LEC 2.2: Marriage & Death and Dying

1. A legal contract

2. A social institution

3. An interpersonal commitment

Marriage as:

A legal contract

Marriage as

• rights and obligations

A social institution

Marriage as

• family formation and social stability

An interpersonal commitment

Marriage as

• intimacy and mutual support

1. Civil marriage

2. Religious marriage

3. Customary marriage

3 Types of Marriage

1. Emotional support

2. S_xual intimacy

3. Procreation/childbearing

4. Economic partnership

5. Social recognition

5 Functions of Marriage

1. Mutual respect

2. Communication

3. Consent

4. Commitment

5. Conflict resolution

6. Shared responsibility

6 Core Elements in Healthy Marriages

Pro-Choice/Autonomy

Ethical Perspective

Contraceptives:

• support bodily autonomy, 

• reduces unintended pregnancies

• improve maternal and child health 

• supports social justice

Religious/Traditional

Ethical Perspective

• Some accept methods that prevent fertilization.

• Some reject methods that may act after fertilization.

• Others oppose all artificial contraception.

Public Health Ethics

Ethical Perspective

• Prioritizes harm reduction.

• Reduces unsafe abortions.

• Reduces maternal morbidity.

Dignity

Being worthy and noble

1. honor

2. respect

3. preservation of one’s humanity, values, and culture

To die with dignity is to pass away with (1) ____, (2) ____, and (3) preservation of one's ____, _____, and ____.

Dying with dignity

dying comfortably, respectfully, and according to one’s wishes

Inviolability of Human Life

• Human life is sacred and should not be unlawfully ended; it must be treated with respect.

• This principle:

  • Affirms that human life has intrinsic value 

  • Does not mean life must be prolonged at all costs 

  • Distinguishes between killing (wrong) and allowing natural death (may be ethically acceptable)

Prolongation of Life

• Treatment that extend life

• Ethical when beneficial

Dysthanasia

• Prolonging the dying process against the patient’s best interest through using “heroic” or artificial means

• Sometimes called “death with cruelty” - it prioritizes extending biological existence over quality of life and dignity.

• Generally considered unethical because it may cause unnecessary suffering

Euthanasia

• Act of ending a life that is believed to be suffering 

Active Euthanasia

• Deliberate action to cause death (ex: lethal injection)

• Usually voluntary

Passive Euthanasia

• Withholding / withdrawing life-sustaining treatment

• Can be voluntary or non-voluntary

Voluntary Euthanasia

• Patient explicitly requests it

Nonvoluntary Euthanasia

• Patient cannot consent (ex: unconscious)

Involuntary Euthanasia

• Against patient’s will

Assisted Suicide

px performs the final act

Euthanasia

the physician performs the final act

Orthotanasia

• normal or natural manner of death and dying. It:

  • Denotes deliberately stopping artificial or heroic means of maintaining life 

  • Is equivalent to passive euthanasia in some contexts

ethical golden mean

Orthotonasia represents this which neither prolonging death (dysthanasia) nor hastening it (euthanasia)

Palliative Care

• practice of relieving distress in terminally ill person during the last hours/days of life, usually via:

  • Continuous intravenous / subcutaneous infusion of a sedative

  • Specialized catheter for rectal administration

Double Effect Principle

Palliative care is aligned by the ___________:

• Intended effect = relief of suffering 

• Foreseeable but unintended effect = possible hastening of death

Advanced Directives

are legal documents allowing you to specify end-of-life care decisions ahead of time

• Give you a way to tell family, friends and healthcare professionals your wishes

• Avoid confusion during crises

• Include living wills, durable power of attorney for healthcare, and DNR orders

Do Not Resuscitate (DNR) Order

medical order instructing healthcare providers not to perform CPR if the patient’s heart stops or breathing ceases

1. When a person has an incurable illness and is expected to die within 12 months ;

2. A person is at risk of dying from a sudden crisis

When does End-of-Life Care begin?

Living Will

legal document stating future healthcare decisions only when a person becomes unable to make decisions on their own

1. Maintain humanity, values, culture

2. Have options to restore sense of control 

3. Receive pain relief consistent with palliative care standards

4. Have advance directives respected 

5. Be treated compassionately

A dying person has the right to:

1. Be knowledgeable about advance directives 

2. Provide pain relief consistent with palliative care

3. Communicate compassionately with patients and families

4. Document decisions carefully 

5. Support patient choice and ethical decision-making

Healthcare professionals must:

• commitment

• consciousness

• competency

Making ethical decisions requires: