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MORTALITY, MORALITY & HONOR:THE END-OF-LIFE PARADIGM
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DA VINCI’S VITRUVIAN MAN - 1490 VITRUVIUS 25
B.C.
THE CIRCLE REPRESENTS THE
COSMIC & THE DIVINE
THE SQUARE, THE EARTHLY
& THE SECULAR
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THE GOAL: LINEAR TO CIRCULAR THE LONG FLAT TABLE NO LONGER
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ANOTHER “DR DEATH ?” MY MANTRA
GROW OLDER & DIE YOUNG AS LATE AS POSSIBLE
PLAN ON IT
PLAN FOR IT
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AND MY WISH?
TO WRITE MY LAST CHAPTER…. AND WHEN IT IS READ, A LONG TIME FROM NOW, HAVE IT BE RECOGNIZED AS A WORK OF NON-FICTION
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A CONSTANT ? OR AN EVER-CHANGING LANDSCAPE ?
IF YOU WANT TO HIT A BIRD ON
THE WING YOU MUST HAVE YOUR
MIND IN FOCUS. YOU MUST HAVE
THAT BIRD IN YOUR MIND’S EYE.
EVERY GREAT ACHIEVEMENT IS A
BIRD ON THE WING.
OLIVER WENDELL HOLMES Jr
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IF YOU A WANT “BEST” READ A “MUST” READ
ATUL GAWANDE MD
“LETTING GO” NEW YORKER
AUG 12, 2010
WHY NOW ? WHY HERE ?
A BIG ISSUE
A DIVISIVE ISSUE
A “CIVIL” RIGHTS BATTLE
0
2
4
6
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What Percent of People Will Eventually Die?
AND IT WON’T BE EASY
GALLUP’S VALUES ANDBELIEFS POLL - MAY ‘10 DWD - PAS 45 % - IT’S MORALLY ACCEPTABLE 32 % - IT’S MORALLY WRONG
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“IT”
THE RIGHT, IN ADULTSOF SOUND MIND, TO EXERCISE CHOICE ANDCONTROL FOR THEM-SELVES AT THE END OFLIFE
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DOES THIS MAKE A DIFFERENCE ?
NATIONWIDE, RECENT POLLS
SHOW THAT >70% OF AMERI-
CANS BELIEVE THAT TERMIN-
ALLY PATIENTS SHOULD HAVE
THE RIGHT TO SELF-ADMINISTER
A LETHAL MEDICATION TO
ACHIEVE A PEACEFUL DEATH.
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I KNOW- POLLS !
‘05 GALLUP75% SAID YES TO DOCTORSBEING ALLOWED TO HELP THE
TERMINALLY ILL DIE
BUT ONLY 58% SAID YES WHEN
THE WORD SUICIDE WAS
INCLUDED
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BUT INCREASINGLY
THE COURTS AND THE PUBLIC
RECOGNIZE THAT TERMINALLY ILL
PATIENTS ASKING FOR AID IN DYING
ARE NOT “SUICIDAL”
AND PROVIDING SUPPORT IS NOT
“ASSISTING SUICIDE.”
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SO WHO IS AGAINST PHYSICIAN ASSISTED DEATH ?
THREE BROAD CATEGORIES:
SANCTITY OF LIFE MUST BE PRESERVED
THE SLIPPERY SLOPE MUST BE PREVENTED
THE MEDICAL SYSTEM CAN ELIMINATE OR
ALLEVIATE END-OF-LIFE SUFFERING
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WITH ALL DUE RESPECT
U.S. CONFERENCE OF BISHOPS –‘11
“ALL PATIENTS – INCLUDING THOSE
IN THE SO-CALLED PERSISTENT VEG-
ETATIVE STATE – BE PROVIDED WITH
ARTIFICIAL HYDRATION AND NUTRITION
IF SUCH CARE COULD EXTEND LIFE, EVEN
INDEFINITELY.”
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CATHOLIC ETHICAL & RELIGIOUS DIRECTIVES – (CERD’s)“VIRTUE IS PROTECTING & PRO-
LONGING LIFE, OVER ALL VIRTUES,
OVERRULING PATIENT CONCERNS
ABOUT THEIR QUALITY OF LIFE.”
