ASSISTED SUICIDE

Ethics at the end of life

GUILLERMO, JANINA
LARUMBE, JOVET
AMA, ARIELLE

JUAN, LIEZ
JAVIER, JUAN
MALABANAN,

ASSISTED SUICIDE:
Assisted suicide is a suicide committed
with the aid of another person, most of
time a physician. The term is often used
interchangeably with Physician-assisted
suicide (PAS), which involves a doctor
knowingly
and
intentionally
providing a person with knowledge or
means or both required to commit
suicide", including counseling about lethal

TYPES ASSISTED SUICIDE:

Euthanasia Mercy killing
Painless killing of the patient from an
incurable or painful disease.
Voluntary request or from the patient to
withdraw ones life.
Physician prescribes the treatment
Physician
directly
administers
the
treatment to the patient that results to the
patients death.

TYPES ASSISTED SUICIDE:

Physician Assisted Suicide (PAS)
Voluntary request or from the patient to
withdraw ones life.
Physician prescribes the treatment.
PATIENT administers the treatment.
Physician
DOES
NOT
participate
in
administering the treatment.

HISTORY AND LEGALITY

In 1997, Oregon enacted the first law in the
country to prescribe a lethal dose of federally
controlled drugs to terminally ill patients who
wished to commit suicide. The Death with
Dignity Act was intended to provide patients
with an option to experience what some see as
a more humane way to die.

HISTORY AND LEGALITY

According to the law, a doctor cannot
inject the drugs into a patient, but the
patient may use the prescription to
privately end their life. The law was
passed in 1997, and since then, 246
people in Oregon have committed drug-

HISTORY AND LEGALITY

In 2001, Attorney General John Ashcroft threatened to
punish any doctor who prescribed a lethal dose of
drugs for the purpose of drug-assisted suicide.
He argued that the law violated the Federal Controlled
Substances Act (CSA) of 1971. Under the CSA, it would
be illegal to prescribe controlled substances to end a
patients life

HISTORY AND LEGALITY

In 2001, Attorney General John Ashcroft threatened to
punish any doctor who prescribed a lethal dose of
drugs for the purpose of drug-assisted suicide.
He argued that the law violated the Federal Controlled
Substances Act (CSA) of 1971. Under the CSA, it would
be illegal to prescribe controlled substances to end a
patients life

HISTORY AND LEGALITY

The case was appealed to the Supreme Court.
Gonzales vs. Oregon was heard in 2005
It was upheld in the Supreme Court and still is
intact today.

HISTORY AND LEGALITY

As of today, Assisted Suicide or PAS is legal in
five countries only:
Netherlands, Canada, Luxembourg, Switzerland
and United States of America. But in U.S. it is
only legal in certain states, which are the
following: Washington, Oregon, Vermont and
Montana.

How does Assisted Suicide

1. FORMAL ORAL REQUEST: The patient must ask for it three
work?
times.
According to the Oregons Death with Dignity only certain
people can ask lethal medication from their doctor.
Qualifications:

a. Age 18 and older Competent (able to make and

communicate an informed decision to health care
providers)
b. Terminally ill (incurable, irreversible disease
expected to cause death within six months, as

How does Assisted Suicide

Qualifications:
work?
c. Able to voluntarily express his or her wish to die Assure
that it is an informed decision, which means the patient has
an appreciation of the relevant facts, after being fully
informed about the following:
Medical diagnosis
Prognosis
Potential risks associated with taking the prescribed
medication
Probable result of taking the prescribed medication
Feasible alternatives including, but not limited to, comfort

How does Assisted Suicide

2.
FILING OF WRITTEN REQUEST
work?
The patient must be mentally competent throughout
this process and there must be two witnesses in the
filing and signing of request of the patient to the
doctor.
If the doctor or the patients family suggests that the
patient is suffering from a psychological disorder or
mental pressure, he or she must undergo re-evaluation
and treatment.

How does Assisted Suicide

3.
SECOND EVALUATION
work?
By law, a second physician MUST review the patients
case and sign off on the first doctors diagnosis.
Evaluate the patient's request: Assess reasons, Explore
and recommend alternatives (palliative care, hospice,
pain/symptom management, psychosocial and/or
spiritual counseling, palliative sedation).

How does Assisted Suicide

3.
SECOND EVALUATION
work?
Refer to a consulting physician, who reviews the
medical record and interviews the patient to confirm
the diagnosis, and confirm that the patient is
competent and is making a voluntary request.
Refer to a counselor if concerned about a psychiatric or
psychological disorder or depression causing impaired
judgment.

How does Assisted Suicide

4.
PRESCRIPTION AND LEGAL DOCUMENTATION
work?
Work with pharmacists to prescribe/get medications.
Document all steps in the medical record.

How does Assisted Suicide

5.
ADMINISTRATION OF THE DRUG
work?
2 days after the request had been signed, the doctor
will prescribed the lethal drugs and under no
circumstances, the patient may already administer it.
The states assisted suicide law mandates that THE
PATIENT TAKE THE DRUG HIMSELF. Mostly this is done
by the patient at home by taking one of the two kinds
of barbiturates.

LETHAL DRUGS
1. SECONAL lethal at 100 grams and must be broken down
in powder to produce three tablespoons. Costs $125. It is
commonly mixed with water to create a bitter drink or
stirred into pudding or applesauce to hide the taste. Death
will be coming to half an hour, but if you are fat, death can
be delayed up to 48 hours.
2. NEMBUTAL comes in more convenient liquid form, cost
$1000.

