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Andalusian project on "Death with Dignity Act"
Terry Schiavo died in March 2005 after years in a persistent vegetative state, to be withdrawn receiving nutrition via a nasogastric tube. This action was requested to judge by her husband, who lived with another woman, against the wishes of the parents of Terry, claiming that Terry would not have wanted that life.
can read the bill HERE
Strengths of the future law
The Act is very positive purposes, such as making it easier for patients to die with dignity and in peace, preventing unreasonably delay the natural death in terminal situations, because of what we been called "therapeutic cruelty." The approved text and ethically impeccable reasonable actions which are already standard practice for years, as the analgesic and sedative treatment to relieve pain in dying, even if it means a shortening of life is not deliberate. The Act also introduces general considerations very positive, as the recognition of palliative care for terminal patients care as an innovation of great importance, which should be available to all citizens of Andalusia who need it. And he points out the patient's right to receive family support and religious as they wish.
misconceptions and criminalization of assistance
However, the law contains some ambiguities in its development and misunderstandings that, in my opinion, alter the concepts of "withholding treatment" and "palliative sedation" defined so ambiguously that accommodate undesirable actions such as denial of common measures and basic support vital, or improperly induced drug coma. The worst thing is that criminalizes threatening to the weight of the law to the medical team who did not practice.
The definition in the Act of key terms in this field, such as "therapeutic obstinacy", "basic life support" or "terminal sedation" different from its meaning in medical practice, developed in the field of palliative care. In the definition of "therapeutic obstinacy" referred not only to therapeutic actions. Thus, we condemn, under the label of a so-called "therapeutic obstinacy" not only the extraordinary life support measures, such as mechanical ventilation, parenteral nutrition or intravenous fluids, which may indeed be disproportionate in some terminal cases, "but even simple care or ordinary means of life support such as food and drink administered orally or by tube.
for ethical practice, and for peace of patients benefiting from concepts such as "avoid therapeutic obstinacy", it seems essential to distinguish between measures of ordinary and extraordinary life support, and in turn, including cases in which the application These measures may be proportionate or disproportionate to the expectation quality of life with the patient.
Another ambiguous is the application of the concept of "terminal sedation." The problem is that, in law, unlike the practice in palliative care, the reduction of consciousness is not intended to apply only to terminally ill patients but can be applied to other terminal patients considered by the standards of clinical practice. In medical practice, and other characteristics that themselves reflected in the law, a patient must have a life expectancy less than six months to be considered terminal, and also have very close to death to consider reducing the conciencia1. However, the law omits the reference to both approaching death as the threshold with respect to life expectancy, and merely states that a terminally ill patient is one who has a "limited life expectancy." Since a "limited life expectancy" is common to all mankind, the ambiguous definition extends, in fact, the implementation of the "terminal sedation" to patients and are facing the agony, not even terminal. This point should be better defined and circumscribe the "terminal sedation" for patients with life expectancy less than six months already facing a death very close.
also in the definition of "terminal sedation" is omitted a key condition for its application in clinical practice, and that the relief sought is unattainable by other measures.
Using these vagueness or confusion of the Act, a patient is terminal, with a broad expectation of life, could require the care team members that will induce an irreversible pharmacological coma. Even as we have seen before, would require not give anything until he died in coma, lack of fluids. That is euthanasia. Therefore, this bill, by using such vague definitions, bolsters euthanasia, in contradiction with the system English law. In cases such as Eluana Englaro (Italy) or Terry Schiavo (United States), this law would condemn the administration of food and drink people as "therapeutic obstinacy" and could force the health care team to withdraw.
Finally, consider that in the health-specific language, the term "terminal sedation" is not commonly referred to sedation itself, but has been applied, by extension, to the profound and sometimes irreversible reduction of consciousness. In a legal text, which must be understood and interpreted by non-health, the concepts should be differentiated de sedación y reducción profunda de la conciencia, pues su naturaleza y sus condiciones de aplicación son muy diferentes. Muchas personas quieren ser sedadas, pero no que se les prive de conciencia, a menos que sea imprescindible.
Atención espiritual en la muerte
Como elemento positivo, la ley establece una serie de derechos que se reconocen a la persona que, en las condiciones actuales de práctica médica, se enfrenta a la muerte. Resulta muy positivo este reconocimiento de la persona en su realidad integral; el moribundo no sólo quiere morir sin dolor y sin angustia por su agonía, sino que habitualmente quiere morir en paz consigo mismo, con su prójimo y con Dios. Según CIS annual survey, over 80% of the people around us declares himself a believer, more than 70% Catholic. Every citizen is entitled to receive spiritual care according to their faith or beliefs when it comes time to death, a right which must be recognized and guaranteed. Just introduce a nuance: in correspondence with the right recognized in Article 16 the family support and religious, paragraph IV of the preamble should explain that health centers will facilitate the support not only family but also religious.
