The Business Of Dying Essay, Research Paper
The Business of Diing
Prepared for: Peru State College
Business Administration 251: Legal environment and Contract Law
Submitted to:
Victor F. La Puma
April 5, 1998
By
Lisa M. Holmes
403 Main Street, box 331
Johnson, NE 68378
402-868-4945 TABLE OF CONTENTS
Chapter 1Die and Pay Taxes 1
Chapter 2The Concept and the Cases3
Chapter 3
Legislation and the Health Care Stand9
Chapter 4Death a affair Ethics, Religion or Legal Realism 13
Chapter 1
Die and Pay Taxes
My male parent one time told me the lone things we have no pick but to make in this life are to decease and pay revenue enhancements. Although he may hold been right, we can likely do some educated picks to impact the consequence of both. Due to the development of our society and progresss of modern twenty-four hours medical specialty, our picks in either of these duties may be huge but besides limited to our cognition and the planning we engage.
Do we hold picks? Henry David Thoreau felt that the revenue enhancements imposed by a war that he was apposed to were unfair. He refused to pay the revenue enhancements and was imprisoned. Thoreau would still hold the right today to protest the revenue enhancement under the doctrine of Natural Law. He would still more so probably be imprisoned if he refused to pay his revenue enhancements, but what of his right to decease? Without an advanced directive or some kind of life will in topographic point, in our so called advanced civilization, Thoreau might non hold a pick in his ain decease. He could easy be kept imprisoned by being kept alive and at the clemency of his keepers.
Under today & # 8217 ; s legal society the wellness attention supplier may exert rights as our keeper. Many of us may presume those wellness attention suppliers, assured that the jurisprudence permits them to make so, will esteem the determinations of their patients, or of their patients appointed determination shaper. As a consequence, most advanced directing Torahs impose no inauspicious effects on suppliers who refuse to follow the instructions of an progress directive. Some may even keep that disobedience is lawfully acceptable. In contrary, in recent old ages wellness attention suppliers who seemingly impose medical intervention and disregard the instructions in an beforehand directive may so be guilty of medical battery.
There are different types of progress directives. The two most common are populating volitions and lasting powers of lawyer for wellness attention. For illustration, your life will may state that you do non desire your life prolonged with machines or that you do non desire tubing eatings or an Intravenous ( IV ) to supply you with fluids. However, your life will could besides state that you want everything possible done to maintain you alive. It is of import that it be a statement of your purpose. A lasting power of lawyer for wellness attention is a papers you sign in which you appoint an agent to do your medical determinations for you if you aren & # 8217 ; t able to do them due to incapacitation. Nebraska jurisprudence recognizes both populating volitions and lasting powers of lawyer for wellness attention. In order to subscribe a life will or a lasting power of lawyer for wellness attention, you must be at least 19 old ages of age and competent. If younger than 19, you must be either married or divorced and competent.
Chapter 2
The Concept and the Cases
History maintains that the construct of our right to decease has interested philosophers since the clip of the Greeks. However, it has merely late go a pertinent societal concern. By the 1950 & # 8217 ; s, progresss in medical engineering had allowed the terminally sick and for good unconscious patients to be kept alive dramatically longer than of all time before. In the past these persons died rapidly from complications or from an inability to eat and imbibe. The new-found capableness of medical scientific discipline brought hard right-to-die issues into the lives of many deceasing patients, where the class of nature one time seemed inalterable. Doctors, patients, and household all of a sudden needed to make up one’s mind when a life should stop. The footings & # 8220 ; populating will & # 8221 ; and & # 8220 ; power of lawyer & # 8221 ; were introduced into our vocabulary to guarantee that our rights in decease were protected. Although Americans may experience strongly about their rights in decease, the statistics show that we still don & # 8217 ; t want to turn to these rights. Harmonizing to a 1991 Gallup canvass, 75 per centum of all Americans approve of life volitions. Conversely, the canvass besides showed that merely about 20 per centum of all Americans soon have a life will or medical power of lawyer. Society is still determining an sentiment on the contention. The events and unfortunate fortunes of several persons of our decennary have defined the quickly germinating epoch of societal, ethical and legal contention environing the right to decease.
The Karen Ann Quinlan instance was one of the first ethical quandary that emerged in the epoch of modern medical specialty. Quinlan suffered a respiratory apprehension in 1975 and was diagnosed with terrible encephalon harm as the consequence of anoxia. She was unable to take a breath without a mechanical inhalator and unable to eat without a eating tubing. Her household set about a drawn-out legal conflict to reason that their girl would non hold wanted to be kept alive in this status. Finally, the New Jersey Supreme Court granted the alleviation.
