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DISCUSSION GUIDE
THE FEATURED SUBJECTS
ELBERT NELSON, a kidney cancer patient who had been treated with the most advanced medical care available, went into the backyard one day and shot himself.What motivated Elbert Nelson to take his life?
What might have made a difference?
DOUG GLADSTONE, a liver cancer patient who had been treated with the most advanced medical care available, died at home under the care of hospice.Why did Doug Gladstone choose to stop treatment and have hospice take over his care?
How else might Doug have approached his own death?
PEGGY SUTHERLAND, a lung cancer patient who had been treated with the most advanced medical care available, chose to die at home under the auspices of Oregon’s Death with Dignity Law.
Why did Peggy Sutherland choose to stop treatment and die by drinking a legally sanctioned poisonous brew?
How else might Peggy have approached her own death?
MERIAN FREDERICK, an ALS (Lou Gehrig’s disease) patient, had been progressively losing function over the past few years. Under the care of very competent physicians she was well aware there was no cure – rather continued debilitation. She decided to end her life and went to Dr. Jack Kevorian for help in dying.
Why did Merian Frederick decide to end her life?
Why did she choose to go to Dr. Kevorkian?
How else might Merian have approached her illness?
The Who, What, Where, When and How
END-OF-LIFE DECISIONS
A. WHAT decisions can be made by terminally-ill, suffering patients?
1. Help to die – legally or illegally
2. Hospice care
3. Suicide
4. Interventions to preserve life (usually in hospital)
5. Do nothing.
B. WHO makes end-of-life decisions? 1. Patient – expressing their autonomy
2. Medical surrogate (individual appointed by patient to make medical decisions for him/her should patient not be able)
3. At the very end of a patient’s life
4. Some combination of the above.
C. WHEN should decisions be made? 1. In advance via Living Will and/or Advance Directive
2. During the patient’s illness
3. Family
4. Physician
5. Other
D. WHY decision-making at the end of life is important. 1. PRO
a. Alleviate patient’s suffering
b. Respect and honor autonomy of patient
c. Allows physician to fulfill responsibility of attending to patient’s suffering. 2. CON
a. Moral issue – could interfere with God’s plan.
b. Goes against society’s mandate to preserve life.
c. Allows physicians to fulfill responsibility of “do no harm” so preserving life.
QUESTIONS TO PONDER
A. What does hospice do? Comment on the role of hospice in the last days experienced by Merian Frederick, Peggy Sutherland, and Doug Gladstone.
B. How does the larger society exercise its role in preserving life.
C. Are there any contradictions in the physician’s dual roles of preserving life and relieving suffering?
D. How do different religions approach with suffering?
E. How do different religious and legal institutions deal with autonomy.
F. Are some personality types more likely to want to be instrumental in how his/her own life ends then others might be?
G. What roles might family and friends assume in the course of a patient’s terminal illness?
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