Law, Medicine and Forensic Science

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14 Δεκ 2012 (πριν από 4 χρόνια και 10 μήνες)

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The Christian and Medical Ethics

ETHICS FOR CHRISTIANS

A HUGE AND CONTINUALLY EXPANDING SUBJECT



Artificial insemination, genetic engineering, birth control,

abortion, sterilization, prolongation of life, transplant

surgeries, suicide, assisted suicide, surrogate motherhood,

d
onation of sperm, eggs, etc., etc.




Medical science continues to present an increasing

number of issues that may be considered ethical issues.




Today we are dealing only with some issues of dying.

DISCLAIMER:


Most of the things presented here are NOT matters of biblical declaration
or interpretation. Scripture does not address most of these things.


Most of the things presented here today are matters of personal taste,
personal conviction, and personal application of a few broad principles.


Let us be careful that we do not attempt to make OUR PERSONAL
OPINION the norm or the mandate for other Christians.


Let us be careful that we do not judge or condemn those who have
personal convictions different from our own!!


One thing we do believe: Human life is precious to God, and “Precious
in the sight of God is the death of his saints

(Psalm 116:15).”

A FEW TOUGH QUESTIONS:


Ought we as Christians to allow medical science to dictate our choices in
life or death issues? How can it be prevented?


Is there life “not worth living”?


A vegetative state?


Intractable pain?


Incapacity to think, relate, enjoy, read, or communicate?


Which is better/worse:


To ACT so as to kill, or resulting in death?


To FAIL TO ACT so as to torture?

THE IMPOSSIBILITY OF AN ABSOLUTIST ETHIC; i.e., one which

provides ABSOLUTE right or wrong answers for any and all

situations.


“The problem is that in spite of impeccable logic and graceful

p
rose, the result is often an absolutist ethic which is unsatisfactory

w
hen applied to particular cases … and is of little use to

practicing physicians; there are few absolutists at the bedside.”



-

James
Rachels

THE MEDICAL


INSTITUTIONAL DILEMMA:


“The technological imperatives tend to prevail over the interests
of patients and sometimes even over common sense.”


TOUGH DISTINCTIONS:


1.
VOLUNTARY vs. INVOLUNTARY vs. NON
-
VOLUNTARY
EUTHANASIA

2.
ACTIVE [action resulting in death] vs. PASSIVE [withholding
action resulting in death] EUTHANASIA

3.
DIRECT [immediate death] vs. INDIRECT [delayed death]
EUTHANASIA

4.
ORDINARY vs. EXTRAORDINARY MEASURES TO
PROLONG LIFE … or the dying process

CRITICAL PROBLEMS OF THE DYING


The Definition of Life and death.


What is a person?


When does a biological entity


homo
sapien



have rights?


When is a person dead?


The Problem of Responsibility.


Who is responsible for decisions? The Patient? The Family? The Physician?
The Judge? Society? What if the family does not want to pay for the
prolonging of life, or a lengthy dying process?


The Problem of Euthanasia versus Cacothanasia.


To kill or not to kill? When to kill? To prolong life or to let die? To prolong the
dying process? Whose duty is it to prevent CACOTHANASIA?


The Problem of Cost. The Cost/Benefit Analysis. Who shall
l
ive
w
hen
n
ot all
c
an
l
ive?


UNETHICAL ACTIONS


Involuntary, active EUTHANASIA. People who are mentally competent are
killed when other people deem them unfit to live because of the low quality of
their life and contrary to the wishes of the patient.


Non
-
voluntary, active EUTHANASIA. People who are mentally
INcompetent

are killed, or allowed to die, when other people deem them unfit to live because
of the low quality of their life.


This raises the question of PERSONHOOD; what is a PERSON?


The law denies the fetus the status of personhood.


Does the infant with seriously defective brain make it incapable of
becoming a person?


Can seriously damaged humans be no longer persons?


“Since other values cluster around and are rooted in human relationships, it
seems to follow that life is a value to be preserved only insofar as it contains
some potentiality for human relationships.”
-

Richard McCormick


UNETHICAL ACTIONS


The inappropriate use of EXTRAORDINARY measures to prolong life or the
dying process.


“A dying man needs to die, as a sleepy man needs to sleep, and there comes
a time when it is wrong, as well as useless, to resist.”
-

Allsop


To allow the technological imperatives to prevail over the interests of patients
and over common sense.


Patients subjected to painful surgery, or distressing medications, which only
serves to prolong, for a very limited period, a life which is not worth living.


Elderly persons whose arrested hearts are reactivated in circumstances which
do little more than give them the dubious privilege of dying twice… or thrice.


Those who can never regain consciousness but whose biological life is
maintained by artificial means.


Abandonment of the patient. This is very common in our culture.

A QUESTIONABLE ETHICAL ACTION:


Voluntary, active EUTHANASIA. People who are mentally competent are killed
(euthanatized) when the patient deems the quality of life is unacceptable and,
therefore, wishes to die. The problems

include the following:


When and how to make the request?


The possibility of a change of mind?


How is the physician sure the condition is incurable?


The moral guilt of those who participate in the killing?


The possibility of injustice? Might one be pressured to consent?


Are there better alternatives?


