HS2610G Chapter 8

What surgery did Hassan Rasouli undergo in 2010?

Hassan Rasouli underwent surgery in 2010 at Sunnybrook Health Sciences Centre in Toronto for removal of a benign brain tumour.

What happened to Hassan Rasouli after surgery?

After surgery, he developed bacterial meningitis and suffered severe and diffuse brain damage.

How was Hassan Rasouli kept alive?

He was kept alive on ventilator support and artificial nutrition and hydration.

What did Rasouli's doctors believe about his condition?

His doctors believed he was in a persistent vegetative state and that continuing life support was not in his best interests.

What did Rasouli's wife want?

Rasouli's wife, Parichehr Salasel, disagreed with the doctors and wanted treatment continued.

What does Ontario's Health Care Consent Act say about incapable patients?

Under Ontario's Health Care Consent Act, when a patient is incapable, treatment decisions fall to a substitute decision-maker, who must follow the patient's prior wishes or, if unknown, the patient's best interests.

What happens under the HCCA when parties disagree about best interests?

When parties disagree about a patient's best interests and appropriate treatment, the HCCA requires the dispute to go before the Consent and Capacity Board.

What is the Consent and Capacity Board?

The Consent and Capacity Board is a quasi-judicial body made up of one doctor, one lawyer, and one layperson who hear both sides and try to establish the patient's best interests.

Why did Rasouli's doctors think the Board had no jurisdiction?

The doctors believed withdrawal of treatment was not itself treatment, so the Board had no jurisdiction and Salasel's consent was not required.

What was the primary legal issue in Rasouli?

The primary issue was the interpretation of "treatment" and "health-related" purpose under the HCCA.

Why did the meaning of "treatment" matter in Rasouli?

If withdrawal of life support was not treatment, doctors could unilaterally remove Rasouli from ventilator support.

What did the Supreme Court majority rule in Rasouli?

The Supreme Court majority ruled that withdrawal of life support aims to prevent suffering and indignity at the end of life and is a health-related purpose.

What else did the Supreme Court say about withdrawal of life support?

The Court said withdrawal of life support often involves physical interference with the patient's body and impacts patient autonomy in the most fundamental way.

What did the Court conclude about withdrawal of life support under the HCCA?

The Court concluded that withdrawal of life support falls under the definition of treatment, so the Consent and Capacity Board has jurisdiction.

What must doctors do after the Rasouli ruling?

Doctors must either respect Rasouli's wife's wishes or challenge her position before the Board.

What happens if the Board agrees with doctors in a life support dispute?

If the Board agrees with the doctors, life support can be withdrawn even if the substitute decision-maker objects.

What must doctors do until the Board makes a decision?

Until such a decision is made, doctors must continue life support.

What did the dissenting judges argue in Rasouli?

Two judges dissented, holding that withdrawal or withholding of treatment is not itself treatment and that courts, not the Board, should resolve such disputes.

What did critics worry about after Rasouli?

Critics worried that giving end-of-life decision-making power to a quasi-judicial body lacking adequate medical experience could affect medical decisions beyond Ontario.

What "elephant in the room" did Rasouli avoid?

The decision avoided the conflict between individual autonomy and the just distribution of scarce medical resources.

Why does Rasouli raise resource allocation concerns?

Keeping Rasouli alive is expensive, and resources used for his care could be used elsewhere.

How have euthanasia and suicide been viewed historically?

Euthanasia and suicide have existed for a long time and received different degrees of acceptance or condemnation depending on philosophical, religious, and social norms.

How did Plato view suicide?

Plato did not condone suicide because he believed the soul was immortal and a person's life belonged to the gods.

How did the Stoics view suicide?

The Stoics accepted that taking one's own life when illness or disease made life unbearable could be rational.

How have Christians traditionally viewed taking life?

Christians have always condemned taking one's own life and taking another's life, even as an act of mercy.

How do Asian religions classify suicide?

In Asian religions, suicide is one of three forms of self-willed death, alongside heroic and religious self-willed death.

What is religious self-willed death in Asian religions?

The religious form includes terminal illness or debilitating old age and is sanctioned by religion and considered rational and public.

Why is voluntary death not a new moral question?