“PATIENTS EXPERIENCING SUFFER-
ING THAT CANNOT BE ALLEVIATED
SHOULD BE HELPED TO APPRECIATE
THE CHRISTIAN UNDERSTANDING OF
REDEMPTIVE SUFFERING.”
IRONY TO ANXIETY: 40 % OF HOSPITALS……
IRONY TO HYPOCRISY: IF WE ARE GOING TO A BETTER PLACE ?…..
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THE HIPPOCRATIC OATH
ORIGINAL ENGLISH TRANSLATION:
“I WILL NOT GIVE A LETHAL
DRUG TO ANYONE IF I AM ASKED”
MODERN TRANSLATION:
“I WILL REMEMBER THAT THERE IS
AN ART TO MEDICINE AS WELL AS
SCIENCE, AND THAT WARMTH, SYM-
PATHY AND UNDERSTANDING MAY
OUTWEIGH THE SURGEON’S KNIFE
OR CHEMIST’S DRUG”
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THE MANTRA – THE MYTH
DOES PAD, (DWD), CONTRA-
DICT A PHYSICIAN’S RE-SPONSIBILITY TO PRESERVELIFE? COMPASSION: THE HUMANE QUALITY OF UNDER-
STANDING THE SUFFERING OF
OTHERS AND THE DESIRE TO DO
SOMETHING ABOUT IT
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IRONYWHAT WOULD HAPPEN IF THERE WERE NO MORE DEATH ?
WE WOULD HAVE NO NEED FOR
PROGRESS OR ART, FAITH OR FAME
WE WOULD HAVE LITTLE TO DO
YET IN THE GREATEST OF IRONIES,
HAVE ENDLESS EONS IN WHICH TO
DO IT.
ACTION WOULD LOSE IT’S PURPOSE,
TIME ITS VALUE
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THE “SLIPPERY SLOPE” WILL ADVANTAGE BE TAKEN NO, ABSOLUTELY NOT!
RATES OF ASSISTANCE IN STATES,
(COUNTRIES), WHERE DWD IS LEGAL
SHOW ABSOLUTELY NO BIAS AGAINST
THE ELDERLY
THE UNINSURED
THE UNEDUCATED
THE MINORITIES
THE POOR
A REVERSE SLOPE ? THE W & W - THE D & A
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AND AS FOR COMPLETE RELIEF
LET US ASK WHY PALLIATIVE
CARE HAS EMERGED AS A
RESPECTED & ESSENTIAL PART
OF OUR MEDICAL LANDSCAPE -
ONLY RECENTLY !
COLORADO SB 102 - 2006
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PAIN & COMPASSION (PLEASE REFLECT ON IT)
WHAT ARE WE GOOD AT ?
OUR MEDICAL SYSTEM IS
EXCELLENT AT TRYING TO
STAVE OFF DEATH WITH:
ICU CARE $5,OOO+/DAY
CHEMOTHERAPY $8,OOO/MO
SURGERY $5,000/HR
BUT ULTIMATELY, THE
OWL CALLS OUR NAMES
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AND NOT SO GOOD AT ?
“AGAINST OTHER THINGS IT IS
POSSIBLE TO GAIN SECURITY, BUT
WHEN IT COMES TO DEATH WE
HUMAN BEINGS ALL LIVE IN AN
UNWALLED CITY.”
“NO ONE WANTS TO DIE. EVEN
PEOPLE WHO WANT TO GO TO
HEAVEN DON’T WANT TO DIE TO
GET THERE. YET DEATH IS THE
DESTINATION WE ALL SHARE.”
AND DOES OUR MEDICAL PROFESSION HAVE A PROBLEM WITH THIS ?
JENNIFER TEMEL MD – MGHNEJM 2010
(RANDOM ASSIGNMENT OF 151 ADV LUNG CANCER PTS TO “REGULAR CARE OR CARE & EARLY DISCUSSIONS WITH PALLIATIVE CARE
GROUP TWO:
BETTER QUALIITY OF LIFE & LESS TROUBLESOME SYMPTOMS IN TIME REMAINING
PHYSICIANS SHOWED A BETTER APPRECIATION OF PT’S WISHES & WERE MORELIKELY TO RECOMMEND CARE CONGRUENT WITH THOSE WISHES
FAMILIES SHOWED LESS GUILT & DEPRESSION AFTER THE DEATH.
