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What ought to be done at the end of life is both a personal and public decision. As our population ages, it is becoming a matter of great concern for the entire nation. Diseases that would have been death sentences a few decades ago are now often treatable.This guide explores end-of-life decisions and examines options and trade-offs inherent in this sensitive and universal issue. Medical advances make it more likely that we will care for relatives in their final days, facing decisions regarding their illnesses or death-as well as our own. Even those who never face such choices will pay for them through tax dollars and the cost of insurance premiums. And as more states consider passing "right-to-die" laws similar to the one that took effect in Oregon in 1997, this debate may become a local one.Under most circumstances, end-of-life decisions remain difficult and uncomfortable. A Consumer Reports survey found that 86 percent of those polled wanted to die at home. But fewer than half of the respondents over age 65 had living wills detailing their dying wishes, leaving them at the mercy of hospitals and stressed-out families forced to decide on their behalf. In 1990, the US Supreme Court affirmed an individual's "right to die." Later, in 1997, the court upheld New York and Washington state laws banning physician-assisted death, leaving it for individual states to decide their legality. These rulings established legal precedence for a national conversation.This issue guide asks: What should society allow, and support, at the end of life? It presents three different ways of looking at the problem and suggests possible actions appropriate to each.OPTION 1:Maintain Quality of Life. That means when continued efforts to keep terminally ill patients alive a few more days or weeks result in needless pain and suffering, life-support treatment should be discontinued. At that point, caregiving efforts should be devoted to keeping patients comfortable and pain free.'OPTION 2:'Preserve Life at All Costs. Do everything we can to prevent death. This means sparing no expense to extend the lives of those who are sick. It should be difficult for doctors to give up on patients, and the end must not be brought about by deliberate medical neglect or intervention. Right-to-die laws must be repealed.OPTION 3:'My Right, My Choice. The freedoms we value so highly in choosing how we live should not be taken away from us at the end of our lives. People should have the right to end their own lives and to enlist their doctors in helping them to die when a terminal illness leaves nothing to look forward to but higher levels of pain and suffering.

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Publié par	National Issues Forums Institute
Date de parution	23 septembre 2016
Nombre de lectures	0
EAN13	9781946206008
Langue	English

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About This Issue Guide
The purpose of this issue guide is to help us talk productively about a difficult issue that concerns all of us.
Deliberation
It’s not a debate. It’s not a contest. It’s not even about reaching agreement or seeing eye-to-eye. It’s about looking for a shared direction guided by what we most value.
It’s about examining the costs and consequences of possible solutions to daunting problems, and finding out what we, as a society, would or would not accept as a solution.
A Framework
This guide outlines several alternative ways of looking at the issue, each rooted in a shared concern. It provides strategic facts associated with each approach, and suggests the benefits and drawbacks of possible solutions. We engage in deliberation by:
■ getting beyond the initial positions we hold to our deeper motivations—that is, the things we most care about, such as safety, freedom, or fairness.
■ carefully weighing the views of others and recognizing the impact various options would have on what others consider valuable.
■ working through the conflicting emotions that arise when various options pull and tug on what we—and others—consider valuable.
It is important to remember that, as a group, we are dealing with broader underlying concerns that are not defined by party affiliation and that your work here is to dig down to the basic values that define us as human beings and Americans rather than as liberals and conservatives.

One Effective Way to Hold a Deliberative Forum *

* This is not the only way to hold a forum. Some communities hold multiple forums.

Ground Rules for a Forum
Before the deliberation begins, it is important for participants to review guidelines for their discussion.
■ Focus on the options.
■ All options should be considered fairly.
■ No one or two individuals dominate.
■ Maintain an open and respectful atmosphere.
■ Everyone is encouraged to participate.
■ Listen to each other.
Contents
End of Life: What Should We Do for Those Who Are Dying?
Option 1: Maintain Quality of Life
Option 2: Preserve Life at All Costs
Option 3: My Right, My Choice
Summary
End of Life:
What Should We Do for Those Who Are Dying?

WHEN PAUL SCHEIER’S DOCTORS TOLD HIM his lung cancer had returned, he decided against chemotherapy, telling his family he wanted to die peacefully at his Orchard Park, New York, home. Six months later, the 86-year-old got his wish.
But the end for John Rehm, husband of radio talk show host Diane Rehm, wasn’t so easy. Rehm, afflicted with Parkinson’s Disease, was totally incapacitated when his request to hasten death was refused on moral and legal grounds. Maryland, where Rehm lived, is not one of five states where physician-assisted death is legal. Instead, Rehm refused water and food until he died of dehydration 10 days later.
What ought to be done at the end of life is both a personal and public decision. As our population ages, it is becoming a matter of great concern for the entire nation. Diseases that would have been death sentences a few decades ago are now often treatable.
“This is medicine’s great problem currently,” Dr. Lewis Goldfrank, director of Bellevue’s emergency department told 60 Minutes . “It will become greater and greater as the population ages. We’ll save lives that no one could have imagined. But we prolong lives that people would have wished to abandon.”
This guide explores end-of-life decisions and examines options and trade-offs inherent in this sensitive and universal issue. Medical advances make it more likely that we will care for relatives in their final days, facing decisions regarding their illnesses or death—as well as our own. Even those who never face such choices will pay for them through tax dollars and the cost of insurance premiums. And as more states consider passing “right-to-die” laws similar to the one that took effect in Oregon in 1997, this debate may become a local one.
Adding to this is the fact that 100 million Americans have chronic diseases. Because of advances in medical science, many of these people can be kept alive through extremely painful and debilitating terminal stages of some of these illnesses. As a result, growing numbers of chronically ill people are asking for the right to take their own lives. These requests reflect their desire to die without further needless suffering.
In Oregon, for example, the majority of physician-assisted-death requests have come from those who have lost the ability to care for themselves. Not every request is carried through. Less than one percent of those who received “end of life” prescriptions actually used them. Clergy and ethicists are concerned that as more states pass laws that make it easier to die, the “right to die” may become a “duty to die,” and that some lives will be valued more than others.
Should a dying young person be allowed to forego treatment that could extend his or her life? Should an active alcoholic receive a liver transplant that will cost the public thousands and deny a lifesaving organ to another? Is the public checkbook unlimited when it comes to preserving life at all costs? There are no easy answers.

©ALEXANDER RATHS/SHUTTERSTOCK.COM
The end of life is frequently the most expensive period of all: on average, Americans will spend five times the money on health care in their last year of life than in any one previous year. In 2011, Medicare spent $554 billion, of which 28 percent, or nearly $170 billion, was spent during the last six months of patients’ lives.

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