ● Person is bedridden but has occasional signs of awareness and responsiveness ● Very small chance of improvement ● 200,000 in this state ● On pages 5056, on page 52 there’s differentiation between the different states Terminal Sedation ● When the pain cannot be controlled other than to kill the person ● Keep them alive by keeping them asleep (until they die) ● Keep the person heavily sedated until death occurs (days, weeks, or months later) ● Sedated → death from disease, starvation, dehydration Advanced directives Documents Give instructions about your wishes when you are not able to communicate them yourself Every state + DC has a law that allows these Started in the mid 70s in California “Natural Death Directives” according to the law Consists of 2 documents 1. Living will (natural death directive) ➢ Free and very simple document to fill out ➢ Put down exactly what you do and do not want done ➢ Ex. If your heart stops, you don’t want to be resuscitated, you don’t want artificial feeding, or you don’t want to be put on a ventilator ➢ Two people must witness your signature ➢ On page 173 there’s an example 2. Durable power of attorney for health care ➢ You appoint someone, a friend, family member, etc. to back up your living will ➢ This only turns over your HEALTH issues to someone else ➢ When this is in place, it’s important that a copy be given to your primary care physician, family members, and of course the person who has your durable power of attorney for health care ➢ Two physicians must certify that you have six months or less to live (basically that you’re going to die soon) before this goes into effect ➢ Also means that this physician and anyone working under this physician can not be sued, in civil or criminal court ➢ A physician who cannot carry this out is suppose to turn your case over to someone who will do this 9 Does a person have to be dying to have the right to die? Individual is not terminal Rita Green ➢ Lived for 50 years in a PVS! Karen Ann Quinlan (p. 276277) ➢ 1950s ➢ Daughter of a Blue Collar and devout Catholic family from Brooklyn ➢ Parents had many miscarriages and a stillborn son ➢ Adopted Karen at 4 weeks old (1954) ➢ They had such sad memories associated with where they were living and so they sold their house and winterized their beach house in NJ ➢ Not long after, mother gave birth to two biological children About Karen ○ Karen was very bright, but an average student ○ Didn’t go to college but instead went to work for a ceramic’s company ○ Was able to save up quite a bit of money and moved into a shared home ○ One evening, at the age of 21 years of age, she went with other young adults to a birthday celebration at a bar. She drank gin and tonics (depressant) and valium (a tranquilizer, a CNC depressant). She turned to a young man and said, “please would you take me back home, I don’t feel very well?” After tucking her in, he could see that the color of her skin was changing to a bluish color. Realized that she wasn’t breathing. Called an ambulance. He started doing artificial respiration. After the EMTs arrived they put her on a portable ventilator and brought her to the hospital. She was in a drug induced coma. Went from 112 lbs to 60 lbs in 5 months. Even with extensive physical therapy, her muscles contracted. She resembled a pray mantis/grasshopper. ○ Said you don’t have to use extraordinary measures, this meant that the ventilator should be disconnected. The doctor and the hospital would not go along with this, for fear that they would be sued. So with the priest’s support, they went to court. Joseph asked to be made Karen’s guardian so he could authorize the removal of the ventilator. There was a little bit of EEG activity. ○ Went to court. People very mad. “Why are you killing your daughter? You’re probably doing this because she’s the adopted child” ○ The court appointed a lawyer who did this probono. “I was there for 7 minutes but it seemed like 7 hours.” He was horrified and thought she should be disconnected ○ Judge ruled against them ○ So the case was appealed and went to the Supreme Court (1976) and there was 70 agreement that the ventilator could be taken off. ○ June in 1976 Karen had been in this vegetative state for 14 months and the hospital said that she would need to be transferred to another facility ○ Parents applied to 22 nursing homes and none of them wanted to take her. They did not want the publicity ○ Then the state and the federal government stepped in. If you wanted to keep receiving financial support, you needed to take her as a patient. So they picked a place ○ They decided they did not want the press taking photographs of her being moved 10 ○ In the middle of the night she was put on a portable ventilator and moved by ambulance to the nursing home ○ In the morning they disconnect the ventilator. She lived. She breathed on her own ○ Died in 1985 due to pneumonia. Parents wanted food and water, just not the technical things ○ Cost 30 thousand a year. Medicaid. ➢ “Sleeping Beauty Syndrome” someday you think she’s going to wake up ➢ This is the first time in the US that something like this went on nationally (but only through newspapers and magazines) Nancy