Reference no: EM133389926
Case 1: Brittany Maynard:
"Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me ... but would have taken so much more." On November 1, 2014, 29 year-old Brittany Maynard said, "Goodbye to all my dear friends and family that I love" and self administered a lethal dose of phenobarbital. She passed in her own bedroom surrounded by the persons she loved most - her husband, mother and step-father. Her husband was the one who
purchased the "suicide" drugs for her.Brittany had suffered excruciating headaches, initially diagnosed in January 2014 with grade II astrocytoma with about 10 years to live and underwent surgery, and then
months later, the tumor had evolved into a glioblastoma multiform (GBM), the deadliest type of brain cancer and gave her a six month death sentence.Brittany viewed her decision to terminate her life not as suicide because she did not want to die. "I don't want to die...If anyone wants to hand me, like, a magical cure and save my life so that I can have children with my husband, you know, I will take them up on it." She made the decision to "die with dignity" based on hearing "horror stories" of the likely quality of the remaining months of her life - headaches, nausea, vomiting, weakness and seizures.
Case 2: Elizabeth Bouvia: 26 year old Elizabeth Bouvia had disabling cerebral palsy and severe degenerative arthritis causing chronic pain. In 1983, she sought court approval for assisted suicide. Physically unable to take her own life, Bouvia wanted the court to order the hospital to help her
commit suicide. "If I really could, I would go out there and kill myself. But I can't. I physically can't" Bouvia stated. She wanted to force the hospital to keep her comfortable while she starved herself to death.
Bouvia described death as "letting go of all burdens. It is being able to be free of my physical disabilities and mental struggle to live." She was unable to live on her own leaving the only alternatives as "life in a convalescent home" or "a continuing struggle outside. Bouvia's argument centered around the quality of her life. She said, "It's not that I don't have the will to live but it's too much of a struggle to live
within the system or to depend on someone in the system. In reality, my disability is going to keep me from doing the living I want to do."Without a court order, the hospital would prolong her life and feed her by tube if necessary to prevent her death. Bouvia did not win her case and eventually changed her
mind about hastening her death.
Case 3: Terry Schiavo: - readings posted
The Terri Schiavo case was a series of court and legislative actions in the United States from 1998 to 2005, regarding the care of Theresa Marie Schiavo , a woman in an irreversible persistent vegetative state. Schiavo's husband and legal guardian argued that Schiavo would not have wanted prolonged artificial life support without the prospect of recovery, and in 1998 elected to remove her feeding tube. Schiavo's parents disputed her husband's assertions and challenged Schiavo's medical diagnosis, arguing in favor of continuing artificial nutrition and hydration. The highly publicized and prolonged series of legal challenges presented by her parents, which ultimately involved state and federal politicians up to the level of President George W. Bush, caused a seven-year (1998 to 2005) delay before Schiavo's feeding tube was ultimately removed.
On February 25, 1990, at age 26, Schiavo went into cardiac arrest at her home in St. Petersburg, Florida. She was successfully resuscitated but had massive brain damage due to lack of oxygen to her brain and was left comatose. After two and a half months without improvement, her diagnosis was changed to that of a persistent vegetative state. For the next two years, doctors attempted occupational therapy, speech therapy, physical therapy, and other experimental therapy, hoping to return her to a state of awareness, without success. In 1998, Schiavo's husband Michael Schiavo petitioned the Sixth Circuit Court of Florida to remove her feeding tube pursuant to Florida law.He was opposed by Terri's parents, Robert and Mary Schindler. The court determined that Schiavo would not have wished to continue life-prolonging measures, and on April 24, 2001, her feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge again ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included Bush returning to Washington, D.C., to sign legislation moving the case to the federal courts. After appeals through the federal court system that upheld the original decision to remove the feeding tube, staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005.
The above three women present different legal and ethical issues affecting end of life decision making and all three could easily be physical therapy patients. What is unique is that all three were young women. As a society, we are more comfortable and accepting when end of life decisions affect older persons.
Read the three types of advance directives - a Health Care Proxy (Surrogate Designation), a Living Will, and a Power of Attorney. Why may all three be needed? Legally, when does a person exhibit competency to execute legal documents such as advance directives or provide consent for medical treatment? What about persons with cognitive impairment - are they competent legally to effectively execute an advance directive?