Is direct euthanasia wrong, but indirect euthanasia right?

WHAT IS EXTRAORDINARY AND QUESTIONABLE?


May depend largely on the age and circumstances of the patient.


What is excessive COST? In pain? In money? Subjective repugnance?


What is not established medical procedure, experimental or bizarre
treatment?


What has little or no possibility of success? “Would this procedure give
him/her a reasonable chance of an appreciable duration of desirable life at
an acceptable cost of suffering and expense?”
-

D. M. Jackson


Allowing social standing and money to dictate treatment. “Do we really
subscribe to the principle that social standing should determine selection [for
treatment]?”



-

Wilhelm
Kolff


Compromising TRUTH and HONESTY with the patient.


Dehumanizing treatment of the patient.


“It is not euthanasia to give a dying person sedatives and analgesics
for the alleviation of pain, when such a measure is judged
necessary, even though they may deprive the patient of the use of
reason or shorten his life.”



-

Ethics and Religious Directives for Catholic






Health
Facilities


The American Medical Association Policy Statement

The statement condemns “the intentional termination of the life of one human
being by another” but allows “the cessation of the employment of extraordinary
means to preserve the life of the body.”


The Relevant Question: “Would this procedure give the patient a reasonable

chance of an appreciable life at an acceptable cost of suffering [and money]?”

ETHICAL ACTIONS


Voluntary and non
-
voluntary passive EUTHANASIA.


“To prolong a man’s life is not always to do him a service.”
-

Phillip Foot


“The right to die places society under an obligation to permit and to facilitate a
person’s control over his own death and dying in accordance with his moral
ideals and aspirations.”
-

John Ladd


“The physician must take all reasonable ordinary means of restoring the
spontaneous vital functions and consciousness and to employ such
extraordinary means as are available to him to this end
.

It
is not obligatory to
continue to use extraordinary means indefinitely in hopeless cases. It is the
church’s view that a time comes when resuscitation efforts should stop and
death be unopposed.”
-

Pope Pius XII




ETHICAL ACTIONS


Ordinary measures of CARE and COMFORT.


To allow death to be unopposed in some circumstances. “To maintain bodily life
at a vegetative level without cause is irrational, immoral, and a violation of the
dignity of human life. It is, moreover, macabre, irreverent and crudely
materialistic to preserve by medical pyrotechnics the hopeless presence of what
could be described as a breathing corpse.”
-

Daniel Maguire


“The physician has a clear duty to preserve his patient’s life in any acceptable
way, but this does not imply a duty to prolong the process of dying by what may
aptly be termed ‘meddlesome medicine.’ The physician has a complementary
duty to relieve suffering by any legitimate means, but these do not include the
deliberate prescription of a lethal dose.”


-

Norman Anderson




COMMONLY HELD POSITIONS:


1.
I
nvoluntary active euthanasia is never justified.

2.
Non
-
voluntary active euthanasia is seldom justified.

3.
Non
-
voluntary passive euthanasia, voluntary active euthanasia, and
voluntary passive euthanasia are sometimes compatible with both
justice and charity. This kind of euthanasia goes on every day in big
city hospitals.

4.
However, while these are “commonly held positions” there is much
disagreement within the medical profession, in society at large, and
among Christian people.


QUESTIONABLE AREAS OF ETHICS WITH THE
SUFFERING AND THE DYING


What is and is not active euthanasia? The law prohibits killing, but gives no
clear directives about letting a person die. The difference, however, is GRAY.


What is and is not hopeless? “To be sure there is no hope can be quite difficult
in some cases. I have a patient who is enjoying life with his wife and children
now, with very little residual disability, who was a total vegetable for over 30
days, in a coma from a cerebral thrombosis 11 years ago.”






-

Paul P.
Kriborian
, M.D.


What is or is not death? Liberal versus conservative?


What about extraordinary cases? “If and when those medical situations arise in
which the mere omission of treatment will not suffice, and if there is no other
human way to benefit the dying one, then it is better to act so as to kill than to
omit to act and therefore torture.”



-

James Nelson


The above is an amazing statement!!

QUESTIONABLE AREAS


What is or is not EUTHANASIA?


“The general rule in the U.S. is that one who either kills one suffering
from a fatal or incurable disease, even with the consent of that party, or
who provides that party with the means of suicide, is guilty of either
murder or manslaughter.”




-

Curran and Shapiro






Law, Medicine and Forensic Science


The above may be a “general rule” of law in the U.S., but it is seldom
applied or enforced in major medical centers in our country.


IMPERATIVES:


THINK! It is irrational and inexcusable to give no thought to the issues
of the dying process and to directives to loved ones regarding end
-
of
-
life
issues.


TALK! It is irrational and inexcusable to NOT talk to one’s closest living
relatives and to your personal physician so that they have a clear
understanding of your wishes under a variety of circumstances in end
-
of
-
life issues.


PLAN! It is irrational and inexcusable to make no plans for the
eventuality of the dying process and for the events following death.


DIRECT! It is irrational and inexcusable not to make a will, and perhaps
also not to make a “living will” (even though “living wills” are not biding on
either physicians or relatives). Clear directions to loved ones are
absolutely necessary.