Cruzan (pages 280 281) ➢ January 1983 ➢ Married, 26 years old, in MO ➢ Hit a patch of black ice and went head down into a creek ➢ Took 15 minutes before she was breathing and her heart was beating again ➢ Suffered brain damage, put in a persistent vegetative state ➢ PEG: Percutaneous (under the skin) Endoscopic (in a tube), gastrostomy (into the stomach) ○ Tubing from her stomach was used to feed/hydrate her ➢ Although she was married, at this point her husband wanted nothing to do with her. Immediately divorced her. Court assigned her parents as the guardians after this. ➢ After 4 years, parents asked the hospital to remove the feeding tubes so that she could die ○ Family went to court and two of her friends testified saying that in informal conversation with Nancy she had said that she did not want to be kept alive if she became a “vegetable” ○ Court said no ○ Went the US Supreme Court. Said they could not rule for her to be disconnected from the feeding tube because she had left nothing in writing. However they ruled that the lower court could reconsider this case ○ Went back to the trial court and once again the two friends said that this is what she would have wanted. Judge ruled and said that there was clear and consistent evidence that Nancy would want to die. Then the feeding tube was disconnected in December 1990 (a year has gone by) ➢ Nancy lived for 12 days without hydration and nutrition ➢ Protesters blanketed the lawn and said you’re murdering your daughter ➢ Grave marker: Born, departed (accident date), at peace (when she finally died from lack of hydration) Both women only had a functioning brain stems, they had NO higher brain functioning 11 Terri Schiavo ➢ Born 1963 ➢ 5’3 and 200 lbs at HS graduation ➢ Met Michael Chivan in 1982. Married him in 1984. ➢ At marriage she was 140 lbs. It was believed that she was a bulimic ➢ 1986 move to FL and lived in a condo owned by her parents. She was a file clerk and he worked at the convenient store ➢ Weight now goes down to 120 lbs ➢ Wants to have a child but she can’t so she goes to a fertility clinic and the physician doesn’t do a good background check and he gives her medication to make her ovulate. 1990 collapses ➢ Extensive brain damage ➢ At first she was fed by an NG tube, then put a peg in ➢ Obstetrician at the clinic sued for malpractice ➢ $1 million awarded, ¾ to Terri and ¼ to Michael. He used it to get better education and becomes a nurse and physical therapist. He used Terri’s money for all types of therapies ➢ 1998, Michael petitioned the court to have the feeding tube removed. He said that Terri had expressed the wish to him to not be kept alive is something happened to her. Tube removed but her parents were very opposed and took action to it reinserted ➢ In 2000 Michaels guardianship was challenged. He was dating other women. Had two sons. Offered Michael $1 million to give up guardianship but he would not do it. ➢ The parents, as very devout Catholics, said she had to have food and hydration. They also said she was not in a persistent vegetative state but rather in a minimally conscious state ➢ 2003, court says, yes the feeding tube can be removed (for a second time). However, the parents now have the world wide web. Within a week, the FL state legislature passed Terri’s law. Gave the authority to put the tube back in. ➢ 2004, FL state Supreme Court said that Terri’s law was unconstitutional ➢ 2005, it finally became know to the U.S. because Michael goes back to the court and they say yes, the feeding tube can be disconnected. However now the federal government gets involved. The state had been clear but the parents have gotten so many people behind saving “her life” that it comes to Washington. Passed a law that the feeding tube had to be reconnected. However it didn’t work. The Supreme Court said there would be no judicial review. On March 26th, the parents announced that they had no more legal options. On March 31st Michael sits with her and she dies. She lived for 12 days without the hydration. ➢ 15 years had gone by since the time of the fall ➢ Cremated, buried in FL, etc. But the parents did not want that. ➢ People ask, why should the federal government have ever got involved in this? Dax Cowart ➢ NOT in a PVS (like the women) considered rational ➢ Act of euthanasia not carried out in this case ➢ Grew up in Texas, after college he went into the air force and became a pilot ➢ Joined father in the real estate business ➢ Went to see land, parked the car, didn’t realize there was a leaking gas line ➢ Returning to the car, the father turned the key in the ignition, there was a spark, and all of these fumes from the leaking gas exploded 12 ➢ Father died instantly, Donald did not ➢ Donald asked a nearby farmer to kill him, which he did not ➢ His burns were 2nd and 3rd degree. Covered most of his body. Eyes badly damaged. One they enucleated (scooped out) and sewed down the other one. All 10 fingers amputated. Ears burned off but could still hear ➢ Obvious he was going to be in treatment for a very long time ➢ Each day was put into a tub of warm antibiotic water ➢ Wasn’t getting better after 5 months and so he was transferred to the hospital at