Death and Dying Final Study Guide
Death and Dying Final Study Guide 76864
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This 21 page Study Guide was uploaded by Rachel Onefater on Friday April 15, 2016. The Study Guide belongs to 76864 at George Washington University taught by Dr. Pamela Woodruf in Winter 2016. Since its upload, it has received 91 views. For similar materials see Attitudes Toward Death and Dying in Psychlogy at George Washington University.
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Date Created: 04/15/16
Summary of Articles "Attitudes toward Suicidal Behavior: A Review of the Literature": The way people feel toward suicide is reflects on values that humans reflect on life. Surviving relatives are said to be in greater grief because their loved ones took their own life. There tends to be a more negative attitude when suicide is the cause of death. The Chinese regarded suicide as acceptable and honorable for defeated generals/deposed rulers. In the Middle Ages the corpse for the individual who committed suicide was disgraced, mutilated etc. Today, there is a range in current attitudes, and most righttodie advocates make a distinction between healthy and terminally ill patients. There are two types of suicide: emotional(irrational selfmurder) and justifiable(rational/planned selfdeliverance)suicide is supported when the decision is ethical and made by an adult who has considered the decision. Those who oppose suicide argue that there is a medical and social justification to intervene and prevent suicide and that every person who wants to die also wants to live, and the desire will pass. 40 States and D.C. ask people to specify what treatments they would accept before they die. The most entrenched attitude toward suicide is to ignore it, and people find it difficult to express sympathy. "Death and the Law": Evelyn was diagnosed with breast cancer, and she medicated through pills and radiation until she was limp and unresponsive, and she had to move to an assisted living facilityshe was able to take medication to die because she lived in Oregon. Oregon(1997)Death with Dignity Acttwo oral requests and one written request at least 2 weeks apart, and be terminally ill with less than 6 months to livethis decision is judged by two separate physicians. Attorney Ashcroft said that this is not a "legitimate medical purpose", and said that any doctor will lose his license, and says that doctors ensure a patient's live and not die. Oregon federal judge said that the Ashcroft may be justified morally, ethically, and religiously, but do not permit a federal statute to be manipulated from its true meaning. 97' Supreme court ruled terminal patients don't have a physicianassisted suicide, and should be decide by the states. "Doctor, I Want to Die. Will You Help Me?": Death is an escape from suffering. For those tired of acute medical treatment, comfort care when applied in a hospice program or other setting, it can health ensure a dignified and individualized death. For unrecognized and undertreated physical symptoms, most symptoms can be made tolerable by comfort care, and unrelieved symptoms should be due to ignorance, inadequate trials of available medical treatment. Consultations from experts regarding pain control and palliative care are available in most major cities. For emergent psychosocial problems, request for help in dying can emanate from unrecognized/evolving psychosocial problems, and many patients have no family or financial resources, and the healthcare reimbursement system is not geared toward terminally ill, so physicians may be the only support that om dying patients have. In spiritual crises, sharing feelings of spiritual betrayal/uncertainty can be the first step for healing, and medically experienced clergy can help explore spiritual issues for the dying. For clinical depression, it is important that a patient understands illness fully and if the patient's depression thoughts are a sign of psychopathology or a normal response. For unrelenting, intolerable suffering, clinicians should explore the potential meaning for patients request to die(based on the indiv. Patient). For patients requesting death, they should feel comfort, dignity, and feel that this is a personal choice. The dying patient want the physician to listen, be compassionate, caring, and creative, promise to be there until the end, give honest opinions, openheart/mind, and to not forget personal support. "38 Who Saw Murder Didn't Call the Police": Detailing the murder story of Kitty Genovese(28 years oldat 3:02 AM). For over 30 min., 38 people saw a killer(Mosely) stalk and stab a woman on three different occasions in Queens. Asst. Chief Inspector is baffled because "good people" failed to call the cops. Might not be dead if someone had called after the first attack. She screamed for help when the killer got her, and lights turned on and people opened their windows to tell him to let her go, but nobody called the cops! Police arrived at 3:50AM(2 min, after being called), and one man said that he did not want to get involved after being asked by the police. Mosely had no previous records, owned a home with his wife and two kids in Queens, and was put under psychiatric observation. "Yes, the Death Penalty is Morally Permissible": Louis Pojman received a doctoral degree in philosophy from Oxford after contemplating his original course path in religion. He says that death is justified on the basis of retribution(those who take the lives of others pay for it with their own lives) and deterrence(bet that the death penalty does deter is against the murder for the innocent). Retributivist positions says that a person who has committed murder must die because there is no parallel between death and a miserable life.forfeits right to live by murdering the victim. Pojman is a moderate retributivist, and he says that a secure society is not threatened by a few murderers because capital offenses do not tear away at social order. By arguing for capital punishment, this is beating that the death of some murderers will compensate for the lives of innocent people being murdered, if you value saving innocent lives more than the loss of the guilty. Those who object to capital punishment say: it is a morally unacceptable thirst for revenge, should be rejected because of human fallibility tin convicting innocent parties and sentencing them to death, and it constitutes a denial