GROUP TWO LIVED A LITTLE LONGER TOO (2.7M)
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MORE ? - THE KEATING STUDY (CANCER 15 2010)
NANCY L KEATING MD, MPHHARVARD MEDICAL SCHOOL
BY QUESTIONAIRRE, (4,000+ PHYSICIANS CARING FOR CANCER PATIENTS
LOOKED AT TIMING OF DISCUSSIONS ON 1. ACCURATE PROGNOSIS 2.WISH FOR “DNR” 3. NEED FOR HOSPICE 4. PREFERRED SITE OF DEATH CONCLUSIONS:
MOST PHYSICIANS REPORT THEY WOULD NOT DISCUSS END-OF-LIFE OPTIONS WITH TERMINALLY ILL PATIENTS WHO ARE FEELING WELL.
“THERE WILL BE TIME FOR THAT LATER.”
BE ADVISED, TALKING ABOUT DYING WON’T KILL YOU, THOUGH…………………
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A DOUBLE STANDARD ?
“WHY DOCTORS DIE DIFFERENTLY”
KEN MURRAYCAP - FAMILY
MEDICINEUNIV SO CALWSJ 3/10/12
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HONESTY – THE BEST POLICY ?
HEALTH AFFAIRS JOURNAL FEB, 2012 POLL OF 2000 MD’s
MORE THAN HALF HADFRAMED A PROGNOSIS IN A MORE POSITIVE LIGHT THAN WAS WARRENTED
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SIGNS OF CHANGE ?
2011 SURVEY BY THE REGENCE
FOUNDATION ON BEHALF OF THE
NATIONAL JOURNAL FOUND
THE 96% OF MD’s BELIEVE IT’S
MORE IMPORTANT TO IMPROVE
PATIENT’S QUALITY OF LIFE THAN
TO PROLONG THEIR LIVES.
79% OF MD’s SURVEYED SAID:
“U.S. SPENDS FAR TOO MUCH
TRYING TO EXTEND LIVES”
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ALZHEIMER’S DISEASE
“A DEGENERATIVE DISEASE THAT
IS 100% INCURABLE AND 100% FATAL, WHICH ROBS ITS VICTIMS OF MEMORY, JUDGEMENT & DIGNITY, LEAVING THEM UNABLE TO CARE FOR THEMSELVES, AND DESTROYING THEIR BRAIN AND THEIR DIGNITY, OFTEN DEPLETING THE RESOURCES OF THEIR CAREGIVERS AND THEIR FAMILIES – BOTH EMOTION- ALLY & FINANCIALLY.