the University of Texas ➢ Just after being transferred he said he wished to be discharged against medical advice to go to his mother’s home to die because without the daily tub, infection would occur ➢ This horrified his mother because she loved him but also religion ➢ He grew up in a fundamentalist christian household. Once he got to college he rejected the religion. His mother's concern was that if he died, he would go to hell. If he was declared incompetent she could be made his guardian and then she would get to make the decisions. So Dr. White, a psychiatrist, was called in to do this evaluation. Had to do four 2 hour sessions. Determined that he was competent and rational. ➢ Demanded to leave the hospital ➢ In the end, he decided not the leave the hospital. Has permitted filming of him. Went on to law school, married a woman he had known in high school, and continues to be a spokesman for Death with Dignity ➢ He says he should have been allowed to die, and that he shouldn’t have been put through all that he was ➢ Said he should have had the right to die and is now an advocate ➢ Changed his name: Dax (hearing problems so he knows when someone says his name) Cowart (in reflexion to not having the courage to being discharged to his mother's house) Standard Euthanasia ● Terminally ill ● Doesn’t have long to live ● Quality of life is so poor (usually has to do with pain that isn’t being managed) that they would rather die right now than life the days or weeks that they have left ● Physician acts directly. Ex. Lethal injection Doctor assisted suicide/death, Physician assisted suicide/death (PAD) Physician proves the means for death but the patient, not the physician, will ultimately administer the lethal medication 1. It’s over Debbie, Dr. Anonymous ○ Debbie is a pseudonym ○ Dr. Anonymous = physician ○ This is a resident in obstetrics gynecology ○ Goes to the on call room where he can sleep. Phone rings, it’s a nurse. He’s told there’s a patient with ovarian cancer, and they have tried to control her pain. Hasn’t helped. He heads to the ward and assumes that this patient is an elderly woman. He is so tired. He arrives and finds it’s not an old lady. There’s a middle aged women next to her that looks a lot like her. She says to him, let's get this over with. He assumes that means she wants to 13 die. He doesn’t ask her and doesn’t clarify it. He has the nurse draw up a large syringe of morphine. Now he makes a nurse complicit in what he’s about to do. He then injects it into her intravenous line and she dies. ○ This physician didn’t try any other form of pain management, he never asked if she wanted to die, didn’t clarify if the other woman was the mother, didn’t consult anyone over him ○ This is why it’s considered a horrible example of what can happen 2. Diane and Dr. Timothy Quilt ○ To compare with Debbie & Dr. Anonymous ○ Upstate NY ○ Internal medicine (primary care) and a hospice doctor ○ Diane was his primary care patient for 8 years ○ Had vaginal cancer ○ Both her parents had been alcoholic and so had she, but she was sober ○ She had clinical depression, but that had been treated ○ She went to him because she was exhausted. He drew blood and within a short time found out that she had a rare form of leukemia, with 25% rate of getting better ○ He saw her as a highly intelligent, very rational individual. She told him, “I do not want any treatment. I want to let the illness run its course. However I want something as a backup so that if the disease becomes very uncomfortable, I can stop my life then” ○ She had already talked this over with her husband and son. They agreed with her. ○ Dr. Quill set her up with a meeting with the Hemlock Society, not known as Compassion and Care ○ She came back and told him what she’d learned and he wrote a prescription for the barbiturate. He didn’t write it as “take everything in this bottle at once” instead he wrote “take one at bedtime, as needed” so that it was filled ○ Then Diane had some weeks in which she invited friends to come individually to say goodbye ○ She reached the point where she was feeling like death. So that morning she asked her husband and son to leave the house for an hour. She put down her favorite shawl and sat down by a window and she took the Seconal. ○ Find her dead and call Dr. Quill. He then calls the quariners office and says, this woman has been my patient for 8 years. She was in hospice (which was a lie) and she has been found dead by her husband and son, do you wish to do an autopsy? They don’t. ○ She was cremated and her ashes buried ○ Dr. Quill writes his article with the New England Journal of Medicine publishes ○ He assisted in her death. NY wanted to see criminal action against him. There was a trial but Dr. Quill was acquitted. ○ In the end, it allowed her to be in charge of what was going on 3. Dr. Jack Kevorkian ○ 285288 ○ Worked in California ○ Did autopsies ○ Retired and returned to Michigan ○ Wasn’t married and didn’t have any children. Did have a sister. ○ Decided that people should be allowed to end their life if they had a good reason 14 ○ Talked it over with his sister, and she agreed to help him with the extent that she would