• UNIFORM DETERMINATION OF DEATH ACT (UDDA):
• DYING -> W/IN CONTEXT OF FAITH
• ORDINARY / EXTRAORDINARY MEANS OF LIFE SUPPORT
• ASSIST / SUBSTITUTE VITAL ORGANS
• DIALYSIS
• VENT
• CPR
• KILLING OR ALLOWING TO DIE?
DETERMINATION OF DEATH
ORDINARY / EXTRAORDINARY MEANS OF LIFE SUPPORT
Uniform Determination of Death Act (UDDA):
• model state law
• approved 1981
• NATIONAL CONFERENCE OF COMMISSIONERS ON UNIFORM STATE LAWS
• AMERICAN MEDICAL ASSOCIATION (AMA)
• AMERICAN BAR ASSOCIATION (ABA)
• PRESIDENT’S COMMISSION FOR THE STUDY OF ETHICAL PROBLEMS IN MEDICINE AND BIOMEDICAL AND BEHAVIORAL RESEARCH
Determination of Death:
(1) irreversible cessation of circulatory and respiratory functionsor
(2) irreversible cessation of all functions of the entire brain, including the brain stem
UNIFORM DETERMINATION OF DEATH:1. STANDARD CRITERIA (CARDIO-PULMONARY):
NO HEARTBEAT AND NO BREATHINGor
2. NEUROLOGICAL CRITERIA; ELECTROENCEPHALOGRAM (EEG)x PARTIAL BRAIN DEATH (NOT ACCEPTABLE) TOTAL BRAIN DEATH (YES ACCEPTABLE)
MEDULLA OBLONGATA
DYING -> W/IN CONTEXT OF FAITH
HUMAN LIFE: YES FUNDAMENTAL VALUE / NOT ABSOLUTE VALUE
USA LIFE EXPECTANCY:
• WOMEN: 81 YEARS
• MEN: 76 YEARS
• COMBINED: 79 YEARS
MANAGEMENT, RELIEF: PAIN / SUFFERING
ANALYSIS: BENEFIT / BURDEN
DIAGNOSIS -> PROGNOSIS
BIOETHICAL MEANS OF LIFE SUPPORT:
• ORDINARY (PROPORTIONATE) / EXTRAORDINARY (DISPROPORTIONATE)
CLINICAL MEANS OF LIFE SUPPORT:
• STANDARD MEDICAL PRACTICE / EXPERIMENTAL TREATMENT
ERD 56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that, in the judgment of the patient, offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.
ERD 57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that, in the patient's judgment, do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.
ETHICAL OBLIGATION RE. VITAL ORGANS: ASSIST / SUBSTITUTE
WHEN TO WITHHOLD OR WITHDRAW LIFE SAVING TREATMENT?
DIALYSIS: SUBSTITUTES KIDNEYS
RESPIRATOR; ASSISTS IN PROVIDING OXYGEN
VENTILATOR; DEPENDS ON THE SETTINGS: ASSIST OR SUBSTITUTE BREATHING
RESPIRATORS: ASSIST BREATHING
(NOT VENTILATOR)
VENTILATOR: PERFUSION
WEANING PROCESS
VENT ~ 2-3 WEEKS BEFORE TRACHEOTOMY
EXTUBATION
TRACHEOTOMY
(TRACHEOSTOMY)
CARDIOPULMONARY RESUSCITATION (CPR):
• ASSISTS / SUBSTITUTES HEART
Defibrillation
• treatment for cardiac dysrhythmias
• Ex. ventricular fibrillation (VF) and ventricular tachycardia (VT)
• delivers a dose of electric current to the heart
KILLING OR ALLOWING TO DIE?