JUSTICE SANDRA DAY O’CONNOR OCTOBER 27TH, 2010 NY TIMES
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AND A SOBERING THOUGHT
STARTING ON JAN 1, OUR 79 MILLION
STRONG BABY BOOM GENERATION
WILL BE TURNING 65 AT THE RATE OF
1 EVERY 8 SECONDS !
AND THE REALITY IS THAT THE
INCIDENCE OF DEMENTIA DOUBLES
EVERY FIVE YEARS AFTER 65
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KAREN KEHL – Am J Hosp & PC “MOVING TOWARD PEACE” A GOOD DEATH
BEING COMFORTABLE
BEING IN CONTROL
HAVING A SENSE OF CLOSURE
MAKING MOST OF RELATIONSHIPS
HAVING FAMILY INVOLVED
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IN WHICH IS THERE TIME FOR…
MORTALITY, MORALITY & HONOR CHOICES AT THE END OF LIFE
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THE SEMINAL CASE KAREN ANN QUINLAN - 1976
CHRONIC VEGATATIVE STATE
PARENTS REQUEST “WITHDRAWAL”
NJ SUPREME COURT RULES IN FAVOR
OF THE “RIGHT TO REFUSE ARTIFICIAL
VENTILATION”
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KAREN ANN QUINLAN - 1954-1985
THE FATHER, A FIRM CATHOLIC,
AND THE ASSIGNED GUARDIAN,
WAS A POSITVE FORCE IN THIS
CASE, FOR ADDRESSING HIS
CONSCIENCE AND MOTIVATIONS
THE FIRST CASE ABOUT THEOLOGY,
BIOETHICS, EUTHANASIA, LEGAL
GUARDIANSHIP AND CIVIL RIGHTS
POSITIVES: BIOETHICS COMMITTEES
ADVANCE DIRECTIVES
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TERRI SHAIVO – CVS – 1990-’05
ESSENTIALLY, A TRAGEDY:
OF PERSONAL LIVES
OF THE LAW
OF POLITICS
ULTIMATELY, AN EMBARRASSMENT
( READ “USING TERRI”)
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THE HISTORY OF END-OF-LIFE CHOICES IN THE UNITED STATES
‘87, ’89, ’91: OREGON WRITESLEGISLATION GRANTINGINDIVIDUAL OPTIONS FOR END-OF-LIFE (SS FRANK ROBERTS)NO BILL LEAVES COMMITTEE
ROBERTS DIES A HARSH DEATHAT HOME AT LEAST – OCT ‘93
‘94 OREGON PASSES VOTER INITIATIVE TO ALLOW DWD (51 TO 49 %) (SIGNED INTO LAW BY ROBERT’S WIFE & GOVERNOR, BARBARA ROBERTS)
INTERCONNECTIONS
APRIL, ‘93, AT THE PEAK OF THE AIDS EPIDEMIC, ACTIVISTS ESTAB-
LISH “COMPASSION IN DYING” IN SEATTLE, WASHINGTON, PUBLI-
CALLY DECLARING THEIR INTENTION TO COUNSEL MENTALLY
COMPETENT, TERMINALLY ILL PATIENTS ON AID-IN-DYING.
PUBLISHED WERE SPECIFIC ELIGIBILITY CRITERIA, GUIDELINES AND
SAFEGUARDS AND VOLUNTEERS TO ATTEND DEATH.
A MEDICAL MODEL EVOLVES WITH CLIENT ASSESSMENT, PROFES-
SIONAL REFERRALS, AN INTERDISCIPLINARY TEAM OF VOLUNTEERS
AND SELF-ADMINISTERED MEDICATION.
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JUNE, 1997
“THROUGHOUT THE NATION, AMERICANS
ARE ENGAGED IN AN EARNEST AND PRO-
FOUND DEBATE ABOUT THE MORALITY,
LEGALITY AND PRACTICALITY OF PHY- SICIAN AID IN DYING. OUR HOLDING PERMITS THIS DEBATE TO CONTINUE, AS IT SHOULD IN A DEMOCRATIC
SOCIETY.”
Median Age 70 (25-96)
White - 97.5%
Education - 67% had attended college
Suffering from cancer - 81.8%
Enrolled in hospice - 87.8%
Insurance - 98.2%
Sex - 53.1% Male - 46.9% Female
94% died at home
Facts on Use of Oregon Law
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OREGON AT 14 YEARS
I CONTEND NO “SLIPPERY SLOPE”
BUT AN AGING POPULATION
WITH MORE CHRONIC DISEASE
AND MORE KNOWLEDGE
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“REASONS FOR ‘CHOICE’”
LOSING AUTONOMY 89.9 %
CANNOT ENGAGE IN
PLEASURABLE ACTIVITIES 87.4 %
LOSING CONTROL OF BODILY
FUNCTIONS 58.7 %
BURDEN TO FRIENDS 39.3 %
INADEQUATE PAIN CONTROL 23.9 %
FINANCIAL CONSIDERATIONS 2.8 %
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THE “HOW TO”
A TERMINALLY ILL, COGNITIVELY
SOUND ADULT, MAY OBTAIN A Rx FOR A
LETHAL DOSE OF MEDICINE, PROVIDED
THE PATIENT:
1. HAS BEEN ADVISED OF OTHER OPTIONS
2. HAS MADE TWO VERBAL APPEALS / 15D
3. HAS MADE A WRITTEN REQUEST
4. WITNESSED BY TWO WHO ARE NOT
CARETAKERS OR FAMILY
5. ORAL, NOT IV MEDS / HELIUM
OUR GOVERNMENT IN MEDICINE
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OBAMA CARE & “DEATH PANELS”
FROM AN OFTEN CITED PROVISION
OF THE UNPASSED BILL WHICH WOULD
HAVE AUTHORIZED MEDICARE REIM-
BURSEMENT FOR PHYSICIANS WHO
WOULD PROVIDE VOLUNTARY COUN-
SELING ABOUT SUCH SUBJECTS AS
PATIENT & FAMILY WISHES, LIVING
WILLS,
AD’s…………..CHOICES…….. AT THE END OF LIFE
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AH…. WHAT TO MAKE OF IT
BETSEY McCOUGHEY
VP CANDIDATE PALIN “MY PARENTS & MY BABY WITH
DOWN’S SYNDROME WILL HAVE TO STAND IN FRONT OF OBAMA’S DEATH PANAL SO BORED BUREAUCRATS CAN DECIDE, BASED ON SUBJECTIVE JUDGEMENT, ON THEIR ‘LEVEL OF PRODUCTIVITY IN SOCIETY’, WHETHER THEY ARE WORTHY OF HEALTH CARE.”