videotape an interview that he would have with patients that came to him ○ Put classified notices in the paper ○ July 1990. First person, Janet Admin. ➢ 50 years, highly educated, teenage son, diagnosed with early onset alzheimer's ➢ Passes interview ➢ Now she is ready for his machine ➢ This is what is used to execute people in the US when they do it with chemicals. Same thing that Kevorkian puts together ➢ 3 liquids: Sodium pentothal (truth serum), cencromian bromide (paralyzes muscles), potassium chloride (affects the heart) ➢ She opens the wheel, liquids flow in, she dies. He puts her in his car and brings her to the emergency room of the hospital. Gets out, goes to the pay phone and says there’s a dead body in your parking area. They bring her in and autopsy her. ○ He goes to trial 4 times. The first three, his lawyer gets him off because he hasn’t done anything to actively kill people. Estimate that he’s helped 130 people to die. Now he ups the ante. There’s man with ALS who can’t turn the wheel himself, so he does it for him. Now they have got him because he’s done something active. In the fourth trial he’s sentenced for 2nd degree murder with a sentence for up to 25 years. Off he goes to one of the state prisons. Spends a number of years in prison. Runs for office, dies in June of 2011. State initiatives for death with dignity ● Some states have authorized physician assisted death ● Usually the law is calldeath with dignity this is to upset fewer people (don’t have the word doctor or suicide in it) ● Washington State has the referendum and a few years later they went on to have California now has it, and that’s by referendum as well. After Brittany’s death many people had it pushed. In VT you have it by the state legislature where the governor of VT signed thNew Mexico has it. State said doctors could take part in doing something. ● 3 ways it’s been made legal in just a few states (5 states) ○ By ruling of the state supreme court ○ By an act of the legislature signed by the governor ○ In the states that allow it, referendum on the ballot Physician assisted suicide in Oregon ● 1994 it was passed on the ballot as a referendum ● 1997, referendum again ● So now it does go into effect ● You must be a resident in the state of Oregon, 2 doctors must certify that you have 6 months or less to live, must be at least 18, rational, not depressed, know about hospice/available pain management ● Must make contact with a doctor 3 times. Twice in person, 15 days apart. In between visits you need to write 1 letter. At this point, the physician will prescribe the legal dose. The physician is now no longer involved. ● Can get it filled now or later. Says “take them all” ● Any number of people get it filled and then don’t feel the need to take it ● 30,000 people die in Oregon from all sorts of causes. 5080 request and get the medicine. Maybe 3545 take it. ● Seconal 15 Abortion ● 42 million abortions a year ● Majority of them are performed outside of the hospital ● 1.2 million in the US Types of Abortions 1. Spontaneous abortion miscarriage ➢ Medical term for a miscarriage ➢ Something has happened to the fetus or the mother such that the development can’t continue ➢ Perhaps the cervix can’t hold the child anymore 2. Induced abortion abortion ➢ Something chemical orsomething medical (surgical) that has been done to remove the embryo or fetus History of abortion ● Sharp object into the uterus (Ex. branch & coat hanger) ● Hot coals on the abdomen ● Jumping and landing on the abdomen ● Shaman, priests, etc. ● Used to put mercury into the uterus ● Rome total control of wife, could insist on abortion, she would have no control ● Assyria death penalty ● Early Jews condemned ● Early Christians called it “infanticide” ● Catholic Church she could abort up to 40 days (for male b/c that’s when he got his soul), she could abort up to 80 days (for female b/c that’s when she got her soul) ● 13th century woman could abort until she felt quickening (feeling movement) ● A lot of colonies took on English common law ● 19th Century Pope Pius the IV : Eliminated the distinction between an animated and unanimated soul. The soul is there from the instant of conception ● 1821 CT passed a law against abortion. Other states soon followed ● 1860 abortion became illegal in ALL the states (with the exception to save the life of the mother) Roe vs. Wade 1/22/73 (allowed abortion) Landmark decision handed down by the U.S. Supreme Court Roe protected the name of the woman, Wade was the name of a town in Texas Young woman said she was rapped and asked to have it be aborted. Denied. Had the child and gave it up for adoption. Her case went on for a couple years before it reached the Supreme Court. Years later she said she wasn’t rapped, then said she was a lesbian, later she came out as a pro choice person, then in the last decade she’s come out as very opposed to abortion. It was a7:2 decision Vote 7:2, Justice Blackmun (majority opinion) The court affirmed the right to privacy under the 14th amendment (“The right of privacy, found in the 14th amendment's concept of personal liberty, is broad enough to encompass a woman’s decision whether or not to terminate a