Tag: bioethics

Categories
Death + the Law Death Ethics Suicide

The Right to Die Free in Montana

Montana Court to Rule on Assisted Suicide Case
Kirk Johnson, New York Times (September 01, 2009)

Since July I have been posting stories on Right-to-Die cases in England. Those posts involved Edward and Joan Downes (who traveled together to the Dignitas Clinic in Switzerland to die) and Debbie Purdy who successfully fought a campaign to have England’s assisted suicide law changed.

Now it is America’s turn and in the great state of Montana no less. State motto: Oro y Plata…which means Gold and Silver in Spanish. I know.

I will let the Billings Gazette take the lead, with the August 29, 2009 article, State Appealing District Court Judge’s Ruling Favoring Assisted Suicide:

Robert Baxter, a 76-year-old former truck driver from Billings, spent his last months fighting for the right to hasten his own death.

Robert Baxter

Baxter was the Montana face and only named terminally ill patient in a legal case that sought to legalize physician-assisted suicide; he wanted doctors to prescribe him medication that would bring about his death and end his struggle with chronic leukemia.

Baxter died Dec. 5, 2008, the same day that Helena District Judge Dorothy McCarter ruled that the Montana Constitution protected the right of terminal patients like him to obtain lethal prescriptions from physicians.

This is an interesting case to watch because it involves the Montana State Supreme Court ruling on whether or not assisted suicide is legal. The other two American states with assisted dying laws, Oregon and Washington, both passed those laws by popular vote.

As always, I will keep my eyes on this case.

Categories
Death + the Economy Death + the Law Death Ethics Suicide

America and End of Life Care: Death, Dying, and Mortality

At the End, Offering Not a Cure but Comfort
Anemona Hartocollis, New York Times (August 19, 2009)

I started and re-started this post on American Health Care reform several times. To watch America’s current Health Care debate (such as it is…) makes me all the happier that I now live in the UK and am covered by the National Health Service. I have no problems with the NHS and I am glad that it exists.

Do Not Resuscitate Tattoo

One part of the NHS that impresses me most is its National End of Life Care Programme. The EOLC Programme’s mission statement provides a succinct mandate:

OUR AIM: To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

What I think is fundamentally important about this NHS program is that it acknowledges the obvious: people die. Indeed, the program was explicitly created to embrace death so that the dying process is made as comfortable as possible for UK residents.

Do No Resuscitate

Herein lies one of the key reasons that I think the American Health Care reform debate is failing: Serious discussions about death, dying, and mortality have been jettisoned. What America needs more than ever, right now, is a National Conversation about dying because until that occurs, health care reform will continue to ignore that one part of human biology that we all share: Death.

And yet, paradoxically, it would seem that this kind of conversation is going on all the time.

The New York Times article at the top offers a lengthy and important discussion on End of Life Care in American hospitals. And NYTimes Health columnist Jane Brody offered this recent piece: End-of-Life Issues Need to Be Addressed.

President Obama made it clear in May that he was interested in a National Conversation about End of Life Care in a lengthy New York Times Magazine interview about the economy.

It is a long(ish) interview, so if you click here you can skip to the bit on Obama’s Grandmother and how her death informed his own thinking about End of Life decisions.

Do Not Resuscitate Bracelet

The problem, of course, is that people rarely talk to their family members about death. To bring home this point, the August 7, 2005 New York Times Magazine featured this article: Will We Ever Arrive at the Good Death?

Here is the key quote from that article:

As J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, said last April to the Senate Committee on Health, Education, Labor and Pensions, “Americans are more likely to talk to their children about safe sex and drugs than to their terminally ill parents about choices in care as they near life’s final stages.”

Let me be clear that I think that President Obama is delving into an extremely urgent topic but, ironically, he is not the first modern American president to discuss end of life decision making. Oh no. Not by a long shot.

Some of the first presidential statements on death involved Ronald Reagan. In the early 1980’s, President Reagan received a series of reports on death and dying from some totally forgotten (but important) bioethics commissions:

  • Defining Death: Medical, Legal and Ethical Issues in the Determination of Death (July 9, 1981)
  • Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (March 21, 1983)

    • So, in a way, President Obama is attempting to carry out a project begun by President Reagan and is actually acting very Reaganesque. But I digress…

    For me, the key reason President Obama has seen his health care debate derailed is that he dared to embrace death. Or, at least, to suggest that end of life care is something that needs to be discussed (on the local and national level) since individuals need to be clear in their own heads about how they want to die.

    And since President Obama is involving himself in this debate, it means that the head of the nation is suddenly speaking out about death and dying. As a result, Obama is acknowledging a much more profound dilemma for modern America: the nation-state (as in America) usually ignores death at all costs.