“NULLIUS IN VERBA”
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THE FALLOUT
STUDIES SHOWED THAT
30 TO 45 % OF AMERICANS
BELIEVED THIS RHETORIC
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MORE GOVERNMENT
JANUARY 1, 2012 – CREATION
OF “INDEPENDENCE AT HOME
ORGANIZATIONS” – GROUPS OF
DOCTORS & NURSES TO Rx PTS
AT HOME & INCENTIVES TO
MAKE THAT WORK APPEALING.
PAID FOR BY SAVINGS FROM
DIMINISHING HOSPITAL STAYS
AND PROCEDURES
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AND AGAIN ?
IN THE AHCA, IN 2014,
THE INDEPENDENT PAYMENT
ADVISORY BOARD, (IPAB),
MAKES RECOMMENDATIONS
ON COST SAVINGS, YET IS
EXPRESSLY PROHIBITED FROM
TAKING ANY ACTION WHICH
WOULD RATION CARE.
BUT…………..
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AN INTERESTING POLL
FIFTY-THREE % OF AMERICANSWOULD JUST AS SOON SEE THEHEALTH CARE BILL REPEALED.FORTY-THREE % SUPPORT IT.
OF INTEREST, 70% OF THE53% OPPOSED, FAVOR 2/3OF THE BULLETS CONTAINEDIN THE BILL.
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THERE’S AN ARGUMENT
ANY CENTRALLY ADMINISTERED
HEALTH-CARE SYSTEM WILL, INEVITABLY,
MAKE “COST-MINDED JUDGEMENTS ABOUT
WHAT TYPES OF CARE” SHOULD BE PRO-
VIDED TO WHICH CATEGORIES OF PATIENT
ALREADY HAPPENING
ARIZONA: THE STATE CUT OFF REIMBURSE-
MENTS FOR ORGAN-TRANSPLANTS FOR THE POOR
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NEVER TALK ABOUT THE COST (BUT BE REMINDED)
25 %OF ALL MEDICARE SPENDING IS FOR THE 5 %OF PATIENTS WHO ARE IN THE FINAL YEAR OF LIFE, AND MOST OF THAT MONEY GOES FOR CARE IN THEIR LAST MONTHS OF LIFE WITH LITTLE BENEFIT IN TERMS OF LONGEVITY OR QUALITY OF LIFE.
(ABOUT 60 BILLION)
AND THE PSYCHOLOGICAL, PHYSICAL AND FISCAL COST TO
FAMILIES ?
OF COURSE, WE DON’T KNOW IT’S THE LAST MONTHS
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CURRENTLY THE LEGAL RIGHT OF EVERY CITIZEN IN EVERY STATE A COMPETENT ADULT PATIENT
HAS THE RIGHT TO REFUSE UN-WANTED MEDICAL TREATMENTTHAT COULD INCLUDE DIALYSIS,SURGERY, BLOOD
TRANSFUSIONS,ANTIBIOTICS AND ARTIFICIAL LIFESUPPORT, EVEN WHEN REFUSALMIGHT LEAD TO DEATH.
THIS RIGHT EXISTS EVEN IF THEPATIENT IS NOT TERMINALLY ILL.