The New Jersey Supreme Court held that Karen had a right of privateness grounded in the Federal Constitution to end intervention. The Court nevertheless, recognized that this right was non absolute but should be considered on a instance by instance footing. The tribunal besides concluded that the & # 8220 ; merely practical manner & # 8221 ; to forestall the loss of Karen & # 8217 ; s privateness right due to her incompetency was to let her guardian and household to make up one’s mind & # 8220 ; whether she would exert it in these fortunes.
Although the Quinlan instance helped specify the ethical and legal contention of the & # 8220 ; right to decease, & # 8221 ; Karen Ann & # 8217 ; s instance did non wholly change the Torahs to back up those rights. The same tribunal that decided the Quinlan instance considered whether a nasogastric eating tubing could be removed from an 84-year-old incompetent nursing-home occupant enduring from irreversible mental and physical complaints. While acknowledging that a federal right of privateness might use in the instance the tribunal, contrary to its attack in the Quinlan instance, decided to establish its determination on the common jurisprudence right to self-government and informed consent. Since there was no life will or power of lawyer in topographic point the tribunal ruled in favour of the nursing place leting continued eatings. The instances continue to be considered, each on an single footing.
Equally recent as 1990 the instance of Nancy Cruzan heard by the United States Supreme tribunal in 1990 has raised concern over societal policy on the issues. On January 11, 1983, Nancy Cruzan lost control of her auto as she traveled down a route in Missouri. The vehicle overturned, and Cruzan was discovered lying face down in a ditch without noticeable respiratory or cardiac map. Paramedics were able to reconstruct her external respiration and pulse at the accident site, and they transported her to a infirmary in an unconscious province. An go toing brain surgeon diagnosed her as holding sustained likely intellectual bruises compounded by important anoxia ( deficiency of O ) . The Missouri test tribunal in this instance found that lasting encephalon harm by and large consequences after 6 proceedingss in an anoxic province ; it was estimated that Nancy was deprived of O from 12 to 14 proceedingss. She remained in a coma for about three hebdomads, and so progressed to an unconscious province in which she was able to orally consume some nutrition. In order to ease eating and farther the recovery, sawboness implanted a gastrostomy eating and hydration tubing in her with the consent of her so hubby. Subsequent rehabilitative attempts proved futile. Nancy was in a Missouri province infirmary in what is called a relentless vegetive province. Hospital employees refused, without tribunal blessing, to honour the petition of her parents to end her unreal nutrition and hydration, since that would ensue in decease. The State of Missouri was bearing the cost of Nacny & # 8217 ; s attention. Again the household petitioned the province for expiration of her eating and prolongment of medical attention. A province test tribunal authorized the expiration, happening that a individual in Nancy & # 8217 ; s status has a cardinal right under the State and Federal Constitutions to direct or decline the backdown of death-prolonging processs. The State Court based their determination on Nancy & # 8217 ; s look to a former housemate that she would non wish to go on her life if ill or injured unless she could populate at least halfway usually, suggested that she would non wish to go on with her nutrition and hydration. The instance was elevated to the State Supreme Court degree by the State of Missouri. The State Supreme Court reversed. While acknowledging the right to decline intervention embodied in the common-law philosophy of informed consent, the tribunal questioned its pertinence in this instance. It besides declined to read into the State Constitution a wide right to privateness that would back up an unrestricted right to decline intervention and expressed uncertainty that the Federal Constitution embodied such a right. The tribunal so decided that the State Living Will statute embodied a province policy strongly prefering the saving of life, and that Nancy & # 8217 ; s statements to her housemate were undependable for the intent of finding her purpose. It rejected the statement that her parents were entitled to order the expiration of her medical intervention, reasoning that no individual can presume that pick for an incompetent in the absence of the formalities required by the Living Will Statute or clear and convincing grounds of the patient & # 8217 ; s wants.
The Due Process Clause does non necessitate a State to accept the & # 8220 ; substituted judgement & # 8221 ; of close household members in the absence of significant cogent evidence that their positions reflect the patient & # 8217 ; s. Without cogent evidence of 1s wishes the inquiry of constitutionally-protected autonomy and involvement in finding the clip and mode of 1s decease will go on to be an issue. Chapter 3
Legislation and the Health Care Stand
As Congress looks for ways to control lifting Medicare costs, wellness attention suppliers and dietary professions are raising their concerns. Within these establishments, the thought of an ethics commission is being considered. The commissions would transport out defined written guidelines for attention of the lasting unconscious. In add-on, dieticians would be required to be a members of or adviser to such commissions and would function an built-in function in development of institutional policy. The dietetics community is involved in the legislative sphere at the province and local degree to advance the usage of advanced directives and to consequence legislative and social alterations that result in appropriate attention for patients in a drawn-out vegetive province.