Dialectic vs. mistrust. culture of trust
Finally, I think a health culture to humanize the death and carnage avoid the undesired effect of scientific and technological progress, is objective and task of all: patients, families, clinical staff and health managers. But every patient is unique in its diversity. In addition, the terminal processes are so complex that hinder decision-making simple, applicable to all problems that can occur in a given person. Therefore, to provide the best possible response to each situation and each patient is essential to facilitate a culture of dialogue and trust between the patient and his family, on the one hand, and medical-care, on the other. Conversely
this, the criminalization and prosecution of medical records as a solution to all this complexity, as well as reveal a confusing view of reality and its causes can induce the "medicine" defense, for fear of professionals to be unfairly prosecuted. This possibility is compounded when such reprehensible acts described are also defined so broadly and ambiguously as in this law believe that by proposing this solution, the legislature assumes an interpretation of reality and confrontation, "doctor obstinate against patients and families who are subjected. " In the realities of health care, therapeutic cruelty situations are not only the result of an alleged medical obstinacy, but also, and probably to a greater extent, "caused by the extreme difficulty involved in taking the death of a loved one. The latter leads in some cases to pressure the care team in demand for interventions when no longer can, or should, do anything.
therefore believe that the best solution is to plant a dialectic of distrust, or acts described to impose health care teams, but to promote a culture of trust among the people served and the healthcare team, facilitating personal interaction, free of unjust coercion and strange. The care team usually has no intention that the best patient care possible and facilitate this difficult transition by which all ultimately have to pass.
NOTES:
1. "Terminal sedation is defined as the deliberate administration of drugs to achieve relief, unattainable with other measures of physical pain and / or psychologically, by lowering expected sufficiently deep and irreversible of consciousness in a patient whose death is very close and with their explicit consent, implicit or delegate "(SECPAL).
2. The very term "stubbornness therapeutic "as used in the law, it seems simplistic and ideological, facing the most often used for" therapeutic cruelty. " "Cruelty" seems preferable, as is a more expressive in terms of rejecting the undesirable action, but assumes a reprehensible intention care team. 
Terry Schiavo died in March 2005 after years in a persistent vegetative state, to be withdrawn receiving nutrition via a nasogastric tube. This action was requested to judge by her husband, who lived with another woman, against the wishes of the parents of Terry, claiming that Terry would not have wanted that life.
can read the bill HERE
Strengths of the future law
The Act is very positive purposes, such as making it easier for patients to die with dignity and in peace, preventing unreasonably delay the natural death in terminal situations, because of what we been called "therapeutic cruelty." The approved text and ethically impeccable reasonable actions which are already standard practice for years, as the analgesic and sedative treatment to relieve pain in dying, even if it means a shortening of life is not deliberate. The Act also introduces general considerations very positive, as the recognition of palliative care for terminal patients care as an innovation of great importance, which should be available to all citizens of Andalusia who need it. And he points out the patient's right to receive family support and religious as they wish.
misconceptions and criminalization of assistance
However, the law contains some ambiguities in its development and misunderstandings that, in my opinion, alter the concepts of "withholding treatment" and "palliative sedation" defined so ambiguously that accommodate undesirable actions such as denial of common measures and basic support vital, or improperly induced drug coma. The worst thing is that criminalizes threatening to the weight of the law to the medical team who did not practice.
The definition in the Act of key terms in this field, such as "therapeutic obstinacy", "basic life support" or "terminal sedation" different from its meaning in medical practice, developed in the field of palliative care. In the definition of "therapeutic obstinacy" referred not only to therapeutic actions. Thus, we condemn, under the label of a so-called "therapeutic obstinacy" not only the extraordinary life support measures, such as mechanical ventilation, parenteral nutrition or intravenous fluids, which may indeed be disproportionate in some terminal cases, "but even simple care or ordinary means of life support such as food and drink administered orally or by tube.
for ethical practice, and for peace of patients benefiting from concepts such as "avoid therapeutic obstinacy", it seems essential to distinguish between measures of ordinary and extraordinary life support, and in turn, including cases in which the application These measures may be proportionate or disproportionate to the expectation quality of life with the patient.