The moral question of voluntary death in old age or disease has been asked for centuries, with many varied answers.

What is new about death and dying ethics today?

Many ethical problems now result from new medical technologies and increased control over life and death.

What can modern medicine now do at the beginning and end of life?

Modern medicine can save lives in acute situations, extend lives in chronic situations, keep babies alive at 23-24 weeks' gestation, and keep comatose patients alive with ventilators and artificial nutrition for years or decades.

What question does modern life-saving technology raise?

It raises the question: should everyone who can be saved be saved, or should everyone be forced to live?

Why is technology not an unmixed blessing?

Technology gives control over situations not traditionally under human control and demands choices no one had to make before.

What choices does modern medical technology force us to make?

It asks us to decide who will live and who will die, and whether what is possible is always desirable.

What fears does modern medicine raise among older or chronically ill people?

It raises fears that they will be kept alive against their will.

What has modern medicine brought into human decision-making?

It has brought what once belonged to nature, God, or fate into human decision-making.

What universal fact about life begins the historical and philosophical discussion?

One universal and unavoidable fact about life is that it ends.

What questions have philosophers asked about death?

Philosophers have asked why death happens, whether death is final, whether death is the worst thing, what meaning death gives to living, and what life is for if its only end is death.

How does Socrates describe death in Plato's Apology?

Socrates says death may be like dreamless sleep or a journey to a happier place where he will meet gods and heroes.

For Socrates, is death the worst thing?

No; for Socrates, some conditions of living can be worse than dying.

What would be worse than death for Socrates?

Renouncing his beliefs and his right to speak them would be worse than death.

What does Plato argue in Phaedo?

Plato argues for the immortality of the soul, which pre-exists the body and survives bodily death.

Is Plato's immortality the same as Christian personal immortality?

No; Plato's view involves reincarnation into another body, even an animal body, not Christian personal immortality.

How does Plato view life?

Life is transient, a period between one death and another.

What is the purpose of wisdom for Plato?

For Plato, the purpose of wisdom is to prepare for death; the true philosopher does not fear and even seeks death.

How did Western philosophers after Plato view immortality?

For over two millennia, Western philosophers influenced by Christianity followed the Platonic belief in immortality but not reincarnation.

When did views of life after death begin to change significantly?

They began to change in the modern period and scientific revolution.

How did some modern philosophers view life after death?

Some questioned life after death and saw life in this world as more important than life in the next.

How did David Hume view the immortal soul?

Hume attacked the notion of an immortal soul because neither the soul nor its immortality can be known by experience.

Was Hume an atheist?

No; Hume was not an atheist but was skeptical about religious matters, including death.

How did Kant view immortality?

Kant strongly believed in immortality.

Why did Kant believe in an afterlife?

Kant believed the purpose of moral law is perfection, and since perfection cannot be attained in this life, it makes sense to believe humans continue perfecting themselves in an afterlife.

What influenced contemporary philosophers more than Kant's immortality?

Contemporary philosophers were more influenced by Darwin and the realization that human life cannot rationally claim uniqueness in this life or immortality in an afterlife.

What role has religion played in questions about death?

Religion has often provided answers to philosophical questions about death.

What was the dominant traditional Western view of death?

The dominant traditional Western view was the Christian view.

What does the Christian view of death include?

It includes belief in an individual immortal soul rewarded or punished in heaven or hell and reunited with the body at resurrection.

How does Christianity understand death?

In Christianity, death is not the end but a transformation; life is changed, not taken away.

How is Christian transformation after death understood?

It is personal, not blending into a universal soul or a temporary state before reincarnation.

Where is the meaning of life and death found in Christianity?

The meaning of life and death is not in this world but in the next.

How does Christianity view suffering?

Suffering is not necessarily bad and may even be good if it purifies the soul.

Why is the Christian view anthropocentric?

It applies immortality only to humans, not animals.

Why can Christianity foster fear of death?

Its emphasis on reward or punishment fosters fear because the soul's fate is determined at death.

Why has the traditional Christian view been transformed?

It has been transformed by declining Christian influence, secularization, pluralism, and increasing faith in science and technology.

How have medical advances changed ordinary experience of death?

Medical advances have distanced people from death, making it relatively rare and hidden from public consciousness.

