PHHE 435/535 Ethical Decision Making for Health Professionals Module 6A

PHHE 435/535 Ethical Decision Making for Health Professionals Module 6A

Determining Life and Death Master of Public Health Program – Copyright © 2017. Board of Trustees of Northern Illinois University. All Rights Reserved. Objectives • Frameworks • When Does One of Us Begin? How Does One Determine Who is One of Us? Shaped Who is one of us? Ethical Judgements 1 How Does One Determine Who is One of Us? • Any one of the biological sciences helps us determine this? • Provides with facts • Society has to interpret these facts Photo Credit: ctot_not‐def How Does One Determine Who is One of Us? • We don’t know all the answers • Our biases reflect our framework of meaning and value http://www.answersingenesis.org/assets/images/articles/wow/operating‐system.jpg Stakes are High • Stakes are high if we are considering life and death issues, especially so when society considered whether ‘someone is one of us’ Photo Credit: april 2 Interdisciplinary Study • Science – Provide facts • Philosophy – Interpret facts Photo Credit: GoToVan Photo Credit: kakine kane Stages of Development • Fertilization, implantation, primitive streak, fetal brain life, viability, birth, end infancy http://www.orwelltoday.com/babyub2.jpg Proposed Markers Photo Credit: oatsy40 3 Stages of Deterioration • Permanent loss: Stages of Deterioration • Permanent loss: – Cardiopulmonary function Photo Credit: The U.S. Army Stages of Deterioration • Permanent loss: Photo Credit: Imagens Livres – Cardiopulmonary function – Brain function (brain stem) 4 Stages of Deterioration • Permanent loss: – Cardiopulmonary function – Brain function (brain stem) – Higher brain functions necessary for awareness and feeling Photo Credit: GreenFlames09 Problems • Reductionist Are we more than biology? • Introduce nonscientific ideas – Soul, mind Can’t verify Same terms may have Different meanings Problems • Soul • Mind • Person Photo Credit: Karl‐Ludwig Poggemann 5 Concepts and Criteria • Concepts – How we think and talk about variety of things • Criteria – Observable facts – Indicates whether ‘someone is/is not one of us’ Classical Framework • Mystery Religions (6th century B.C.E.) – belief that humans were more than their material bodies • Doctrine of the ‘Soul’ Photo Credit: fiction of reality • Socrates, Plato – each person composed of body and soul – Soul immaterial, eternal, animates body, enables one to think, choose, abstract thought/concepts Photo Credit: fiction of reality 6 Body • Material • Organic • Arises from seed mixing with bloody fluid in the uterus Photo Credit: Stew Dean • Immaterial • Inorganic Photo Credit: Anders Sandberg • ‘Rational’ Soul arrives after body achieves ability to feel Photo Credit: Fons Heijnsbroek Soul Body is a Receptacle for the Soul 7 Body is a Receptacle for the Soul • Socrates, Plato – each person composed of body and soul Photo Credit: Ben Crowe Photo Credit: aaron wolpert – Beginning of life is when immaterial rational soul enter body – Death permanent cessation of spontaneous movement Body is a Receptacle for the Soul • Aristotle – Develop criteria for when soul enters developing fetus • Vegetative soul • Animal Soul • Rational Soul Photo Credit: Karl‐Ludwig Poggemann http://clendening.kumc.edu/dc/pc/Aristotle.jpg Feelings Animal Soul Vegetative Soul Rational Soul 8 When Did I Begin? 90 days 40 days Photo Credit: Olivier Vax When Did I Begin? • Important factor in moral evaluation of when abortion takes place When Did I Begin? • Hebrew Bible Photo Credit: FirewallJC – Exodus 21:22 – considered unborn not yet one of us/ not a crime of murder – Greek translation – developed fetus is one of us 9 When Did I Begin? • Christianity – Aristotle had influence for 2000 years – Not killing one of use until sufficient development occurred and God created a soul – Not before fetus has sensation Photo Credit: Karl‐Ludwig Poggemann When Did I Begin? • Gratian Decretum – a fetus did not become one of us until the human soul entered the fetal body some weeks after conception When Did I Begin? Thomas Aquinas 1225 – 1274 The deliberate destruction of a fetus before it is animated is morally wrong, but it is not murder 10 Breakdown of Seed Explanation • Attempt to move the time of soul infusion earlier in fetal development • Technological advances in reproductive medicine When Did I Begin? • Two components – Egg and Sperm • Discovery of DNA 1827 Photo Credit: Erin Campbell Smith When Did I Begin? • Fertilized Human Egg Is this the moment when the rational soul arrives? Photo Credit: Andrea Crisante Arbitrary interpretation 11 When Did I Begin? • Is the destruction of a fertilized ovum the destruction of one of us? • Is the ‘Right to Life’ being violated? • Arbitrary Interpretation Modern Concepts • Concept of Person/Personhood – So widely defined, includes practically everyone – So narrow, only those with selfconsciousness/rationality/moral agency/rights to be respected Conflict Modern Concepts • Concept of Self – Consciousness that accompanies thinking – Also controversial http://imagecache2.allposters.com/images/pic/130/009_575‐010~Norman‐Rockwell‐Triple‐Self‐Portrait‐Posters.jpg 12 When Did I Begin? • No way to prove when human gains or loses immaterial soul/mind • For a person who has permanently lost awareness, is there a reason for saying the body has retained immaterial rational soul? No criteria New Conceptual Framework: Two Extreme Positions • Body receptacle for soul • Humans are nothing more than their bodies – Marxist ideology – Behaviorism New Conceptual Framework • Living human body is – Biological – Psychological Human body is a perceiving body 13 New Conceptual Framework • I experience myself as a psychic, a body that both perceives, and is aware of perceiving • My body is me http://www.internetbusinessdirectory.co.uk/cheshire/chester/ ibd230b.jpg New Conceptual Framework • Body perceives and has the capacity to perceive http://www.integrative‐breakthrough‐coaching‐solutions.com/images/perception.jpg Three criteria to determine if a body is one of us: 1) Must have human DNA 2) Body exists as an individual whole 3) Awareness/capacity for awareness Can verify if a body is one of us 14 When Do We Begin? Photo Credit: AndreaLaurel Photo Credit: Duncan Hull Photo Credit: woodleywonderworks When Do We Begin? • Moment of Implantation (Conception)? • Zygote will not necessarily become one of us – Successfully implanted? http://embryology.med.unsw.edu.au/Medicine/images/day8and9.jpg When Do We Begin? • Bottom line about assessment – Not plausible within first two weeks after fertilization 15 When Do We Begin? • Not necessarily the beginning of a new individual body – Splitting and Fusion http://content.answers.com/main/content/wp/en/6/6b/Embryo,_8_cells.jpg When Do We Begin? • Individual body becomes psychic? • Development of neural pathways (weeks 7 – 20) • Fetus becomes one of us when they can perceive When Do We Begin? • No immaterial soul needs to arrive • Part of a natural development of the fetus itself Photo Credit: Ray Fujloka 16 When Do We Begin? • Both biological and psychological aspects are entwined in a mutual and complementary way Photo Credit: adrigu When Do We Begin? • This area generates much controversy • Depends on how one conceives of themselves Photo Credit: Adam Sporka Continue Photo Credit: Tracy Sorensen 17 PHHE 435/535 Ethical Decision Making for Health Professionals Module 6B Determining Life and Death Master of Public Health Program – Copyright © 2017. Board of Trustees of Northern Illinois University. All Rights Reserved. When Does One of Us Die? http://www.millresort.com/images/pic_citizen.jpg When Does One of Us Die? • Concept of ‘Death’ • Criteria ‘Death’ – Allows us to verify that death has occurred (temperature, rigor mortis) – Can be misleading with use of life-support machines 1 When Does One of Us Die? • Why is this important in health care ethics? • We don’t want to make mistakes When Does One of Us Die? • Use of new technologies further complicates the issue: Photo Credit: Social Work 2012 When Does One of Us Die? • Use of new technologies further complicates the issue: – Life support technology Photo Credit: Basic Life Support Certification 2 When Does One of Us Die? • Use of new technologies further complicates the issue: – Life support technology – Organ transplantations Photo Credit: Global Panorama When Does One of Us Die? • Machines may delay the onset of indicators of death Photo Credit: reluctantMANGO When Does One of Us Die? • Cardiopulmonary Criteria – functions have irreversibly ceased • Provide oxygen to blood and distribute to body http://www.upstate.edu/chp/cp/ 3 When Does One of Us Die? • When it happens, evidence death has occurred Photo Credit: Kris Radder • Life-support technology, feeding tubes prolong life long after it would have ceased naturally When Does One of Us Die? • Brain death – occurs even though body maintained on life-support Photo Credit: Kris Radder – Evidence of necrosis When Does One of Us Die? Photo Credit: Kris Radder • Are patients with dead brains and living bodies alive or dead? 4 When Does One of Us Die? https://www.theguardian.com/sport/2015/sep/15/sydney‐boxer‐davey‐browne‐jr‐dies‐in‐hospital‐after‐title‐fight When Does One of Us Die? • ‘Harvard Criteria’ – Irreversible coma – EEG electrical activity http://drx.typepad.com/psychotherapyblog/images/2007/07/21/brain.jpg When Does One of Us Die? • Second criteria – irreversible cessation of all brain functions • Patients in irreversible coma, sustained on life-support were in fact dead 5 When Does One of Us Die? • State laws recognizing brain-death criterion Photo Credit: lanbirdart • Not the same in all states When Does One of Us Die? • Uniformed Determination of Death Act: – Irreversible cessation of circulatory and respiratory functions – Irreversible cessation of all functions of the entire brain, brain stem Brain-Death • Whole brain – means person is truly dead Photo Credit: Marcy Gilbert Medical Center • Brain stem – control of respiration and BP – if dies, then need to be on ventilator 6 Brain-Death – Definitive Criterion • If diagnosed as brain dead, when life-support removed from corpse • Life support is not keeping patients alive Brain-Death • Not definitive tool http://www.cnsforum.com/content/pictures/imagebank/hirespng/placement_EEG_leads.png • EEG only used in secondary role to confirm clinical diagnosis Brain-Death • Hard to diagnose in children in first year of life • Neurological development incomplete http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/9854.jpg 7 Brain-Death • Problems with criterion still exist – Not all states have passed laws, MDs uncomfortable using – Right to life groups fearful of slippery slope – lead to accepting euthanasia and abortion http://placebojournal.com/gazettes/j0314371.jpg Cerebral Death • Neocortical – Support functions of awareness • Not currently recognized as criterion Coma PVS Both Unconscious • Coma • Looks like in a deep sleep • Can’t be aroused 8 Both Unconscious • PVS • Alternating sleep and arousal (not aware) • Eyes open • Facial expressions • Can make sounds http://images.google.com/imgres?imgurl=http://www.ejumpcut.org/archive/jc48.2006/SchaivoStaiger/balloonfolder/Picture‐ 9.jpg&imgrefurl=http://www.ejumpcut.org/archive/jc48.2006/SchaivoStaiger/index.html&h=167&w=220&sz=7&hl=en&start=21&tbnid=LCj36k‐ TBrWT5M:&tbnh=81&tbnw=107&prev=/images%3Fq%3DTerry%2BShaivo%26start%3D20%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN Permanent Loss of Capability for Awareness • If we accept the idea of the psychic body (awareness), perhaps neocortical death does mean death has occurred • No longer one of us Confusion and Grey Areas http://ccforum.com/content/figures/cc105‐2.jpg • Continues to be confusion over concept of brain death 9 Confusion and Grey Areas http://a.abcnews.com/images/Nightline/ntl_life_death_070917_ms.jpg • Grey areas over life and death raise ethical concerns Moral Well-being http://www1.istockphoto.com/file_thumbview_approve/1401729/2/istockphoto_1401729_virtuous_woman_kjv.jpg • Morally virtuous person treats all life with respect, and a high degree of dignity and care Matter of Interpretation? • Is the manner in which we designate transitions in embryonic and fetal development an arbitrary exercise? • If we choose the definition of death as no brain function, how do we separate/distinguish developing fetus and brain dead adult when human existence is over? Absence of brain life/ (Brain death) 10 What’s Wrong with Analogy that says Human Existence is Over with Brain Death? • Fetus is alive (just not yet developed awareness) • Brain-dead patient is dead http://www.ccmep.org/2003_articles/Palestine/tom3.jpg http://content.answers.com/main/content/wp/en/thumb/f/f3/250px‐Fetus.jpg When Does One of Us Die? • Concept of death • Criteria death – Allows us to verify that death has occurred (temperature, rigor mortis) – Can be misleading with use of life-support machines Conclusion Photo Credit: Ben Seldelman 11

