Euthanasia JP

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    Dr. Endang Melati Maas, SpAn.KICDr. Endang Melati Maas, SpAn.KIC

    Department of Anesthesiology & ReanimationDepartment of Anesthesiology & Reanimation

    Faclty of Medicine, !nsriFaclty of Medicine, !nsri

    palem"angpalem"ang

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    • Euthanasia derives from the Greek Euthanos

    • Eu means good, with no pain and thanatos  means death

    •   Euthanasia means good death with no pain

    • The development of euthanasia has never been away from the development of death concept

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    In Indonesia, according to Indonesian MedicalIn Indonesia, according to Indonesian Medical

    Ethics Code, the terminology of ethanasiaEthics Code, the terminology of ethanasia

    sed today means#sed today means#

    1 The moving of the body to the other world safely and peacefully, with no pain, for those with his faith would say !llah on lips

    2 "hen the life ends The pain of the sick may be lighted by administering the tran#uilli$er 

    3 %ut an end to the sick man&s life and suffering intentionally upon his and his family&s will

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    '

    Ethanasia differs from#Ethanasia differs from#

    1  !ctive euthanasia

    2 %assive euthanasia

    3  !uto euthanasia

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    (

    •  !ctive euthanasia is an intentional action

    conducted by the doctor or other medical

    professionals to shorten or put an end on

    patient&s life

    • %assive euthanasia is a condition on which

    doctors or other medical professionals give

    no medical life supports to prolong patient&s

    life intentionally

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    )

    •  !uto euthanasia is a condition on which

    patients by his concerns strongly re*ect receiving the medical treatment and he knows it may shorten or end his life, by this re*ection he makes his hand+ written

    statement

    • undamentally !uto euthanasia is a

    passive euthanasia upon his demand

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    -

    $he isse of ethanasia raises pro and contra$he isse of ethanasia raises pro and contra

    • $hose %ho disagree ethanasia arge that ethanasia is a silence illing, therefore it is against the 'od(s %ill

    • $hose %ho agree ethanasia affirm that this action is pon patient(s %ill and condcted to lighten patient(s pain.

    • $here is a mercy for those se)erely siced and no medical e*pectation to li)e, together %ith a respect to manind "y a free choice as hman rights.

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    .

    /efinitions of death/efinitions of death

    • 0n the unconscious state patient certainly

    would not receive the agreement from the

    patient and at least the doctor asks his

    family, so there raise a #uestion

      "hen a patient considered dead

      "hen all medical support stopped

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    The terminology of deathThe terminology of death

    • 4linical death

    • 4erebral death, cortical death

    • 5iological death • 6ocial death

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    • 4linical death is a condition on which

    respiratory arrest8no spontaneous breathing and cardiac arrest by terminating all cerebral activities irreversibly

    • 4erebral death is an irreversible damage of cerebrum, particularly in neocorte9 and othe supratentorium structures, but medulla works well

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    • 5rain death is a cerebral death

    accompanied by thorough necrotic brain including cerebellum, mid brain and brainstem

    • 5iological death :pamorganic death; is an unpreventable death after the clinical death if no cardio+pulmonary+brain resuscitation performed or the resuscitation fails

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    • 5iological death is an autolytic process in

    all tissues starting from the neuron cells

    turning into necrotic without any circulation

    within an hour, accompanied by heart,

    kidneys, lungs and liver necroti$ed within 2 hours after having no circulation and

    ended by necroti$ing skin within hours or

    days

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    • 6ocial death is a persistent vegetative

    state suggesting the irreversibly severe

    brain damage in an unconscious and

    irresponsive patient but has an active

    EEG, few refle9es and ability to breathe

    spontaneously

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    The criteria of brain death applied inThe criteria of brain death applied in

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    1(

    • =% article 3''? those who terminate other&s life upon his will, by which he mention it clearly and seriously will be condemned within the least of 12 years in

     *ail

    • =% article 3'(? those who intentionally persuade others to commit suicide, assisting him to do it, or encourage him to commit suicide will be condemned within the least of ' years in *ail

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    1)

    • K!01 article 2# those %ho intentionally terminate others( life, de to common homicide

    %ill "e %ithin the least of +3 years in 4ail

    • K!01 article 5/# those %ho intentionally and plan to terminate others( life %ill "e condemned

    de to the planned mrder 6moord7 %ith capital pnishment or 4ailed %ithin the least of -/ years or throgh his life

    • K!01 article 38# those "y their o%n case people died %ill "e condemned %ithin the least of 3 years in 4ail or + year in the detention home

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    • 4oncerning the articles of =% in either

    active or passive euthanasia prohibited in

    0ndonesia, however if it regards the

    terminology of torturing in =% article

    3(1:torturing;, does the administration of ineffective treatment for the sake of

    patient&s recovery mean a torture to the

    patient

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    1.

    • $hat crrent isses of death determination together %ith the termination9 delay on life spport remain a ma4or isse encontered "y the doctors "oth in or otside hospital

    • For instance# ho% to assert the classic death, "rainstem death and the follo% p remain o"scre to s

    • In addition, ho% %e enconter this no hope to this reco)ery patient %aiting for his dead end remain o"scre to s.

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    1

    •  :ear +82;# holding the %orshop a"ot

    the termination of long period resscitation. $he participants are the

    representati)es of clinical association

    "y means of IDI, la% professionals,

    social and clergies.

    • $he e)ent organi

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    • $he otcome of this %orshop is to

    legali

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     !ccording to 0/0 recommendation 1.. !ccording to 0/0 recommendation 1..

    and 17, a person so called dead if?and 17, a person so called dead if?

    a 6pontaneous respiratory and

    cardiovascular function have stopped irreversibly :classic death; or 

    b %roven to be brainstem death

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    • 4linical death is a condition on which spontaneous

    respiratory and cardiovascular function have stopped

    and known after being performed an emergence resuscitation

    • 4linical death is respiratory arrest :no spontaneous

    respiration; together with total cardiovascular arrestwith all brain activities stopped, but reversible

    • 4ardio death is a continuous asystolic ventricular

    :flat graphics on E4G; during the least of 37 minutes

    after being performed resuscitation and optimal treatment

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    • M>? is "rainstem death

    • $he termination of life spports 6so called

    passi)e ethanasia is to terminate half or fll

    life spport therapies gi)en to the patients

    • $he delay of life spports 6so called passi)e

    ethanasia7 is not to gi)e life spports for a

    ne% a"normality arosed, %hile proceeding the gi)en therapy

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    6igns of clinically dead person or6igns of clinically dead person or

    cardio8respiratory arrest, are?cardio8respiratory arrest, are?

    1

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    0f the livor mortis, and or rigor0f the livor mortis, and or rigor

    mortis found in the dead bodymortis found in the