    At a certain point, the nation can do absolutely nothing about death and instead it focuses on mortality. Death is utterly ignored by the nation because it represents that one, final act that an individual can choose and that beyond a certain point-in-time no life will return. President Obama isn’t anywhere near making statements about who lives and who dies. But he is making it clear that death is inevitable. (I am unfairly paraphrasing Michel Foucault’s comments from his Society Must Be Defended lectures, p. 248).

    That alone, I think, is causing some of the biggest problems.

    Do Not Resuscitate Logo

    All of this is to say, that American health care reform begins and ends with death. And until those discussions occur, America will continue with its current system.

    If you’re interested in making sure that your own end of life requests are followed, then use this information offered by Jane Brody of the New York Times.

    To help people make sound health care decisions and get the care they would want for themselves or their family members as life draws to a close, the National Institute on Aging has produced a comprehensive 68-page booklet, “End-of-Life: Helping With Comfort and Care.” Individual free copies can be obtained through the institute’s Web site, www.nia.nih.gov, or by calling 800-222-2225.

Categories
cremation Death + Technology Death Ethics Eco-Death

Reduce – Reuse – Recycle – the Dead…

Body Heat
The Economist (August 6, 2009)

Let us all say it together: Reduce – Reuse – Recycle. Now add: Dead bodies. It’s true. Shocking, but true.

A strong case can be made that organ donation, for example, is the noblest form of cadaveric recycling and that the reuse of human organs and tissues to extend life is a huge social good. That said, the dead human body offers up numerous recycling possibilities and many local and/or national governments have turned those postmortem opportunities into actual policies.

Reduce Reuse Recycle

These particular recycling plans focus on transforming the by-products produced through the final disposition of human remains (say from cremation) into new goods. That is a wordy way of saying that the various kinds of Green Technologies running rampant across the globe can also be used on dead bodies.

I am all for it.

The short Economist article at the top is about two different kinds of postmortem recycling. The first section explores the recycling of artificial joint implants (hips, knees, etc.), which can then be re-used in other industries. The left-over metal is melted down and sold to companies that use the different alloys in their own products. These companies often include ones that make joint implants. It’s all a bit circular (…just like the reduce reuse recycle arrows…) but it works. And many of the metal recyclers donate portions of their sales to designated charities.

Artificial Hip Joint

In about three years Denmark’s crematorium association has earned $15,000 from salvaged parts. America is a bit behind both Europe and the UK when it comes to implant recycling but at least one US company in Detroit, MI is making a go of it: Implant Recycling. I like to imagine that Detroit’s economic re-birth will start because of postmortem recycling.

Author Mark Harris, whose book Grave Matters: A Journey through the Modern Funeral Industry to a Natural Way of Burial is a good primer on eco-friendly burial, has one of the best photos that I have ever seen of a hip replacement post-cremation. Note how the metal hip replacement glows red amongst the remains:

Hip Replacement in the Crematorium

The second section of the Economist article discusses a topic that I am actually working on: recycling crematorium heat. Regulations require crematoriums to filter toxic substances from waste gases by cooling them from around 800°C to 180°C. Crematoriums capture the excess energy from this process and send the “waste heat” into building heating systems.

I remember explaining this concept a few years ago to a group of American college students. A few of them were aghast, to say the least. In early January 2008, officials at the Dukinfield Crematorium near Manchester, England announced that they would, indeed, begin capturing the crematorium’s exhaust, filter it, and then re-use it to heat the building. The always excitable Daily Mail ran a predictably over-the-top article on the plan: Crematorium to keep mourners warm by burning bodies of loved ones.

But, as even the Mail admits, not one person in the surrounding community (or in the Anglican Church for that matter) complained about the plan.

So here is the big lesson (and I learned it with the aforementioned students): when people understand that the heat being captured and re-used is already being produced vis-a-vis cremation, and that the same excess, potentially useful heat would otherwise go to waste, they are agreeable to the whole concept.

Indeed, the Haycombe Cemetery and Crematorium on the southern edge of Bath (near the University of Bath where I work) has a state-of-the-art facility capable of heat recycling. Haycombe’s Manager, the always good humored Rosemary Tiley, will gladly give a tour of the facility and/or the public can visit during one of the crematorium’s Open Days.

The larger question to ask about crematorium heat recycling, however, is how any surplus energy (after the local needs are met) could/can be channeled to the national grid? That is the next leap. Cremation rates in the UK are high: 72% nationally (the US cremation rate is currently at about 33% but growing) so making use of the crematoriums in this way makes sense.