  Excellent Good Fair Poor
Main Posting 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

 

Supported by at least three current, credible sources.

 

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

 

At least 75% of post has exceptional depth and breadth.

 

Supported by at least three credible sources.

 

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

 

One or two criteria are not addressed or are superficially addressed.

 

Is somewhat lacking reflection and critical analysis and synthesis.

 

Somewhat represents knowledge gained from the course readings for the module.

 

Post is cited with two credible sources.

 

Written somewhat concisely; may contain more than two spelling or grammatical errors.

 

Contains some APA formatting errors.

 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

 

Lacks depth or superficially addresses criteria.

 

Lacks reflection and critical analysis and synthesis.

 

Does not represent knowledge gained from the course readings for the module.

 

Contains only one or no credible sources.

 

Not written clearly or concisely.

 

Contains more than two spelling or grammatical errors.

 

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)

Posts main post by day 3.

 0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)

Does not post by day 3.
First Response 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

 

Responds fully to questions posed by faculty.

 

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

 

Demonstrates synthesis and understanding of learning objectives.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are fully answered, if posed.

 

Response is effectively written in standard, edited English.

 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are answered, if posed.

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

 

Response is effectively written in standard, edited English.

 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

 

Responses posted in the discussion may lack effective professional communication.

 

Responses to faculty questions are somewhat answered, if posed.

 

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

 

Responses posted in the discussion lack effective professional communication.

 

Responses to faculty questions are missing.

 

No credible sources are cited.
Second Response 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

 

Responds fully to questions posed by faculty.

 

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

 

Demonstrates synthesis and understanding of learning objectives.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are fully answered, if posed.

 

Response is effectively written in standard, edited English.

 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are answered, if posed.

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

 

Response is effectively written in standard, edited English.

 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

 

Responses posted in the discussion may lack effective professional communication.

 

Responses to faculty questions are somewhat answered, if posed.

 

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

 

Responses posted in the discussion lack effective professional communication.

 

Responses to faculty questions are missing.

 

No credible sources are cited.
Participation 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

 0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on 3 different days.
Total Points: 100