How does the medical system encourage war with death?

Its technological focus encourages conquering illness or at least staving off death as long as possible.

How is death often viewed in modern medicine?

Death is seen less as an inevitable fact of life and more as a failure of medical technology.

What does it mean that society is "at war with death"?

It means society treats death as something to fight rather than as a normal part of life.

What have many people lost regarding death?

Many have lost the notion of spiritual immortality that once gave death meaning but have not replaced it with acceptance of mortality.

What does it mean that we have lost the supernatural dimension of death but refuse its natural dimension?

It means we no longer rely on religious meaning but also do not fully accept death as a normal biological reality.

How do we often see death instead of a biological condition?

We see death as "a correctable biological deficiency."

What does medicine confuse about disease and mortality?

Medicine confuses its power to alter, control, or eliminate disease with a power to banish mortality.

What does it mean that we have lost the moment of death?

Technology has prolonged the stages of death, and this prolongation has become an end in itself.

Have we always extended life through technology?

Not always; often we have simply lengthened the process of death.

How has the moment of death changed?

It has been taken from nature and handed to the medical team.

What choices must now be made around death?

Choices must be made about whether to let a patient continue living or allow them to die.

Why has the moment of death become a moral issue?

Because medical teams now decide whether and when life-sustaining technologies are stopped.

Why is it harder to determine death today?

High-tech medicine makes death less an event than a process that cannot be marked by a single point.

How has death become a series of events?

Death is now a series of small events, each open to further treatment, with no one event clearly marking when treatment should stop.

How was disease generally experienced before the last century?

Disease was generally acute, not chronic; people either recovered fully or died relatively quickly.

How have drugs, therapies, and technologies changed death?

Fewer people die when seriously ill, but many do not fully recover either.

How does death often occur now?

Death often comes later in life after long periods of chronic illness and degenerative disease.

Are people living longer necessarily healthier lives?

No; we may live longer but not necessarily healthier lives.

How can technology cause suffering at the end of life?

In some cases, suffering at the end of life is caused by the technologies themselves.

What are "half-way technologies"?

Half-way technologies are interventions that both work and do not work, creating a medical purgatory where patients are alive but not really living.

How does chronic disease affect treatment decisions?

Chronic disease evolves slowly and treatment is incremental, keeping the patient going without improving health.

What questions arise about stopping treatment in chronic illness?

At what point is the patient dying, and at what point is stopping treatment practical and morally correct?

Why is the 80-year-old woman on dialysis example difficult?

Without dialysis she will die quickly, but with life-preserving technology it becomes unclear whether she should be considered dying.

What other cases raise questions about stopping treatment?

Conscious or unconscious patients on ventilators, Alzheimer's patients with pneumonia, and elderly patients needing organ transplants raise similar questions.

What is happening to the line between life and death?

The line between life and death is vanishing, and prolongation of life is slipping into prolongation of death.

How is death now different from something that simply happens?

Death is now something allowed to happen or not allowed to happen.

Who is in charge of death in technological medicine?

The doctor, not nature, is in charge.

What does "death is no longer destiny but decision" mean?

It means death is often determined by human decisions about treatment rather than by nature alone.

Why do people dying in hospitals not die simply by nature taking its course?

Sophisticated medical technologies can keep them alive indefinitely, so death depends on deliberate decisions often made by others.

What new fear do people have besides death itself?

People now fear being kept alive against their will.

Why do more people want control over death?

Because death is increasingly a human decision, many want that choice to be theirs.

What shows technology's effect on the blurred line between life and death?

The shifting definition of death best shows technology's impact.

What was the traditional definition of death?

Traditionally, death was determined by heart and lung function: breathing stopped and the heart stopped beating.

What is the cardiopulmonary definition of death?

The cardiopulmonary definition says a person is dead when breathing and heartbeat stop.

What two developments made the cardiopulmonary definition problematic?

The mechanical respirator and organ transplantation made it problematic in the late 1960s.

How did the respirator challenge the definition of death?

It made it possible to keep people alive indefinitely by artificially supporting heart and lung function.

Why did organ transplantation challenge the definition of death?

Organ transplantation required dead bodies but live organs, so doctors needed to know when organs could be removed without being accused of murder.