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WHAT ABOUT OUR CITIZENRY ?
“DO YOU APPROVE ORDISAPPROVE OF LAWSTHAT LET PATIENTSDECIDE ABOUT BEINGKEPT ALIVE THROUGHMEDICAL TREATMENT?”
84% APPROVE
PEW RESEARCH CENTER ’01-’05
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WHO’S SIDE ARE YOU ON?(IS IT NOT PART OF OUR LEGAL DNA?)
“THE ROOT PREMISE IS THE CONCEPT,
FUNDAMENTAL IN THE AMERICAN
JURISPRUDENCE SYSTEM THAT EVERY
HUMAN BEING OF ADULT YEARS AND
SOUND MIND HAS A RIGHT TO
DETERMINE WHAT SHALL BE DONE
WITH HIS OWN BODY.”
JUSTICE BENJAMIN CARDOZO
NY COURT OF APPEALS 1914
(US SUPREME COURT 1932-38)
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A DEVIL’S ADVOCATE – MAY I ?
A FEW THOUGHTS ON
END-OF-LIFE PLANNING
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STEPHEN JAY GOULD
BROOKLYN/HARVARD PALEONTOLOGIST
‘85 ESSAY:« THE MEDIAN & THE MESSAGE »
Dx; ABDOM MESOTHELIOMA - ‘85
THE LITERATURE: BRUTAL (8MO’s)
BUT THE CURVE BEYOND THE MEDIAN
WITH A LONG, ALBEIT, SLENDER TAIL
INTERESTED GOULD
GOULD GETS SURGERY & CHEMO -
AND TWENTY YEARS – D ‘02
A NATURALIST SPEAKS
“IT HAS BECOME, IN MY VIEW, A BIT TOO TRENDY TO REGARD
ACCEPTANCE OF DEATH AS SOMETHING TANTAMOUNT TO INTRINSIC
DUTY. OF COURSE I AGREE WITH THE PREACHER IN ECCLESIASTES
THAT THERE IS A TIME TO LIVE AND A TIME TO DIE, AND WHEN MY
SKEIN RUNS OUT I HOPE TO FACE THE END CALMLY AND IN MY OWN
WAY. FOR MOST SITUATIONS, THOUGH, I PREFER THE MARTIAL
VIEW THAT DEATH IS THE ULTIMATE ENEMY AND I FIND NOTHING
REPROACHABLE IN THOSE WHO ‘RAGE MIGHTILY AGAINST THE
DYING OF THE LIGHT.’”
STEPHEN JAY GOULD 1985
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SO WHAT IS IT WE REALLY WANT SIMPLY, NOTHING MORE THAN YOU WANT CHOICE AND CONTROL AT THE END! HENCE: ADVANCE DIRECTIVES EUREKA!!!
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AD’S & THE ULLYSES PACT
A FREELY MADE DECISION THAT
IS INTENDED TO BIND ONESELF
IN THE FUTURE
IN MEDICINE, WITH AD’s & LW’s,
THERE EXISTS CONTROVERSY
OVER WHETHER DECISIONS MADE
BY ONE IN ONE STATE OF HEALTH
CAN BIND ONE IN ANOTHER
WHEN AM “I” NOT “ME” ?
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COMPASSION & CHOICES
WHO WE ARE AND
WHY YOU SHOULD
GET TO KNOW US
ABOUT USCompassion & Choices is the oldest and largest nonprofit organization advocating for comprehensive end-of-life care and treatment options. Founded in 1980 as the Hemlock Society, and merged with Compassion in Dying in 2004, over the years the organization has grown, become more mainstream and now focuses on improving care and expanding choice at the end of life.