pregnancy. Nor shall any state deprive any person of life, liberty, or 16 property without due process of law, nor deny to any person within its jurisdiction, the equal protection of the law”) Trimesters Gestation 3940 weeks. Set it up by trimesters of 13 weeks each First trimester the decision to have an abortion is solely between the woman and her physician Second trimester the state may have two powers: (1) to determine who may do an abortion and (2) where an abortion may take place (has to meet the requirements of a surgical center, ex. the width of the hallway, where electrical outlets are, etc.) Third trimester where there can be viability (fetus could live) has to be based on the health and life of the mother Methods (surgical & chemical) Dilation and curettage (D and C) ➢ Can tell what was there ➢ At one time it was the only way that an abortion could be done safely when it was done in the medical facility Suction vacuum aspiration ➢ Most common ➢ Tranquilizer, twilight sleep, series of hollow rods pushed up through the cervix into the uterus. On the outer ends of the rods are tubing and there’s a vacuum pump. Turned on and the content of the uterus comes out into a bottle and the procedure is over ➢ Comes out of the twilight sleep, given juice, and when stable she is told for the next two days to take her temperature every 6 hours (looking for infection) Saline ➢ Second trimester ➢ Done in the hospital ➢ Woman has a very long and thin needle pushed through her abdomen and into her uterus. About a liter of amniotic fluid is drawn out. In its place sterile saline goes in. This reverses osmosis in the fetus. Women will then go into labor. Usually sedated as she expels the fetus (looks burned up from the salt). Hysterotomy (cesarean section) ➢ Can be done up to 20 weeks ➢ Hysteria ➢ Women has an incision made right above the pubis ➢ The physician cuts all the way down into the uterus ➢ Then a pair of forceps grip the head of the fetus and the bones are crushed and then the fetus can be pulled out ➢ Women is stitched up and then the body is disposed of Dilation and extraction (D & X) ➢ Beyond 20 weeks...entering into viability ➢ Prolife people referred to this as a “partial birth abortion” ➢ Physician pulls on the feet so that they are hanging out of the woman’s body. Then the physician reaches up and fierces the skull and suctions out the brin. As the brain is sucked out, the skull collapses and then the fetus is pulled out the rest of the way. 17 Dilation and evacuation (D & E) ➢ Cervix is dilated and the physician uses instruments, mostly scalpels, to cut the fetus into pieces while it is in the uterus ➢ With little small forceps, the pieces of the fetus are pulled out ➢ Basically the fetus is dismembered Drugs (RU486Mifeprex) ➢ CHEMICAL METHODS ➢ First developed in France, manufacturer wouldn’t sell it in the US ➢ Approved 8 years later in the US ➢ First given in a doctors office, then the woman takes the other medication when she’s at home ➢ There are very painful cramps ➢ Could be used up to 7 weeks after intercourse but TODAY they said it can now be used for up to 10 weeks from the time of intercourse ➢ Considered safe...8 deaths out of a few million (women usually have underlying condition with her heart that caused the death) The Morning After Pill Plan B ➢ 4872 hours ➢ Age 18, then dropped to 17, then 16, and now there’s no age limit ➢ Used to have to ask the pharmacist for it, now it’s over the counter ➢ Weeks increased from 7 to 10 weeks Methotrexate ➢ Used for cancers and arthritis ➢ HIGHLY toxic, poison, stops rapidly growing cells ➢ Kills placental cells Ella ➢ Used up to 120 hours after intercourse UD ➢ Many feel that they are a form of abortionkills fertilization! ➢ Pieces of plastics in different shapes ➢ After menstruous, woman is dilated and IUD is placed in ➢ Fertilization happens in the fallopian tube ➢ When the fertilized egg drops into the uterus, it sets up a situation where the lining is toxic to the egg, and so it can’t embed itself and multiply ONLY 8 doctors still living who will do one after 21 weeks HOMICIDE/MURDER ● Homicide = The killing of one human being by another ○ Can involve non criminal and criminal acts ○ When it’s not criminal it’s called justifiable homicide/self defence/to protect another person or property/to prevent a robbery ○ Might be someone employed in a public position (police officer/sheriff) ○ The killing of an enemy in wartime ● First degree murder or murder 1 ○ Most primanal type of homicide ○ Deliberate and premeditated (thought about ahead of time) 18 ○ Deliberate, been thought about ahead of time (premeditative) ○ Legal words: malice: forethought, evil ○ Could be that the killing takes place during a felony ○ In states that execute it’s called capital murder (comes from capital punishment) ● Second degree murder ○ Carries a much shorter sentence ● Manslaughter ○ Negligence contributing to the dead ○ Voluntary manslaughter killing in the heat of passion ○ Ex. Man comes home and finds his wife in bed with another man ○ Involuntary manslaughter death takes place when there’s a misdemeanor (driving under the in
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