Another ambiguous is the application of the concept of "terminal sedation." The problem is that, in law, unlike the practice in palliative care, the reduction of consciousness is not intended to apply only to terminally ill patients but can be applied to other terminal patients considered by the standards of clinical practice. In medical practice, and other characteristics that themselves reflected in the law, a patient must have a life expectancy less than six months to be considered terminal, and also have very close to death to consider reducing the conciencia1. However, the law omits the reference to both approaching death as the threshold with respect to life expectancy, and merely states that a terminally ill patient is one who has a "limited life expectancy." Since a "limited life expectancy" is common to all mankind, the ambiguous definition extends, in fact, the implementation of the "terminal sedation" to patients and are facing the agony, not even terminal. This point should be better defined and circumscribe the "terminal sedation" for patients with life expectancy less than six months already facing a death very close.
also in the definition of "terminal sedation" is omitted a key condition for its application in clinical practice, and that the relief sought is unattainable by other measures.
Using these vagueness or confusion of the Act, a patient is terminal, with a broad expectation of life, could require the care team members that will induce an irreversible pharmacological coma. Even as we have seen before, would require not give anything until he died in coma, lack of fluids. That is euthanasia. Therefore, this bill, by using such vague definitions, bolsters euthanasia, in contradiction with the system English law. In cases such as Eluana Englaro (Italy) or Terry Schiavo (United States), this law would condemn the administration of food and drink people as "therapeutic obstinacy" and could force the health care team to withdraw.
Finally, consider that in the health-specific language, the term "terminal sedation" is not commonly referred to sedation itself, but has been applied, by extension, to the profound and sometimes irreversible reduction of consciousness. In a legal text, which must be understood and interpreted by non-health, the concepts should be differentiated de sedación y reducción profunda de la conciencia, pues su naturaleza y sus condiciones de aplicación son muy diferentes. Muchas personas quieren ser sedadas, pero no que se les prive de conciencia, a menos que sea imprescindible.
Atención espiritual en la muerte
Como elemento positivo, la ley establece una serie de derechos que se reconocen a la persona que, en las condiciones actuales de práctica médica, se enfrenta a la muerte. Resulta muy positivo este reconocimiento de la persona en su realidad integral; el moribundo no sólo quiere morir sin dolor y sin angustia por su agonía, sino que habitualmente quiere morir en paz consigo mismo, con su prójimo y con Dios. Según CIS annual survey, over 80% of the people around us declares himself a believer, more than 70% Catholic. Every citizen is entitled to receive spiritual care according to their faith or beliefs when it comes time to death, a right which must be recognized and guaranteed. Just introduce a nuance: in correspondence with the right recognized in Article 16 the family support and religious, paragraph IV of the preamble should explain that health centers will facilitate the support not only family but also religious.
Dialectic vs. mistrust. culture of trust
Finally, I think a health culture to humanize the death and carnage avoid the undesired effect of scientific and technological progress, is objective and task of all: patients, families, clinical staff and health managers. But every patient is unique in its diversity. In addition, the terminal processes are so complex that hinder decision-making simple, applicable to all problems that can occur in a given person. Therefore, to provide the best possible response to each situation and each patient is essential to facilitate a culture of dialogue and trust between the patient and his family, on the one hand, and medical-care, on the other. Conversely
this, the criminalization and prosecution of medical records as a solution to all this complexity, as well as reveal a confusing view of reality and its causes can induce the "medicine" defense, for fear of professionals to be unfairly prosecuted. This possibility is compounded when such reprehensible acts described are also defined so broadly and ambiguously as in this law believe that by proposing this solution, the legislature assumes an interpretation of reality and confrontation, "doctor obstinate against patients and families who are subjected. " In the realities of health care, therapeutic cruelty situations are not only the result of an alleged medical obstinacy, but also, and probably to a greater extent, "caused by the extreme difficulty involved in taking the death of a loved one. The latter leads in some cases to pressure the care team in demand for interventions when no longer can, or should, do anything.
therefore believe that the best solution is to plant a dialectic of distrust, or acts described to impose health care teams, but to promote a culture of trust among the people served and the healthcare team, facilitating personal interaction, free of unjust coercion and strange. The care team usually has no intention that the best patient care possible and facilitate this difficult transition by which all ultimately have to pass.
NOTES:
1. "Terminal sedation is defined as the deliberate administration of drugs to achieve relief, unattainable with other measures of physical pain and / or psychologically, by lowering expected sufficiently deep and irreversible of consciousness in a patient whose death is very close and with their explicit consent, implicit or delegate "(SECPAL).
2. The very term "stubbornness therapeutic "as used in the law, it seems simplistic and ideological, facing the most often used for" therapeutic cruelty. " "Cruelty" seems preferable, as is a more expressive in terms of rejecting the undesirable action, but assumes a reprehensible intention care team.
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