of the wrongdoer’s essential dignity as a human being. He is against it, and would vote for its abolition if those contemplating murder would set an example for him. "Born on the Fourth of July": Marine wanted to be a winner, and the idea of being home, in high school, playing games was far better than what was actually going around him nowwar and death. When the Amtrac took him back to the battalion are, he reported back to the lieutenant than when they were retreating, one of the men got shot. Repeating what happened over and over again, he shot him with his rifle, he pulled the trigger on the corporal. In recalling this memory, he turned the gun toward his own head(wanted to kill himself and also felt the power of killing another human being). He was supposed to kill a Communist, and he wanted to think of this as an accident. Took a pregnant woman and her son and tied them on top of a hill so they could see if anyone was going to come after them, when they heard shooting, marines started running back to the trench and the corporal was the last to gotold the major he thought he killed him. At the Church and realized it was not so clear as bad guys and good guys just shooting at each othernot like the movies. Terms Suicide: Cide = to kill Who has the right to decide with these matters of life and death? The individual (patient)? The family members? The physician? ● Federal law, religion, etc – many prohibit suicide. Some states allow doctor assisted suicide, although it is prohibited by federal law. ● Religious dogma – 10 Commandments ○ Stated what was right and what was wrong ○ But what has changed? Our faith in technology. And often it has replaced our faith in religion. Technical solutions can be inappropriate to solve moral problems, such as life support machines; whether it is right or wrong to disconnect it. Shneidmandefinition: The human act of selfinflicted, selfintended cessation Categories: 1. Committed: “he committed suicide” you’re dead 2. Attempted: “she attempted suicide” the method didn’t work 3. Threatened: “he threatened suicide; if you leave me I’m going to kill myself” 4. Ideation: suicidal ideation, which means to have thoughts about suicide, you just haven’t verbalized them yet Sociological Model, Durkheim, Le Su (1897): Published book Le Suicide His model focuses on the relationship between the individual and society Connectedness to Society: Looked at the individual behavior in social settings ● Group dynamics that influenced behavior – strongly attached to society’s rules by moral obligation, structural independence, or both ● Suicide is a result of the disturbance in the ties between the individual and society ● You have to look at social integration as a factor in order to understand why a person wants to kill themselves ● Culture is another factor – can show an extremely high level of cohesiveness or solidarity, or very little 1. Topology 1. Egoistic: a person is under integrated; these are people who just don’t have enough involvement with society, it occurs when a person’s mental energies are concentrated on the self to such an extent that social sanctions are completely ineffective. Individual has very little concern for the community, people who live on the fringes of society, people who are disenfranchised. To them, society is an uncaring, faceless entity. Talks about figures such as Kurt Cobain 2. Altruistic: being overintegrated with an excessive concern for the community that is part of a very high solidarity culture. Two other names for this type of suicide: suicide by convention, and the Great Death. There is a word called “suttee” – in India, being a widow; your husband is being burned on the funeral pyre and what the funeral directors say is that often times the women did not jump into the flames; sometimes they would drug the women and throw them on. HariKari = seppuku. Same thing, just used in different countries. These mean to stab oneself. Many samurais would do this. It means ripping open your abdomen with a dagger 3. Anomic: some underintegration, but mostly lack of solidarity in the culture. Occurs when relationship between individual and society is suddenly shattered; some traumatic event or catastrophe. Ties are weakened, and because of these broken ties person experiences anxiety, isolation, loneliness. The anomic event is a severe loss; being fired from a job, the death of a close friend, an amputation, any sudden and disruptive change, whether it’s perceived as positive or negative, can precipitate the anomic suicide. Even sudden wealth can do this; many people who win the lottery have high suicide rates, higher than the national average. Divorce is a big one 4. Fatalistic: where someone experiences too much control by society, and today it is found in those who suffer political oppression, religious oppression, sometimes both. An example might be northern Ireland, where you had something both political and religious. A culture that stifles and oppresses some of its people may encounter fatalistic suicide. Totalitarian regimes. A way to escape the oppression and a hopeless life. Psychological Model 1. FreudPsychoanalytic: 1. Introject the love object: we identify with a love object (person). We internalize the person, the love object. He called it introject. Emotionally, b/c we love the person so much, we make them part of us and identify with them. Later we may have ambivalent feelings about this person, i.e. sometimes feelings of love and sometimes of hate. Sometimes the hate gets so strong that we want to kill the person, and we kill ourselves. 2. Eros and thanatos: life and death instincts. There are motivations we are unaware of and they exert a powerful influence on our behavior and under situations of stress, these forces may be so great that they overwhelm all of our ego defense mechanisms, the life instinct Eros, etc and so we take this aggression and turn it on ourselves, hence the suicide takes place Kastenbaumcultural meanings of suicide: 1. Sinful: especially in monotheistic religions. Morally wrong. 