Legal and Ethical Concerns
Advance Directives: A person can give directions in the form of advance directives (see Section 1, Chapter 9) about the type of care he wants before he needs it. Advance directives are legal written agreements that allow a person to establish values and treatment preferences to be honored in the future when competency or capacity has lapsed. For example, advance directives can prohibit resuscitation or tube feeding, if this is the person's wish. Advance directives may be in the form of a living will, which expresses the person's preferences for medical care, or a durable power of attorney, in which the patient designates another person to make health care decisions, or both (see Section 1, Chapter 9).
Suicide: Many dying people consider suicide--even more so as the public debate about assisted suicide grows. Discussing suicide with a doctor may help; the doctor can increase efforts to control pain, assure the person and family that they are cherished, and help them find meaning. Nevertheless, some people opt for suicide to relieve an intolerable situation or to retain control of when and how they wish to die. However, people can ordinarily exert control by refusing treatments that might prolong life, including feeding tubes and ventilators. Making such decisions is not considered suicide.
The Death With Dignity Act was passed in Oregon in 1998, and similar measures are being considered in other states. This law made it legal for doctors in Oregon to prescribe drugs to assist terminally ill people who want to die. Included in this law are several measures to prevent potential abuses. Among these are a mandatory waiting period, counseling, and a second medical opinion following a request for assistance in dying.
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