The Multi-Society Task Force on Prolonged Vegetative States has already established guidelines for feeding a patient in a drawn-out vegetive province and within single establishments. Normally, the nutritionary impression of & # 8220 ; when in uncertainty, provender & # 8221 ; is considered indispensable for the patient & # 8217 ; s rights.
Sing patients who are for good unconscious, tungsten
ith regard for personal liberty, assorted ethical principals may be in struggle of the “when in doubt” thought. If attention suppliers decide that there is an duty to feed a for good unconscious patient, does that duty of all time halt? As yet, there is no official consensus among doctors that handling a patient in a relentless vegetive province is inappropriate or that protracting life is non an independent and overruling end of medical specialty. The possibility of positive result should be assumed until the patient has non shown advancement over clip. Harmonizing to the place of those in the medical profession, a consensus on the issue of drawn-out attention and protracting life may be long in coming. They add that such a consensus may non be desirable. If doctors agreed, society might be foolish plenty to give the wellness attention supplier one-sided say over what is best for the patient.
The Hippocratic Corpus encourages doctors to acknowledge when medical specialty has reached its bound of utility. A common method of separating between obligatory and optional is to see the effects, both benefits and loads. Nutrition and hydration can be effectual to keep life, but entirely they can non reconstruct consciousness. The Corpus goes on to province, & # 8220 ; because the ultimate end of any medical intercession should be betterment of the patient & # 8217 ; s forecast, comfort, well-being, or general province of wellness ; hence, nutrition may be futile as a medical treatment. & # 8221 ;
The Hippocratic Oath has been the steering ethical codification for doctors since ancient Greece. Medical professionals still take the curse upon their indoctrination. It states in portion, & # 8220 ; I will keep the extreme regard for human life from the clip of construct ; even under menace I will non utilize my medical cognition reverse to the Torahs of humanity. & # 8221 ; It is ill-defined merely what mandates the exact Torahs of humanity. While natural jurisprudence provides that we use moral and ethical rules built-in in human nature and our natural intelligence, we still must see what our natural rights may be sing the development of society. A wide definition of the jurisprudence consists of enforceable regulations regulating relationships between persons and between persons and their society. In today & # 8217 ; s society we can jest about decease and we can see decease on telecasting and in the media, but we still don & # 8217 ; t want to believe about be aftering for our ain decease or the decease of those we love. We surely do non look frontward to fixing a documented history of what we would desire in an exigency or drawn-out life state of affairs. The issues of justness and the right to decease with self-respect may be turning in strength, but each single attacks that universal, common terminal called decease with different spiritual, philosophical and personal attitudes and values. The statute law passed to protect these rights merely made a meager effort to protect the single & # 8217 ; s rights to fix for their ain decease.
The Patient Self-Determination Act, which took consequence on December 1, 1991, requires all Medicare/Medicaid wellness attention suppliers to inform patients of their right to fix an progress directive and to decline intervention. The Act is based on rule, which was affirmed in a 1891 instance, that & # 8220 ; No right is held more sacred, or is more carefully guarded by the common jurisprudence, than the right of every person to the ownership and control of his individual, free from all restraint or intervention of others, unless by clear and unquestionable authorization of the jurisprudence & # 8221 ;
The act was established to guarantee that patients, non the household or establishments, make their determinations about their medical intervention. In instances where there is no documented grounds of the persons wants, the tribunals are left to make up one’s mind them on a instance by instance footing. Surely non all instances and patient state of affairss are non the same. Some interesting points to consider may be what considerations we should do for kids poetries older grownups, or pregnant adult females. With regard to patients in a relentless vegetive province, the development statute law and societal alterations may be the solution. As clip base on ballss and our society evolves, farther statute law is likely to be passed, therefore modeling what defines the hereafter right to decease issues. If through the development, the definition of decease were changed to be the decease of higher encephalon maps, a patient in a relentless vegetive province would be considered dead.
Chapter 4
Death a affair Ethics, Religion or Legal Realism
John Stuart Mill established the useful theoretical account of moralss. He saw ethical determinations as those that produce the greatest positive balance of value over negative balance of value for all individuals affected. To the novitiate this means that under useful moralss, an action is morally right or right when it produces the greatest sum of good for the greatest figure and when the action affects the bulk adversely it is morally incorrect. His positions concentrate on the effects of an action, non on the nature of the action itself or on any set of preestablished moral values or spiritual beliefs. The deontological point of view of moralss, expressed by Immanuel Kant, states that some Acts of the Apostless are incorrect and other are right independent of their effects. American society extremely values tolerance of conflicting moral values. It besides values the right to the single to command or regulate 1s ain logical thinking and ethical values. While wellness attention professionals have an built-in ethical duty to esteem the holiness of life and to supply alleviation from enduring. Beneficence, liberty, and justness are accepted moral rules regulating the behaviour of wellness attention professional within society. With the technological progresss in medicine come struggles between application of moral rules and usage of certain types of medical intervention. The determination of which moral rule takes precedency in what state of affairs creates the struggle. The current guidelines written by wellness attention suppliers and the American Dietetic Association do back up the patient & # 8217 ; s right to self-government as the overruling rule. However, the footing for self-government bent by the individual yarn that a life will or some kind of medical power of lawyer exists.