2. Criminal: for many centuries in the European countries, a family couldn’t inherit, the state would take all of the property. In US we even had individual state laws against suicide, and most state legislatures repealed it. In Great Britain it can be part of a criminal record 3. Weakness or Madness: we tend to think of it as cowardly. Madness – she must have been crazy to have done that 4. Great Death: suicide by convention, or Durkheim’s altruistic suicide. That would be the culturally approved forms of suicide 5. Rational Alternative: if individual feels that their quality of life is worse than death Kastenbaumindividual meanings of suicide 1. Reunion: you may join a deceased loved one 2. Rest and Refuge: you relieve yourself from a situation 3. Revenge: a way of expressing resentment or a way of getting back at being rejected 4. Penalty for Failure: for the disappointment of not meeting selfexpectations or the expectations someone has for you 5. Mistake: the attempt was made as a cry for help and wasn’t intended to be fatal Lethality: how effective a suicide method is. Order of Lethality: what method is the most likely to succeed. In order of effectiveness: 1) gunshot 2) carbon monoxide. Catalytic converters are much more effective than they once were, so sometimes people don’t succeed with the carbon monoxide, but if the garage is attached to the house, you might kill other people in the house, particularly if it’s nighttime and they’re asleep. 3) hanging. Sometimes hanging can be a mistake if you are trying to carry out autoerotic asphyxiation. 4) drowning. 5) suffocation – in most cases it’s a plastic bag over the head. 6) impact. (jumping) into water, onto cement, etc. 7) fire – called selfemulation. Has been used as a form of protest by people such as Buddhist nuns and monks – they set their robes on fire as a protest against the Vietnam war. 8) poison. Things like insecticides, rat poisoning, antifreeze, etc. 9) Drugs. Prescription or recreational. Hard to kill yourself with antidepressants, but easier with antianxiety (benzodiazepines). 10) gas (propane). 11) cutting. Very ineffectual, even if you’re in a bathtub full of water. Neck is more effective than wrists. ● How the method is applied influences the degree of lethality Military Suicide: Combat veterans and veterans that are in combat – there have been more suicides that those killed in action in war. 18 veterans a day commit suicide. Male veterans have a twofold increase in death by suicide over their civil counterparts. Female veterans are three fold. They use weapons because they are familiar with them. Native American Suicide: have an extremely high rate of suicide; 3x the national average. High rates of depression, alcoholism, dropping out of high school, poverty, unemployment, domestic violence, sexual abuse. Childhood and Adolescent Suicide: We define child suicide as ages 914 ● About 500 deaths per year of those within that age range, but 12,000 attempts that are so serious that the child cannot just be treated in the ER, but has to be hospitalized in a medical ward ● Adolescent suicide is ages 1524. Brain does not reach maximum maturation until 25. About 4,000 deaths a year in that age range. We see a lot of triggers in the suicides of young people: low selfesteem, lack of relationships with one’s peers, being bullied or teased, overly high expectations for achievements and success, excessively high expectations by parents, teachers, coaches ○ Factors: Sometimes it’s feeling out of control of your own life, it might be a desire to escape a difficult situation, a reunion with a deceased loved one, adults not valuing the ideas of the young person, perhaps an attempt to control others, might be an impulsive action, cognitive constriction where you don’t see alternatives ○ Cluster Suicide: are common in young people; having a suicide pact with one or more others. ○ Warning Signs: Acting recklessly, talking about suicide, withdrawing from activities, isolating oneself from family and friends, visiting or calling people to say goodbye. Giving away possessions that are of value to the young people is probably the best indicator of a coming suicide ○ Western cultures have tried to prevent suicides by attaching shame, stigma, etc to the death, religions ban it Suicide by Cop: Provoking a police officer to use excessive force in order to kill youSome people have notes on their person saying to the cop “don’t feel upset or guilty, I wanted to die” The right to die: Is there a right to die? ● Film of Brittany Maynard done 1 year after foreshortening her life! Moved to Oregon to access death withdignity law because this was not allowed in California. Euthanasia: Greek wordgood death, happy death, painless death, or mercy killing: to foreshorten the life of someone who is terminally ill. ● 70% of adults in the U.S. approve of this assisted dying. ● Wanted to encourage people of any age to talk things over with their physician 1. Voluntary: Competent, rational person decides to die 2. Involuntary: decision is not made by the patient, and is made my parents, or another competent person or maybe that individual in advance, people in a vegetative state, sever dementia 3. Active: direct action is taken to end the life f a person in a short time (i.e. injecting with large dose of morphine, person takes a large amount of a barbiturate) 4. Passive: Either a treatment is not started, and person with pneumonia do not get medication, person with a heart condition cannot be given paddles, or you can withdraw a treatment that has already begun History of Suicide/Euthanasia 1. Greeks: Socrates, Plato, Aristotle: Ancient Greeks supported Euthanasia: Socrates, Plato and Aristotle said that defective children should be allowed to die and no attempt should be made to keep an invalid alive when there is no hope for recovery. ○ They reserved the right for death 2. Romans: Seneca: Romans had a similar View: Seneca(philosopher)believed in the "simple and easy" death over torturous death 3. JudeoChristian: no condemnation: 6 Examples of Suicide, non of which are condemnedChristian in New Testament: Betrayer of Christ hangs himself and/or disembowels himself. 4. St. Augustine: 4th Century Augustine of Hippo wrote in the book City of God that Suicide is detestable > Deprives them of the opportunity to repent > An individual should suffer 1. St. Thomas Aquinas: Agreed completely with Augustine and suicide is a sin against self, neighbor, and God, only God should determine when someone dies. 2. Sir Thomas More: Diplomat to King Henry VIII(very trusted and respected),Devout Catholic, and Henry broke with the Catholic Church and Thomas More did not change his views to common line with Henry's and wrote a work called Utopia in which he fully supported Euthanasia, and something his Church stood against. > Was beheaded by the King over a matter of Church and State 1. David Hume: wrote Essay on Suicide if a person cannot promote interests to society, and his leaving life is innocent and praise worthy, 1870 (France) legalized Suicide 2. 