VALUES IN DECISIONS ABOUT FUTILITY DETERMING MEANING IN

VALUES IN DECISIONS ABOUT FUTILITY DETERMING MEANING IN LIFE AND DEATH 1

QUALITY OF LIFE I: WAYS OF TALKING • THE SUBJECTIVE SATISFACTION EXPRESSED OR EXPERIENCED BY AN INDIVIDUAL IN HIS/HER PHYSICAL, MENTAL, AND SOCIAL SITUATION. • THE SUBJECTIVE EVALUATION BY AN ONLOOKER OF ANOTHER’S SUBJECTIVE EXPERIENCES OF PERSONAL LIFE. 2

QUALITY OF LIFE II: WAYS OF TALKING • • THE ACHIEVEMENT OF CERTAIN ATTRIBUTES HIGHLY VALUED IN OUR SOCIETY, AS REFLECTED IN A SOCIAL AND CULTURAL BIAS ABOUT THOSE FACTORS WHICH CONTRIBUTE TO A LIFE WORTH LIVING. A LEVEL OF CAPABILITY AND ACTIVITY WHICH CONTRIBUTES TO THE INDIVIDUAL’S ABILITY TO FLOURISH. • FLOURISHING --- THE FULFILLMENT OF THE POTENTIAL AN INDIVIDUAL MAY POSSESS FOR MEANINGFUL EXISTENCE [BEYOND MERE SURVIVAL] 3

QUALTIY OF LIFE: ESSENTIAL FEATURES • • • ACTIVITY (WORK, PLAY, STUDY) --INVOLVEMENT IN OCCUPATION. TASKS OF DAILY LIVING --- ORDINARY LIFE ACTIVITIES. HEALTH (FEELING OF WELL-BEING) --PERCEPTION OF ONE’S OWN HEALTH. SUPPORT FROM FAMILY AND FRIENDS. PSYCHOLOGICAL, SPIRITUAL OUTLOOK ON LIFE. 4

FINITUDE: LIMITATIONS OF EXISTENCE I • DEATH. • “THOU OWEST GOD A DEATH. ” • • DISEASE. DECISION MAKING (MORAL RISKS). UNCERTAINTIES IN LIFE AND MEDICINE. NEEDS FOR NURTURING (SELF AND OTHERS). 5

FINITUDE: LIMITATIONS OF EXISTENCE I • • • EXPERIENCE OF HELPLESSNESS. MISFORTUNES. INCOMPLETENESS (LOST DREAMS/AMBITIONS). AGING. LIMITATIONS ON RESOURCES. 6

DIGNITY • • WORTH. • CREATOR-CREATURE RELATIONSHIP. • SPECIAL PLACE [OR INTEGRATION] IN NATURE. • MATURATION. • CHOICES. INSTRINSIC TO THE PERSON. REINFORCED/RESPECTED BY ANOTHER. GROUNDED IN INNER RESOURCES. 7

INNER RESOURCES: PECULIAR TO EACH PERSON • • BELIEFS FEELINGS ATTITUDES COGNITIVE CONTENT VALUES/VALUE PRIORITIES CHOICES EXPECTATIONS HOPES • • PROCESS OF AGING TOLERANCE FOR RISKTAKING NEEDS ACTIVITIES RELATIONSHIPS DISEASE/RESPONSES SYMPTOMS/RESPONSES THERAPY/RESPONSES 8

SELF-DETERMINATION: ESSENTIALS • “FORM, REVISE, AND PURSUE PERSONAL PLANS FOR LIFE. ” • INFORMED BY VALUES & GOALS GROUNDED IN PRINCIPLE OF AUTONOMY. • WELL-BEING OF PATIENT IS BEST DETERMINED BY THE INDIVIDUAL’S SUBJECTIVE JUDGMENT. 9

FOUNDATION OF PERSONAL RESPONSIBILITY • • • CORE OF A SENSE OF ONE’S DIGNITY. • RESPECTING PATIENTS’ RIGHT TO DEFINE AND PURSUE THEIR OWN VIEW OF WHAT IS GOOD IS A MAJOR FORM OF RESPECTING DIGNITY PIVOTAL ROLE OF ACCURATE AND RELEVANT INFORMATION. [CONTEXT OF A LIFE OF VIRTUE]. 10

ADVANCE DIRECTIVES AND SELF-DETERMINATION • • DOCUMENTED FORM OF SELFDETERMINATION. SPECIFIC INSTRUCTIONS. • CRUZAN (1990) SPECIFIC WITH REGARD TO TREATMENT AND CONDITION - CLEAR AND CONVINCING EVIDENCE OF WISHES OF AN INCOMPETENT. RESPECT FOR PATIENT’S VALUES, WISHES, GOALS. ACTIVE PARTICIPATION IN DECISIONMAKING. 11

THE RESPONSIBLE PATIENT • • • ACCEPTING RESPONSIBILITY. DEVELOPING A LIFE OF VIRTUE. ESSENTIAL VIRTUES. • • • EXERCISING AUTONOMY. BEING INFORMED. BEING ASSERTIVE. BEING COMMUNICATIVE. TAKING RISKS. 12

RIGHT TO PRIVACY • • • RIGHT TO REFUSE TREATMENT. AMENDMENTS 1, 4, 5, 9, 14. FIRST IDENTIFIED IN GRISWOLD V. CONNECTICUT (1965). CENTERPIECE OF ROE V. WADE (1973). FIRST USED IN CASES OF DYING IN IN RE QUINLAN (1976). 13

CRUZAN V. DIRECTOR, MISSOURI DEPARTMENT OF HEALTH (1990) • • RIGHT TO REFUSE TREATMENT. LIBERTY RIGHT. 14 TH AMENDMENT ONLY. REITERATED IN VACCO V. QUILL (1997). 14

PATIENT SELF-DETERMINATION ACT (1990) • • RIGHT TO REFUSE TREATMENT IS ENDORSED AND RECOGNIZED --- NOT CONFERRED. • ALSO RIGHT TO CONSENT TO TREATMENT. RIGHT TO REFUSE TREATMENT IS FOUNDATION STONE. 15

VACCO V. QUILL (1997) • • • LIBERTY RIGHT GROUNDED IN 14 TH AMENDMENT. REITERATES CRUZAN (1990). “EVERYONE, REGARDLESS OF PHYSICAL CONDITION, IS ENTITLED, IF COMPETENT, TO REFUSE UNWANTED LIFESAVING MEDICAL TREATMENT. ” 16