Everything that I am writing today may seem a bit crass and bit too Soylent Green but a good public education plan goes a long way in explaining why these programs are socially useful.

In fact, cemetery planners in Santa Coloma de Gramanet, Spain (near Barcelona) have installed solar panels on the mausoleums to collect energy. It’s a great plan to help produce electricity for local homes and since most cities (large, medium, and small) have cemeteries in their vicinity, this might just work in other places. The Spanish authorities effectively explained the merits of the program and the public got behind it.

Not everyone is a fan of these Green burial initiatives. Evangelical Christian leader Chuck Colson, he of Nixon Administration infamy, lambasted an early 2009 Slate.com article on Green Burial technologies. Colson offered a special commentary in his BreakPoint Ministries column on the absurdity of eco-burial concerns. I firmly believe that Colson missed the entire point of the Slate article but so it goes.

So let us all say it together one more time: Reduce-Reuse-Recycle…

Categories
Death + Crime Death + the Law Death Ethics Suicide

Important Right-to-Die Court Decision in the UK

Debbie Purdy wins ‘significant legal victory’ on assisted suicide
Afua Hirsch, The Guardian (July 30, 2009)

An important turn today for UK Assisted Dying supporters (which is about 62% of the public…). Debbie Purdy successfully argued that it would be a violation of human rights for her to not know whether her husband would be prosecuted for accompanying her to the Swiss clinic Dignitas, where she wishes to die if her multiple sclerosis worsens.

Debbie Purdy and Omar Puente

The Purdy case is important and it will presumably force a change in UK law. As it currently stands, the UK’s 1961 Suicide Act decriminalizes suicide if you kill yourself. But any person whom:

aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.

What that aiding, abetting, counseling, and procuring entails is really ambiguous. It is all so unclear that UK Prosecutors have been declining to press charges against families that accompany, say, a loved one to die in the Dignitas Clinic.

For an extremely thorough history on the Assisted Dying debate in the UK, see the Guardian’s Assisted Suicide page.

I discussed much of this information a few weeks ago in a Death Reference Desk post about the recent deaths of Edward and Joan Downes.

Since the Downes’ deaths and that discussion, I came across the following article: ‘Romantic’ death may idealize suicide: critics. Maybe. But I’m not so convinced. If anything, what Edward and Joan Downes chose to do was die and to die together. It was an act of love, to be sure, but I’m not ready to call it romance.

They chose death over a biological life neither one of them wanted to live.

It is absolutely acceptable to choose death. And family members and/or friends who want to assist in that choice should be able to do so without fear of the law.

But LOOK OUT: Scotland might beat England to the punch. Scottish MPs are discussing a change to Scotland’s own assisted suicide laws.

And Scottish MP Margo MacDonald is leading a fierce charge.

Categories
Death + Technology Death + the Law Death Ethics

Re-thinking the Definition of Death in Canada

Ethicist Seeks Law to Say When Dead Is Truly Dead
Tom Blackwell, National Post (July 16, 2009)

How and when an individual is determined to be dead is a persistent bio-ethical, medical, and philosophical debate. I came across this article on the debate in Canada and I think that it highlights a common set of points for any modern nation which uses life support machines. First and foremost, the entire debate about the definition of death is a human-made problem. The use of life support machines in the 1970s suddenly meant that individuals who might have normally died from heart failure could suddenly be kept alive for long periods of time, although artificially. The person might not be conscious and could have brain damage from a prolonged absence of oxygen but that same person’s heart might still beat.

Before the advent of life support machines, the heart stopped beating and the person died. Once it became clear that the human heart could be kept artificially beating, bio-medical attention turned towards a definition of death using brain activity. If the brain is not fully functioning, then most of what we call the “person” is also dead. This then led to debates (which continue today) about whether Whole Brain or Partial Brain criteria should be used to determine death. Philosophically, this is an interesting point: where is the “person” located in the modern body, the heart or the brain?

Ventilator

I am skipping through decades of debate with this particular post but it is most certainly an issue that Death Ref will continue to present. Here, too, is an interesting aside on the topic. Right before President George W. Bush left office, the President’s Council on Bioethics (which President Bush created in November 2001 and President Obama has since disbanded) released this report: Controversies in the Determination of Death: A White Paper by the President’s Council on Bioethics.

It’s a long report but worth reading. The President’s Council on Bioethics upheld the use of brain death criteria and suggests that the determination of death in America remain neurologically based. Given the intense social, legal, and political battle over Terri Schiavo during the beginning of President Bush’s second term, this is a most intriguing finding.