1872 word euthanasia used: book written by physician that law should be changed to permit Euthanasia, and used to mean good death, happy death, painless death, or mercy killing Arguments by Opponents to Legalization: 1. It goes against the Hippocratic Oath(400 B.C.) the original version, all Doctors stand with physicians and recitesays that you cannot give someone medicine that will kill them! 2. 6th Commandment: Thou Shalt not Kill, and only god has the right to determine when life will end 3. Mistake in Diagnosis 4. Future Discoveries might provide a Cure 5. If you allow Euthanasia, it will destroy a patient's confidence in the doctor as a healer and an executioner 6. Can be used in an abusive way if a family member pressures a Doctor to do it 7. Patient may feel pressure t sacrifice life if they feel like they are a burden Rule of Double Effect: Thousands of Dr.'s around the world have done this and comes out of Catholic thinking, and most people who practice it don't know where it comes from. ● The act of the Dr. has to be good, and engage in a good effect which is to relieve pain or suffering and must not intend the evil effect, ● so Dr. should not intend to kill the patient. Evil effect must not be the means to the good effect, ● and there must be a proportionately great reason to risk the evil effect. Kastenbaum 1. Not viable: cannot keep person going regardless of all the life support that you are using 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 4. Recovery with Significant Impairment: there are mental and motor losses, but still alive 5. Recovery with Minimal Impairment: Can lose personality The Harvard Ad Hoc Committee to Examine the Definition of Brain Death(1968): Establish an operational criteria to legally say someone is dead, and all these years later we are still using it, but many would like to see it modified ● Patient is unreceptive and unresponsive to even painful stimuli ● No movement and no breathing(absence of spontaneous respiration) ● No reflexes(Ex: Shine light in patient's eye, and the pupils do not constrict) ● EEGMeasuring brainwaves and they are flat ● No circulation of blood within the brain, and the test must be repeated 24 hours later by the same physician that did it the first time 1. body temp. is not low 2. They don't have a CNS depressant in their body like a barbiturate Definitions 1. Cardiopulmonary: the heart and the lungs are not functioning 2. Decerebrate: no circulation of blood to the brain 3. Neocortical: brain functioning, the cerebral cortex is not functioning, no consciousness, no personhood or higher rational activity PVSPersistent Vegetative State: Have only a functioning brainstem(near neck)and controls very basic functions like digestion, and some people would prefer it be called permanent>>smack their lips, grind their teeth, stick their tongue in and out the way a snake does, have no swallowing reflex(if you did, it would kill them), yawn, eyes may blink, pupil may go sideto side, and even if they do regular physical therapy, some of them have their limbs contract so they begin to look like a grasshopper or a praying mantis(25,00 people in the U.S keeping alive and the cost is $200,000). Advanced Directives 1. Living Will (Natural Death Directive): ahead of time you say what you want and don’t want, for example how much pain meds you want, if you want your heart restarted, etc. Every time you’re admitted to the hospital they ask if you have a living will and if not, if you want to fill one out. They do this for even benign procedures. There have to be 2 witnesses to your signature. 2 physicians have to agree that you’re near death. About 42% of adults have a living will. Only 38% have a last will and testament 2. Durable Power of Attorney for Health Care: Backup copy of living will. It means that the individual is not in charge of your finances or anything else except for making decisions about your treatment. It’s best that you only pick one person. Terminal Sedation: keep person asleep until death occurs Does a Person Have to Be Dying to Have the Right to Die? 1. Karen Anne Quinlan: tried to kill herself via prescription, then starving herself, forced on ventilator for ten years from adoptive parents, died of pneumonia, medicaid paid to keep her alive even though she didn't want to be 1. Nancy Cruzan: married, car accident after skidding on black ice, ejected from car and head first into ditch, wasn't wearing seatbelt, took 15 minutes for her to breathe again, suffered trauma to brain (lack of oxygen and physical trauma), was in PVS, husband divorced her, feeding tube, parents asked to remove it 4 years later so she could die, trial court said it could be removed but supreme court said couldn't be, lower court said yes to removal, died peacefully and comfortably 2. Terri Schiavo: wanted to conceive but had hard time b/c of bulimiccollapsed from respiratory and cardiac arrest, PVS with feeding tube, she said not to keep her alive if something happened but parents against this due to religious beliefs, court said it could be removed, husband's guardianship questioned, passed "Terri's Law" applied only to her for feeding tube to be put in (orders of governor), says what state legislature did was unconstitutional, feeding tube removed 3. Dax Cowart: Grew up in TX, and after College, he went into the air force where he became a pilot, and after that, he joined his father in the real estate business that involved land appraisal and development. Sustained burns of 2nd and 3rd degree, and asked to be killed by the farmer, but instead he took him to the hospital. ○ Wanted to leave the hospital to die on his own from infection. ○ He decided not to be discharged because he did not want to disappoint his Mother ○ Went to Law school and married his high school sweetheart, but he should have been allowed to die! Physician Assisted Suicide 1. It's Over Debbie, Dr. Anonymous: This article appeared in a medical journal. A 20 year old woman with cancer to an overtired gynecological resident that she wanted to die so he killed her with a lot of morphine. It is unclear is she wanted to die asking for pain relief or death, he didn't know patient, made the decision unilaterally 2. Diane