Religion may be the lone establishment that comes near to a possessing consensus. While Orthodox Judaism does non accept the thought of & # 8220 ; encephalon decease & # 8221 ; it does specify decease as the absence of respiration, cardiac map, and encephalon map. The Judaic belief supports that the determination to proved attention should be based on a sensible organic structure of medical sentiment that attention is non required when a instance is hopeless. Roman Catholics and some Protestant church governments have rejected the impression of protracting life despite quality. While both conclude that protracting life by unreal agencies was distinguishable from mercy killing, they concur that the remotion of life support was acceptable if being allowed to decease would be better for the patient. In 1992, the National Conference of Catholic Bishops released a paper opposing all wilful self-destructions but saying that Roman Catholics are non obliged to utilize extraordinary or proportionate agencies when there is no hope for recovery. In General most faiths support the statement that if there is no benefit, the process can non be obligatory. Merely as faith holds that the holy Bibles were given by godly inspiration, so do they believe that life is a gift. While the methods of each church or faith differ, the overriding faiths of the Western hemisphere do non back up protracting life when their is no benefit to the person and no hope of their recovery.
Decision
& # 8220 ; An column of kinds & # 8221 ;
Although there are several instances affecting right to decease issue, no clear cut definitions exist in jurisprudence or statute law about what is considered right or incorrect when it comes to the Health Care Provider taking agencies drawn-out life support to a patient in a persistant vegetive province. The fact remains that if an person does non hold life will or some kind of progress directive in topographic point, they are fundamentally go forthing the picks up to the infirmaries the tribunals and in conclusion the household. In some instances the household did non even have the last say.
I have to inquire if it has non become an issue of money to some in the wellness attention profession. When provinces are picking up the check the infirmaries and nursing places seem to contend to go on in their quest to protract life. Frankly I was appalled that the infirmaries could even action to go on attention. If the household is contending to stop the attention of the patient, what benefit other than money could the infirmary or nursing place foresee?
Wholly I hold the same sentiment or belief as the held by faith. If there is no hope of recovery, wellness attention suppliers should non protract life. I see no benefit to the greater good of society if wellness attention suppliers are allowed to protract the inevitable.
Bibliography
Blue Rivers Area Agency on Aging ( BRAAA )
Larry Ossowski, Director
Gage County Courthouse, Room 24
Beatrice, NE 68310
World Federation of Right to decease Societies Newsletter
Issue # 29, November, 1996
ISSN 0742-535X
Choice in Dying Issues
hypertext transfer protocol: //www.choices.org/issues.htm # debut
Legal and Ethical Issues
The American Dietetic Association
216 West Jackson Boulevard
Chicago, Illinois 60606-6995
hypertext transfer protocol: //www.eatright.org/alegal.html
Freeman EA.
Protocols for vegetive patients.
Med J Aust. 1993: 159:428.
LaPuma J, Orentilicher D, Moss RJ.
Advanced directives on admittance:
Clinical deductions and analysis of Patient Self-Determination Act of 1990.
JAMA, 1991: 266:402-405.
The Multi-Society Task Force on PVS ( Persistent Vegetative State )
Medical Aspects of the Persistent Vegetative State.
New England Journal of Medicine. 1994 ; 330: 1499-1506
Hippocratic Curse
hypertext transfer protocol: //www.hsd.uvic.ca/HIS/programs/s97cours/h270/rmatting/hipoath.htm
Tong R.
An Exercise in Futility:
Are we bidden to & # 8220 ; dainty & # 8221 ; the un-treatable?
North Carolina Medical Journal
1993:54: 386-391
Council on Scientific Affairs and Council on Ethical and Judicial Affairs.
Persistent Vegetative State
The determination to retreat or keep back life support.
JAMA 1990: 263: 426-430
New ANA Guidelines on Withdrawing or Withholding Food and Fluids
Nurs. Mentality
1988:36 ( 3 ) : 122-123, 148-150
Kinney H, Korein J, Panigraphy A, Dikkesp, Goode R.
Neuro-pathological findings in the encephalon of Karen Ann Quinlan.
New England Journal of Medicine.
1994: 159-428
Brahams D.
Persistent vegetive province.
Lancet1993:341:428
U.S. Constitution, Fith and Fourteenth Amendments
Kate L. Turabian
Student & # 8217 ; s Guide for Writing College Papers
Third Edition, revised and expanded.
Court instances mention in footers throughout text
