Pain Management: “Killing or Allowing to Die?”
Subject: Medical Ethics
Table of Contents Uniform Determination of Death Act Catholic Declaration on Life and Death Health care proxy Advance Directives, Living Will, PoA, DNR ERD paragraphs #: 24, 25, 26, 27, 28, 55, 59, 61, 62 summaries References Uniform Determination of Death Act Uniform Determination of Death Act (UDDA) is a document that was established in 1981 by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. The central aim of the act was to establish the legal standard (for all states) for death using neurologic criteria (DNC) (Lewis, 2020). It means that the procedure for legal declaration of death is unified for the whole country by precise neurologic criteria.
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The Act provides two definitions of when a person can be legally declared dead. The first one is “an individual who has sustained irreversible cessation of circulatory and respiratory functions”, and the second one is “irreversible cessation of all functions of the entire brain, including the brain stem” (National Conference of Commissioners on Uniform State Laws, 2009). The first definition is the most common situation when death is declared. In this case, the heart has stopped functioning, and (or) an individual is not breathing. The second situation refers to the stop of brain activity, even though other organs are still functioning. Within the context of faith, physical death is not considered as the end but instead as the beginning of a new life. Some people will experience face-to-face communication with God, as a reward for faith. Thus, death in the context of faith is viewed as a blessing and a hope for a new eternal life of the soul. Pain management faces some ethical challenges that scientists and philosophers are trying to resolve. According to the work of Carvalho et al. (2018), pain relief is a moral obligation. Moreover, medical schools are obliged to teach pain management on a mandatory basis. Lastly, preventing patients from opioid treatment is considered highly unethical. First, it is essential to consider both definitions (pain and suffering). According to IASP (2017), pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Concerning the suffering, it is “an unpleasant or even anguishing experience which severely affects a person at a psychophysical and an existential level (Bueno-Gomez, 2017, para. 3). It can be logically observed from both definitions, that the two conditions (pain and suffering) can occur together or separately. For instance, a person can experience both pain and suffering when he or she is severely injured. Another example is when a person feels pain without suffering: physical pain from an intensive workout. An individual has an uncomfortable feeling in muscles but does not experience suffering. In the same way, a person can suffer without pain. Most of the situations when people experience suffering do not include physical pain: sadness, guilt, depression, oppression and other conditions that can be considered unfavourable. There is a continuous debate over the moral question “killing or allowing to die?” or the legalization of euthanasia. It is a philosophical question of whether “killing” a person is worse than allowing to die, and people are divided in their views. The first group thinks that killing is morally worse, so euthanasia is seen as an immoral act. These people tend to believe that it is better to let a person die. Another group shares the opposite opinion that euthanasia cannot be considered as “killing” because it prevents a person from great suffering. In my personal opinion, euthanasia cannot be regarded as “killing”, but a person needs to sign a legal document (when he is conscious) that in case of a particular health condition he does not mind the procedure.
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Catholic Declaration on Life and Death Catholic Declaration on Life and Death is a document that allows a person to provide his or her directions on medical situations that involve their bodies or health (in case they cannot communicate the message any longer). For instance, a person can donate his or her organs after death or refuse artificial nutrition when unconscious. Free and informed consent from a Catholic perspective is viewed as a free will of an individual to decide for him or herself. It refers to diagnostic and different kinds of treatments, including preventive and palliative measures. Before making any decision regarding the abovementioned treatments, a person should be well informed about his or her medical condition, possible risks, and alternatives. From the Catholic perspective, a person should be able to view the risks and benefits of medical treatments through their values and beliefs, and their decision should be made voluntarily. Health care proxy Health care proxy (or it is also called a surrogate decision-maker) is a legal document (an advance medical directive) that allows another person that is called proxy to make health care decisions for a person in a situation when he or she is unable to communicate his or her wishes any longer. The proxy has the right to accept or refuse any treatments for the person who is incapable of delivering his or her directives. Advance Directives, Living Will, PoA, DNR Advance directives are legal documents in which a person can plan his life end in case he or she is unable to deliver a wish. The document consists of two parts: a living will and a medical power of attorney (National Hospice and Palliative Care Organization, 2016). Concerning the living will, it is an advance directive that is a guideline on treatments for relatives and medical professionals in case a person is unable to communicate his wishes. The document is legal when a person signs it, and it will come into force when the person is not able to deliver his or her wishes. A medical power of attorney is a legal document that allows an individual to choose a person that will make decisions on medical care in case the individual is unable to communicate due to a health condition. The document is legal when a medical professional decides a person is no longer able to represent him- or herself. Another document is DNR or A Do Not Resuscitate that “is a written physician’s order that prevents the healthcare team from initiating CPR (cardiopulmonary resuscitation)” (National Hospice and Care Organization, 2016, para. 8). The physician approves the DNR order at a person’s request. ERD paragraphs #: 24, 25, 26, 27, 28, 55, 59, 61, 62 summaries Directive 24 states that a Catholic health care institution will inform patients on their legal rights but will not respect an advance directive that is against Catholic teaching. Directive 25 states that a person can choose a surrogate to make health care decisions in case he or she is unable to communicate it. Decisions that are made by the proxy should be following Catholic principles and values or interests of a person. Directive 26 states that free and informed consent (a person’s or his or her surrogate’s) is needed for any medical treatments except emergencies. Directive 27 states that free and informed consent requires that the person or his or her surrogate was well informed on all relevant medical information. Directive 28 states that the person or the surrogate should receive all information regarding the counselling, medical, and moral questions. Directive 55 states that Catholic health care institutions should provide possibilities to prepare for death (to a person in danger of death). Directive 59 states that withdrawal of life-sustaining procedures (decisions made by a patient) should be respected and accepted if it does not contradict Catholic teaching. Directive 61 states that patients should receive pain relief treatments as much as possible. Directive 62 states that a medical professional should make a declaration of death following accepted scientific criteria. References Bueno-Gomez, N. (2017). Conceptualizing suffering and pain. Philosophy, Ethics, and Humanities in Medicine, 12(7). Cambridge Dictionary. (2020). Prognosis. In Cambridge Dictionary. Web.
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Carvalho, A. S., Pereira, S. M., Jacomo, A., Magalhaes, S., Araujo, J., Hernandex-Marrero, P., Gomes, C. C., Schatman M. E. (2018). Ethical decision making in pain management: A conceptual framework. Journal of Pain Research, 11, 967-976. IASP (2017). Pain terms. Iasp-pain. Web. Lewis, A. (2020). It’s time to revise the uniform determination of death act. Annals of Internal Medicine, 172(2). 143-144. Web. National Conference of Commissioners on Uniform State Laws. (2009). Uniform determination of death act. The laboratory of comparative human cognition. Web. National Hospice and Palliative Care Organization. (2016). Understanding Advance Directives. NHPCO. Web. Rakel, R. E. (2018). Diagnosis. Encyclopedia Britannica. Web.