and Dr. Timothy Quill: published in New England Journal of Medicine. Diane was his patient of Quill as a primary care doctor for 8 yearshad had vaginal cancer and had an excellent recover. Both of her parents and her were alcoholics, but she had had many years of sobriety, her clinical depression had been treated and she went to him because she felt exhausted and drew some blood and within a short period of time, learned that she had a virulent form a leukemia. Only 25% survive and of those who do, the treatment is brutal nausea, vomiting, weakness. She did not want treatment and wanted to have the illness take over herboth her son and husband agreed that she did not have to have treatment. Went to the Hemlock society to learn how to foreshorten her life. Wrote prescription barbituratesprescription is not written to take all at once because pharmacist would not write the prescription, and she invited friends to come individually and then doctor was called once she was dead and he called the Coroner. After writing the article NY took him to court, but he was acquitted. 3. Dr. Jack Kevorkian: From MI, was an anatomical pathologist in CA(did autopsies), and after retirement he moved back home and decided that people should be allowed to end their life if they had a good reason(1990's). His sister would videotape an interview with patients who would come to him. First person to come to him was Janet Atkins at 50 years old and was diagnosed with early onset Alzheimer'sshe passed the interview with him and she is ready to for his machine(The Thanatron) to die: 3 liquids(sodium pentathol, pancromium bromide, potassium chloride) with an I.V., and drives her to the emergency room and leaves her in the parking lot of the hospital after calling the hospital informing them of a dead body. Another man could not turn the wheel(too sick) so he turned the knob on the I.V., so this was active assistance in death. Ran for Congress in 2008 after he was granted parole, and died in 2011. State Initiatives for Death with Dignity: has these words to not have people upset and not have the words doctor and suicide in it. Physician Assisted Suicide in Oregon: 1994 passed on the ballot as a referendum, and you can get enough signatures on a petition to defeat it, so it passed. However, many right to life people that blocked it going into place. Greater majority passes it in 1997must be a resident in the state of Oregon, 2 doctors have to certify that you are going to die within the next 6 months, at least 18, mental sane, know about hospice, not depressed, make contact with Dr. 3 times, one in person and the next time, 15 days apart, and in between you have to write a letter to them, and at that point, the physician will prescribe a legal dose. *NOTE: Legal in 5 statesruling in supreme court, signed by legislature, or states that have a referendum signed on the ballot. New Mexico has itdoctors can take part Abortion: 42 million abortions per year worldwide, and the majority are performed outside the hospital. 1.21.5 million in the US. In 2014, it was 1.2 million, so it had dropped a bit 1. Spontaneous Abortion=miscarriage: the medical term for a miscarriage environment is such that the fetus cannot continue 2. Induced Abortion: (we just call it abortion) something mechanical or chemical has been used to produce death in the embryo or the fetus and it is then expelled 3. History of Abortion Roe v. Wade1/22/73(allowed abortion): Vote 7:2, Justice Blackmun: U.S. Supreme Court, landmark decision can normally take years before there is one that is handed down. Wade, TX and Roe protected the name of a womanyoung female carpenter said she was raped and asked to be aborted and the had the baby, and it was put up for adoption. Case went on for a few years before it went to Supreme Court and she admitted years later that it was not a rape. Chief Justice Earl Warren did not write the decision, although he was in support of it. Justice Blackmun wrote the decision. Write to Privacy in the 14th Amendment: Write to Privacy that pertains to the Supreme Court's decision.Broad enough to encompass a woman's decision to end her pregnancy. First trimester: decision is between woman and her decision Second Trimester: Who may do an abortion? State could say this is only someone who is a licensed OBGYN and cannot be done by a nurse practitioner etc. Where can an abortion take place? The states have said that the place where this take place should meet all the requirements of a surgical center. Third Trimester: Where there can be violability(the fetus might live) that is where it has to be based on the health of the Mother or the life of the Mother. Methods First Trimester 1. Dilation and Curettage(D and C): First trimester up until 12 weeks. A medical procedure in which a woman is first given a relaxant and then she is given medication that puts her into a "twilight" sleepsomewhat aware of what is going on around you. Scalpel(razor and blade)inside of curved surface(uterus is scraped) this is used for many medical problems in the female(can determine Cancer in the Uterus). 2. SuctionVacuum Aspiration: 3. Most common method that we have today, tranquilizer that indices twilight sleep and a series of hollow rods are pushed up through the cervix, and a piece of tubing is attached and the content of the uterus comes out into a bottle and then the procedure is overhas to take her temperature for next 2 days every 6 hours to be sure that there is no infection( if temp. goes up)! Second Trimester 1. Saline: Needle pushed into abdomen to the uterus and amniotic fluid is pulled out and saline goes in, and the contents of the uterus dies and shrivels upreverses the osmosis and pulls liquid out of the fetus. She will go into labor within the next few hours and can be sedated as she expelled the fetus and the skin looks burned. Can be done up tot 20 weeks. 2. Hysterotomy(Cesarean Section): 3. A Woman has an incision made above the pubis (horizontal) and the physician cuts into the uterus, and forceps grip head of fetus and the bones are crushed(they are soft), pulled back out and the fetus is dead. The woman is stitched up, and by crushing the head, the incision does not have to be very wide. Third Trimester (beyond 20 weeks) 1. Dilation and Extraction(D&X): Many people who believe abortion should not take place, refer to this as a partial birth abortion. Up until very near delivery, the feet of the fetus are hanging down(breech birthbaby can smother). The physician pulls on the feet so that they are hanging out of the woman's body, then the physician reaches up and pierces the skull and suctions out the brainskull is going to collapse, and then the fetus is pulled out the rest of the way. 2. Dilation and Evacuation(D&E): The cervix Is Dilated and the physician use instrument sot cut the fetus into pieces while it is in the Uterus and with small forceps, the pieces of the fetus are pulled outfetus is dismembered. 