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A YOUNG ORGANIZATION – WITH TIMELESS CHALLANGES1980 – HEMLOCK SOCIETY
2003 – FOUNDER, DH, LEAVES
TO FORM “FINAL EXIT”
2004 – “COMPASSION & CHOICES”
Clients need not be members
Clients need not be“terminally ill”
Services may includereferral to other specialists, organizations, or officials
We never charge forservices
Eligibility for Services
DYING USED TO BE ACCOMPANIED BY A PRESCRIBED SET OF CUSTOMS
REAFFIRM ONE’S FAITH
REPENT ONE’S SINS
LET GO OF WORDLY AFFAIRS
LAST WORDS
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AND A COMFORT TO ALL -
A WORD ABOUT HOSPICE
BRITISH MD – DAME CICELY SAUNDERS 1940’S ST. CHRISTOPER’S – LONDON 1964 YALE SCHOOL OF NURSING THE CONNECTICUTT HOSPICE 1974
“WE DO NOT HAVE TO CURE TO HEAL”
US MD – ELISABETH KUBLER-ROSS “ON DEATH AND DYING” FIVE STAGES OF GRIEF
“IT HAS BROUGHT DEATH OUT OF THE DARKNESS”
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HOSPICE - A COMFORT TO ALL ?
MEDICARE COSTS FOR HOSPICE
HAVE INCREASED MORE THAN IN
ANY OTHER HEALTH CARE
SECTOR ‘05 TO ‘10 – 70% !!
IN 2010, 42% OF DEATHS
OCCURRED IN HOSPICES
(22% IN ICU’s)
MEDICARE PAYS FOR 84% OF ALL
HOSPICE PATIENTS -
(<6 MOS & ACCEPTANCE)
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“AMERICAN” HOSPICE PROBLEMS ON THE HORIZON ?HOSPICE NOW A $4.5 BILLION
PER YEAR INDUSTRY
40% OF HOSPICES ARE NOW
“FOR PROFIT”
AND COSTS ? 29% HIGHER/PT
AND NOW ? FRAUD ? LAWSUITS ?
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IS THERE ANY CHANCE
THAT WE CAN COME
TOGETHER AND ALL BE
OF ONE “MIND” - BE IT
AS ZEBRAS OR HORSES?
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CAN IT BE DONE ?
YES, IF WE RECOGNIZE THAT….
“EVERY GREAT ACHIEVEMENT IS A
BIRD ON THE WING.”
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JOHANN WOLFGANG von GOETHE
“AS LONG AS YOUARE NOT AWARE OFTHE CONTINUAL LAWOF DIE AND BE
AGAIN,YOU ARE MERELY AVAGUE GUEST ON ADARK EARTH.”
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HEMINGWAY - 1960
“THE WORST DEATHFOR ANYONE IS TO LOSETHE CENTER OF HIS BEING,THE THING HE REALLY IS”
IS THERE A TIME AND A PLACE HERE
TO SAY…………………
2011 - 22% OF DEATHS OCCURRED
IN AN ICU
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THE GRATEFUL DEADSTANDING IN A SHAFT OF LIGHT
RISING UP TO PARADISE,
I KNOW I’M GONNA SHINE
ACCEPTANCE OF DEATH WHEN IT ARRIVES IS ONE THING, BUT TO ALLOW IT TO UPSTAGE THE JOYS OF LIVING IS INGRATITUDE
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LIFE – A CIRCLE OR A LINE ?
“ I LIVE MY LIFE INWIDENING CIRCLES THATREACH OUT ACROSS THEWORLD. I WILL NOT COM-PLETE THIS LAST ONE,BUT I GIVE MYSELF TO IT”
RANIER MARIA RILKE
MORTALITY AND MORALITY HONOR CHOICE AT THE END OF LIFE
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SO THE QUESTION IS NOT
“WILL I DIE?”
BUT
“WHEN AND HOW?”
NO, LIFE & DEATH ARE NOT “THE FLAT TABLE”
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THERE ARE TWO KINDS OF LIGHT THOSE THAT GLOW AND ILLUMINATE
AND
THOSE THAT GLARE AND OBSCURE
“NOT A SHRED OF EVIDENCE EXISTS IN FAVOR OF THE ARGUMENT THAT LIFE IS SERIOUS, THOUGH IT IS OFTEN HARD AND EVEN TERRIBLE. SINCE EVERYTHING ENDS UP BADLY FOR US, IN THE INESCAPABLE CATASTROPHE OF DEATH, IT SEEMS OBVIOUS THAT THE FIRST RULE OF LIFE IS TO HAVE A GOOD TIME; AND THE SECOND RULE OF LIFE IS TO HURT AS FEW PEOPLE AS POSSIBLE IN THE COURSE OF DOING SO. THERE IS NO THIRD RULE.”