How does Assisted Suicide

6.
DEATH
work?
Sign the death certificate. List the underlying terminal
disease as the cause of death.
Send a copy of the dispensing record to DOH within 30
days.

REASONS WHY PATIENTS

CONSIDER
ASSISTED
SUICIDE?
(Statistics based on U.S between 1994 to 2006 in Oregon, Washington and
Montana)

Decreasing ability to participate in activities that

made life enjoyable
Loss of autonomy and loss of dignity
Severe discomfort
Fear of uncontrollable symptoms
Actual pain / severe pain from a disease /
treatment
Loss of meaning
The feeling of being a burden.

ETHICAL ISSUES ON
ASSISTED SUICIDE:

Responsibility of the physician to preserve life,

not end it.
Physicians code of professional behavior demand
application of all method to preserve life.
Death is a final and irrevocable decision: Life is
lost.
Death should be always in a natural process.
Always hope for the possibility of the discovery of
cure to certain diseases. PAS restricts the

ETHICAL ISSUES ON
ASSISTED SUICIDE:
Suicide is never an option.
Incompatible with the healing goals of
medicine.
A request for death needs psychological
care.
People may prejudice the fate of old,
crippled and weak.

MECHANICS OF THE DEBATE

1. Each group will draw lots for their side to form two teams; Con
negation and Pro - affirmation.
2. The Con group SHOULD express NEGATION about the principles and
practice of ASSISTED SUICIDE without stating additional facts or
circumstances to the situation of the case or the statement, same rules
are expected for the PRO group.
3. For each case, each group will be given 3 minutes to study and analyze
the case. Also, within the 3 minutes preparation, each group are
expected to choose 3 members who will represent their group for the
given case. During the Debate, no member is allowed to go back to
his/her team, but discussion within the 3 representatives are allowed.
The chosen members are not allowed to represent the next case; unless
the group is insufficient in number, hence one or two is allowed to

MECHANICS OF THE DEBATE

4. During the debate, each member will be given 1 minute and 30 seconds
to defend the case in favor of their stand as pro or con. Deduction will be
given to the group when the member refuses to stop, but finishing early is
fine.
5. Each team is given only three times to present or defend their side.
6. Any question or clarification for the case should be raised properly before
the actual debate starts.
7.

Each team will be judged based on the following criteria:

Knowledge of the topic / ethical issue 30 pts.
Fidelity to the side presented 20pts.
The use of principles of ethics to defend the case 15 pts.
Clarity and relation of the presented ideas to the topic 15 pts.

CASE STUDY

CASE 1
Brittany Maynard, a 29 year old, was diagnosed with grade
2astrocytoma a form of brain cancer and had a partialcraniotomy and
a partialresectionof hertemporal lobe on January 1, 2014. The cancer
returned in April 2014, and her diagnosis was then elevated to grade 4
astrocytoma, also known asglioblastoma, with a prognosis of six
months to live. No treatment existed that would save her life, and
recommended care would, in effect, destroy the quality of the life she
had left. After much research, she came to the conclusion that Death
with Dignity was her best option. She believed she had the right to have
the
option
to
die
before
her
disease
could
kill
her.
Maynard ended her life on November 2, 2014 with drugs prescribed by
her doctor,
she outlived
her doctor's
2014 prognosis
she had
Statement:
Death
with April
Dignity
was thethat
best
six months to live.

option for Britanny Maynard.

CASE 2
Mrs. SR is a 42-year-old married woman who is the mother of an 8 yearold son. Mrs. SR suffers from amyotrophic lateral sclerosis (ALS),
commonly known as Lou Gehrigs disease. Her life expectancy is
between 2 and 14 months, and her condition is rapidly deteriorating.
Very soon she will lose the ability to swallow, speak, walk, and move her
body without assistance. Thereafter she will be confined to her bed,
unable to breathe without a respirator and unable to eat unless a
gastrostomy tube is inserted into her stomach. Mrs. SR understands her
condition. She is aware of the trajectory of her illness and the
inevitability of her death. Her wish is to control the circumstances,
timing, and manner in which she dies. Mrs. SR does not wish to die so
long as she still has the capacity to enjoy life. However, by the time she
no longer is able to enjoy life, she will be physically unable to terminate
her life without assistance. Mrs. SR wants a qualified medical

CASE 2
Statement: Should the medical practitioner be
allowed to facilitate Ms. SRs wish to
determine the time of her death?

CASE 3

Steve Crossley is a 65-year-old engineer living in Grand Rapids, Michigan.

After a vigorous professional life, he has been looking forward to retirement.
Just six weeks ago, he began to notice that he is losing weight. His appetite
has deceased, and he now has growing pain in his lower back. Steve went to
see his family physician, who was worried enough to send him to a
specialist. Now, after 2 weeks of testing, Steve knows the truth. And
abdominal CT scan revealed a mass in his pancreas. The diagnosis:
incurable cancer of the pancreas.
Steve has always been an active man, and the prospect of chemotherapy
with all of its complications and side effects does not appeal to him. Besides,
he is a pragmatist and knows when it is his time to go. He is not sure what
lies beyond the grave, but he does not wish to suffer the severe pain that
his current diagnosis offers. Steves wife left him five years ago. His two
daughters are grown, with active lives of their own. They have never been
close to their father. Just this morning, Steve met with Dr. Jack, an

CASE 3
Statement: Being diagnosed with a terminal
disease is justifiable to consider assisted suicide
as the solution to eliminate pain and waiting.