3. Chemical MethodDrugs(RU486Mifeprex): French manufacturer would not sell it in the U.S. because of how contentious we are about abortion, they did not want to lose their U.S. market. Actually 2 medications. Mifepristone and Misoprostol and these two drugs together are called Mifeprex. First is given in the Doctor's office and then the woman take the other medication when she is at home. Painful cramps, and can now be used to up to 10 weeks after the time of intercourseapproved in 92' in France and was only approved in 00' in the States. 8 Deaths of woman, usually a heart condition in combination with the medicine, so it is considered safe. * Plan B is an overthecounter pill that can be taken 710 weeks after intercourse to prevent pregnancy Homicide: used interchangeably with murder(often) means the killing of one human being by another Can involve noncriminal or criminal acts, when it noncriminal it is called justifiable homicide, selfdefense, to protect another person, to protect another person or property 1. Murder(types): Premeditated Firstdegree murder Killing takes place during felony such as robbery, rape, or kidnapping, often call it Murder 1 for first degree murder. In the states the execute, it is called capital murder, and not all states execute. Those who don’t have it or depending on the decision life imprisonment Second Degree Murdercarries much shorter sentence(1025 years) Manslaughter negligence contributing to the death without intending to do so Voluntary manslaughterkilling in the heat of passion Involuntary manslaughterreckless driving, driving under the influence of alcohol, swimming pool without a high enough fence and somebody climbs over the fence and drowns. Kitty Genovese: bystander effect: If there are other people present they will either remain neutral or actively encourage violence and seldom do they intervene 1964, 28 years old is return into her apt. in the Queens, NY from job as bar manager. Parked her car in the Long Island Railroad Parking Lot, and she noticed a mannever made it to the police box. Man was a paranoid Schizophrenic and had a knife on her People had her windows open and he begins to stab Kitty in the passageway and 3 times she gets away, and it took him 30 min. to kill her. 30 people heard her screams and did nothing about it. Serial Murder: defined by the FBI as killing 3 or more people over a period of time. 1. Jack the Ripper 2. The Boston Strangler 3. Ted Bundy women from coast to coast 4. John Gacy killed 30 boys in Chicago. He would dress as a clown for children’s parties. 5. Juan Corona 25 migrant workers in California 6. Jeffrey Dahmer killed adolescent males and ate some of them. Mass Murder: (several people die in a single episode) Profile is of a male, with firearms who is also suicidal. 1. Charles Whitman from the clock tower at the University of Texas killed 16 people, wounded 30 and had already killed his mother and wife before coming to the university. 1966 2. Richard Speck killed 8 nurses who lived in the same dorm like building in Chicago. 1966 3. James Huberty killed 21 people in a McDonald's in San Diego in 1984. It was called the Big Mac attack. 4. Assorted disgruntled postal workers (going postal). The first occurred in 1984 in Edmon, Oklahoma where 14 employees died. 5. April 1, 2007 32 students and faculty died at Virginia Tech (Seung Hui Cho) 6. November 11, 2009 Major Nidal Hasan a physician, killed 13 and wounded 42 at Fort Hood, Texas 7. Summer of 2012: Colorado – movie theater Wisconsin – Sikh Temple Collective Murder: A special type of mass murder is known as a collective murder. It means that there is more than one killer murdering more than one person in a brief time. It would include the killings done by the Manson Family (Charles Manson and his friends) when they murdered the pregnant actress, Sharon Tate, and the other people present at her dinner party (Helter Skelter). There is another example of this that took place during the Vietnam War. It was March 16, 1968. Lt. William Calley ordered his men to kill all the people in the village of My Lai in South Vietnam. He said he thought there were enemy soldiers in the village. There were no enemy soldiers but there were women, children and old men. All 455 of them were killed. Many were killed while praying. The were killed with clubs, bayonets or shot at close range. Lt. Calley was court marshaled. He was sentenced to life in prison. It was reduced to three and a half years. In Haditha, Iraq in the fall of 2005 Marines killed 24 civilians in their homes after a lance corporal was killed by an improvised explosive device (IED). Trials were by the military but no convictions. Genocide: political murder on a large scale Ethnic Cleansing: When such killings which are sanctioned by a particular social group occur on a large scale and are directed at a specific social, national or ethnic group, it is called genocide or ethnic cleansing. 1. From 19151923 the Ottoman Turks exterminated 1.5 million Armenians. 2. Stalin from 1929 to 1932 killed 11 million Russians by starvation and massacre. 3. During World War II the Nazis exterminated 6 million Jews and 4 million people in other categories such as the retarded, Gypsies, homosexuals, political opponents. 4. In the mid 1970s the Khmer Rouge executed 2 million Cambodians. 5. Dafar region of Sudan (starting in 2003) Assassination: political murder on a small scale. The assassination of political leaders has been commonplace for centuries. Consider Julius Caesar. In the United States 4 presidents have been assassinated and one fourth have had attempts on their life Lincoln, Garfield, McKinley, Kennedy Terrorism: Related to assassination and usually political in its aims is terrorism. It is the use of threats and violence to intimidate or coerce. Although murder is a common result of terrorist activity, the primary purpose of terrorism is to frighten, anger or otherwise emotionally arouse. It is carried out mostly against civilians. In the US there has been the World Trade Center in 1993 with the bombing in the underground garage, the Federal Building in Oklahoma City with a bomb in a truck outside the building and September 11, 2001. Terrorist groups go back to ancient times. Capital Punishment: The death penalty has been applied to hundreds of different crimes since ancient times. 1. Under the Code of Hammurabi the death penalty was decreed for selling beer. 2. A Roman wife could be executed for taking the keys to her husband’s wine cellar without permission. 3. The ancient Egyptians executed people for worshiping idols. 4. In Persia a person could be put to death for accidentally sitting on the king’s throne. Historycruel and inhuman methods approved: During the Middle Ages capital punishment was widely used in crimes against the state and against the church. By 1819 there were 223 different capital crimes listed under British law. In the British colony of Massachusetts in 1636 there were 13 capital crimes. They included adultery, blasphemy (cursing God), idolatry, sodomy and witchcraft. Most of the capital crimes in colonial times seem to reflect feelings about sex and religion. A common dilemma in the past was devising the most cruel and inhumane method of execution possible. The person was often tortured before being executed by being branded, flogged or mutilated. 1. boiling in oil, water, tallow or wine. The caldron was made of brass. Tied hand and foot. 2. burning at the stake: heretics, Joan of Arc 3. stoning (Jackson’s story, The Lottery) Still used in Saudi Arabia, Yemen, Sudan, Iran, Pakistan, and Afghanistan. Tied, buried up to neck in sand, head covered with a sheet. 4. crucifixionPersians, Carthaginians, Romans for 1,000 years –flogged first – had to carry the cross piece. 5. beheading with an ax later the guillotine was invented 6. being thrown to hungry wild animals (lions, tigers, bears, dogs, leopards, wild boars, hyenas) slaves, Christians 7. crushed Furman vs. Georgia 1972(abolished death penalty): A landmark US Supreme Court decision on capital punishment was handed down in 1972 in the case of Furman v. Georgia. Vote 5:4: It was a 5 to 4 decision in which the court judged Georgia’s death penalty law as unconstitutional according to the Eighth Amendment prohibiting cruel and unusual punishment. Reinstated 1976: By 1976 capital punishment was reinstated through three different decisions that the court made that year. After 1972 the states that had capital punishment rewrote their laws on the subject. The Supreme Court now said, “When applied thoughtfully, carefully and under the right circumstances, capital punishment is not unconstitutional”. 37 states got back the death penalty right away. New York did not reinstate it until 1996 and then rescinded it in 2005. New Jersey abolished it in 2007. There are now 34 states with the death penalty. Methods of Execution 1. Hanging: The person is blindfolded and hooded. A gallows (scaffold) has to be constructed. A nonstretch rope is used. The knot is placed against the blood vessels on one side of the neck. The person stands on a trap door on a platform. The trap door is opened. The weight of the person’s body below the neck causes traction and tearing of the cervical muscles and blood vessels. The upper cervical vertebrae are dislocated and the spinal cord is separated from the brain. The volume of blood to the brain falls drastically. Respiration slows and the heartbeat slows and stops. Initially during hanging the body moves in response to pain. Later there is a second set of movements which are spinal reflexes. 2. Shooting: The prisoner is tied to a chair (used to be a pole) in front of sand bags. There is a blindfold and a hood. A target is fastened over the heart. There are five men with rifles and one of them has blank ammunition. The cause of death is usually blood loss through the rupture of the heart and lungs. 3. Electrocution: first carried out by ConnEdison in New York State in 1888. The head and the calf of a leg are shaved. Usually the pants are slit. The prisoner is fastened to a heavy wooden chair that in turn is fastened to the floor. There are straps across the chest, groin, arms and legs. Moistened copper terminals on rubber strips are attached to the head and one leg. About 2,000 volts are applied for 30 seconds at a time. The prisoner is examined by a physician. More current may be applied. There is often the smell of burning flesh/meat cooking. Dead Man Walking 4. Lethal Gas: the prisoner is strapped to a metal chair in a fairly small airtight chamber. Sodium cyanide crystals are dropped into a bath of sulfuric acid that is below the chair. It is done by depressing a lever that is on the outside of the chamber. Hydrogen cyanide gas is formed and inhaled. A sufficient concentration of the gas to constitute a lethal dose can take several seconds to a few minutes. The gas causes difficulty in breathing and then asphyxia. There seems to be a lot of pain and there are spasms of the body. 5. Lethal Injection: the prisoner is strapped to a surgical table in several places. A canula is inserted in a vein in each arm to keep a vein open. Three solutions flow in. There is sodium pentothal which acts as an anesthesia in 3 to 5 minutes (barbiturate) – states can no longer get sodium thiopental. There is curare (pancurium bromide) which causes paralysis of the muscles and potassium chloride which stops the heart by interfering with the electrical current within 15 minutes. The American College of Anesthesiologists has said its members are not to take part in executions. Some prisoners have brought suits saying it is cruel and unusual punishment because of the pain that is felt when one is paralyzed but not fully unconscious. 12/14/06 in Florida an execution took 34 minutes. The prisoner grimaced and more chemicals were given. NOTE: 3,000 people are on death row. It is much more expensive to execute someone than to keep them in prison for the rest of their life. Do not ill many women. There is a gender and race different for people that we execute. War: Another type of legal political murderinvolves the social approved organized killing of humans who are defined as enemies. 1. Objectives: producing deathbody count is important. Was done after Vietnam. The bigger the number, it made people think they were winning. It is not really any sort of measure for how well we are doing. Can be a measure of strength. Killing is accomplished speedily, massively, and with minimal losses to one side. War killing is acceptable considered necessary and at times, heroic. Death Work 1. Calling: the way someone feels, equated with the highest social and religious values. 2. Job: necessary of the work of the society undertaken mostly by young adults, considered a contribution by society, something that must be done and you do it to the best of your ability. 3. Slavery: in US, civil war in 1861 up until 1970's which is the draftcalled slavery because the choice is entirely eliminated. Can get out by leaving the country, being a college student(i.e. student deferment). Starting in Vietnam by something called fragging, it meant doing things by harming officers by pulling grenade and putting it in the officer's tent. Socialization to Death Work 1. "the rabbit lesson": the platoon in a classroom, the table at the front with a sergeant holding a rabbit. The sergeant would stroke and pet the rabbit. Suddenly the sergeant broke the rabbit’s neck, disemboweled it, then threw the mess all over the classroom and people. “Do anything you have to do in order to survive” 2. Euphemisms: “Friendly fire” – killing of your own (accidental). “Collateral damage” = when you bomb a hospital, orphanage, school, library, etc, instead of a military target. Normally it is not intentional, but civilians die. “In theatre” = where the combat is actually taking place. “Mopping up operations” = you go into a small entity (a village, small town) and you kill everything that moves; you kill all the people there. That’s the “mopping up” operation. 3. Enemy as inferior: called the GermanKrauts, the JapaneseJaps, the word rag head in the middle east, Commie, ChineseYellow, 4. Invulnerability: Vietnam – about a 24 hour delay between when video or film was taken, brought to the US, processed, and then shown on evening television. People would often eat dinner while watching the news. What they saw of the military’s activities became so routine that when a long segment was showing baby seals being clubbed to death for their fur, the television stations got numerous phone calls/letters about the seals being clubbed, but nothing about the footage of the killing of humans that was shown 5. Ethnocentrism: belief that your country is better than other countries(religion, ethnic group, culture) 6. Patriotism: values that support war 7. God's on one's Side: God is on the side of everyone, regardless of who was an enemy of whom 8. Correctness of One's Leaders: president, King, Prime Minister, Dictator, Tribal Leader must be right. We believed there were Weapons of Mass Destruction in Iraq. Can be a thrill that comes with killing. The more you kill, the easier it is and you see it as the one way to solve an issue. Johnny Got His Gun: Trumbo(1939): Dalton Trumbo write it. Wrote an award after a war for the scripts of the movies he wrote, and was part of the communist party and wrote scripts under different names even though he was blacklisted from Hollywood. About a young man from US who goes to France in 1917 and he is right there when a cannon blows up, deaf, blind, mute, no arms or legs, and can only breathe with a machine and fed though a stomach tube. He can feel. He is put on an examining table, and know when people come in the room. He can feel being massaged and touched and rubbed. He knows Morse code and how he communicates. He can move his head from sidetoside. One side is the dots and the other side is the dashes. He can tap out messages on his pillow from sidetoside. They did not let him become a living exhibit at noon to let people come and talk to him, and they did not want people to see what the future could look like. Civilian casualties literally outnumber military casualties 1011 million and 20 million Russian starved to death(ate rats and grass) and freezing to death. Nuclear Holocaust: Nuclear destruction is called nuclear holocaust. Holocaust means to be completely consumed by fire. 1. Manhattan Project: Large number of scientist in the field of mathematic, physics and chemistry who fled Germany I the late 1930's some to Switzerland and Canada, but majority in the U.S. try to create a weapon that would be extremely powerful (AKA the Atomic bomb). Scientists were distributed among three location: Washington, New Mexico, Tennessee. In TN, scientist separated the Uraniumhad separation process that involved 100's of workers, lots of metal plates with little holes in them and an electromagnet made of silver. Leslie Groves(general in charge of the project). Once they had enough uranium, it was put in a case that was lined with lead sheets and a man in civilian clothing got on a commercial airline and flew it to New Mexico. Called the bomb, "the Gadget" and many people had no idea what they were working on. Head scientist named Robert Oppenheimer and he was always suspected of being a Communist. Decided they were going to test one of these gadgets before one was dropped on Japan. War in Europe now ended VE Day(Victory Europe Day). Japan did not want to consider a surrender. Truman became President and knew nothing of these projects and he had to make the decision of whether there was going to be a dropping of one or more of these bombs. Day set for the test was Monday, July 16th. 2. Hiroshima and Nagasaki, (August, 1945): Japan is asked one more time and declines the surrender. Plane was a B29. Pilot was 29 years old and the weather was not good over many of the cities in Japan. Had the aircraft and the bomb over islands in the Pacific and he had to learn how to turn play around quickly because once dropped, shock waves were made after drop, plane would be pulled down. Plane dropped at 8AM at mostly civilian population. Called the bomb "little boy". 200,000 people who died and many more were going to die later from radiation sickness. Dropped second bomb three days later Plutonium bomb named "fat man". 3. Growth of Nuclear Weapons: growth has brought about encounter with death that could lead to unprecedented death. Nuclear destruction is called nuclear holocaust. Holocaust means to be completely consumed by fire. people started building bomb shelters in the US and in DC which in the 50'sDC was considered ground zero, not NYC. People did build bomb shelters in their basements with the thought that they could survive. Tes
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