Download pdf - Euthanasia JP

8/20/2019 Euthanasia JP

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

Department of Anesthesiology & ReanimationDepartment of Anesthesiology & Reanimation

Faclty of Medicine, !nsriFaclty 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 beenaway 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 ethanasiaEthics Code, the terminology of ethanasia

sed today means#sed today means#

1 The moving of the body to the other worldsafely and peacefully, with no pain, for thosewith his faith would say !llah on lips

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

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


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Ethanasia differs from#Ethanasia 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*ectreceiving the medical treatment and heknows it may shorten or end his life, bythis re*ection he makes his hand+ written

statement

• undamentally !uto euthanasia is a

passive euthanasia upon his demand


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$he isse of ethanasia raises pro and contra$he isse of ethanasia raises pro and contra

• $hose %ho disagree ethanasia arge thatethanasia is a silence illing, therefore it is againstthe 'od(s %ill

• $hose %ho agree ethanasia affirm that this action ispon patient(s %ill and condcted to lighten patient(spain.

• $here is a mercy for those se)erely siced and nomedical e*pectation to li)e, together %ith a respectto manind "y a free choice as hman 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 spontaneousbreathing and cardiac arrest byterminating all cerebral activitiesirreversibly

• 4erebral death is an irreversible damageof cerebrum, particularly in neocorte9 andothe supratentorium structures, butmedulla works well


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• 5rain death is a cerebral death

accompanied by thorough necrotic brainincluding cerebellum, mid brain andbrainstem

• 5iological death :pamorganic death; is anunpreventable death after the clinicaldeath if no cardio+pulmonary+brainresuscitation performed or theresuscitation 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 within2 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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• =% article 3''? those who terminateother&s life upon his will, by which hemention it clearly and seriously will becondemned within the least of 12 years in

*ail

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


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• K!01 article 2# those %ho intentionallyterminate others( life, de to common homicide

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

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

de to the planned mrder 6moord7 %ith capitalpnishment or 4ailed %ithin the least of -/ yearsor throgh his life

• K!01 article 38# those "y their o%n casepeople died %ill "e condemned %ithin the leastof 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 ofineffective treatment for the sake of

patient&s recovery mean a torture to the

patient


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• $hat crrent isses of death determinationtogether %ith the termination9 delay on lifespport remain a ma4or isse encontered "ythe doctors "oth in or otside hospital

• For instance# ho% to assert the classic death,"rainstem death and the follo% p remaino"scre to s

• In addition, ho% %e enconter this no hopeto this reco)ery patient %aiting for his deadend remain o"scre to s.


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• :ear +82;# holding the %orshop a"ot

the termination of long periodresscitation. $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 otcome of this %orshop is to

legali


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

and 17, a person so called dead if?and 17, a person so called dead if?

a 6pontaneous respiratory and

cardiovascular function have stoppedirreversibly :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 emergenceresuscitation

• 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 optimaltreatment


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• M>? is "rainstem death

• $he termination of life spports 6so called

passi)e ethanasia is to terminate half or fll

life spport therapies gi)en to the patients

• $he delay of life spports 6so called passi)e

ethanasia7 is not to gi)e life spports for a

ne% a"normality arosed, %hile proceedingthe 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 dead body

then can be said irreversiblythen can be said irreversiblydeaddead


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The effort of resuscitation performed inThe effort of resuscitation performed in

clinical death is when the pulse ofclinical death is when the pulse of

bigger artery :circulation; andbigger artery :circulation; and

respiratory stop but hesitated if bothrespiratory stop but hesitated if both

cardiovascular and respiratory functioncardiovascular and respiratory function

fail irreversiblyfail irreversibly

or e9amples?or e9amples?


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• @inor cardiac infarct, causing electrical

death• !dams+stroke attack

• !cute hypo9ia

• /rugs 0nto9ication and over dosage• Electrical shock

• /rowned and other accidents that give

chance to live


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Resscitation not performed %hen#Resscitation not performed %hen#

• 1atient %ith the criteria of do not resscitate or all

treatments e*clding C1R#

• for patients %ith fnctional "rain or hope for "rainreco)ery, %hich ndergo the cardioplmonary failre orother mltiple organs in terminal stage of the incra"ledisease, e.g. ad)ance carcinomatosis.

• All possi"le treatment comfort the patients. 1rolonginglife %ill not "e performed after cardiac arrest.

• If it happens C1R %ill not "e performed and patientneglected dead


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In the emergency setting, resscitation may "eIn the emergency setting, resscitation may "e

ended %hen there has one of these follo%ings#ended %hen there has one of these follo%ings#

1 0f reappears an effective spontaneous circulationand ventilation

2 The effort of resuscitation taken over by othermore competent personnel and responsible to

proceed the resuscitation if no doctors;

3 ! doctor takes over the responsibility if there is no

doctors previously;


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' The assistants are so weak that they are

unable to proceed the resuscitation

( %atient confirmed dead

) %reviously known that after the resuscitationstarted, patient remains in the terminal stage ofan incurable disease? or nearly confirmed thatthe patient will not gain back their cerebral

function, namely 7,( +1 hour, proven to haveno pulse in normothermic without 4%A


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Bong term resuscitation ended whenBong term resuscitation ended when

meeting one of these followings?meeting one of these followings?

1 5rainstem death

2 The terminal stage of an incurabledisease eg social death


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• The decision of brainstem death is a medical

decision, so that the authorities is given to the

medical professionals

• The medical professionals consist of 3

competent doctors of which one of them is

anesthesiologist8intensivist, and the other 2

doctors;

• The decision is made in the e9amination reportand the decision making


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• That before performing the e9aminationprocedure of having no brainstem refle9, doctorsare obliged to e9plain the patient&s condition,e9tent of brainstem death definition and the

follow up to the patient&s condition if any;


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6igns of brainstem function loss are?6igns of brainstem function loss are?

• 4omatose

• Co abnormality of body posture

:decorticated or decerebrated;

• Co epileptic *erk

• Co brainstem refle9

• Co spontaneous breathing


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Ae#uirements and procedures ofAe#uirements and procedures of

brainstem death procedures are?brainstem death procedures are?

+. Ensring that there is some certain condition, sch ascomatose and apnea together %ith the incra"le "rain

strctre damage o%ing to disorders to%ard

"rainstem death

-. Eliminating the irre)ersi"le case of comatose and

respiratory arrest 6drgs, into*icated, electrolytes

disorder, meta"olic and endocrine7

. Ensring the non=refle*i)e permanent "rainstem and

respiratory arrest


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5rainstem refle9es are?5rainstem refle9es are?

1 Co light response

2 Co cornea refle9

3 Co vestibulo+occular refle9

' Co motor response in distributing the cranialnerves to the ade#uate stimulation in somaticarea

( Co vomiting refle9 gag refle9; or coughing

refle9 to the stimulation of the inserted suctioncatheter into trachea

/ifficulties in diagnosing the brainstem death/ifficulties in diagnosing the brainstem death


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/ifficulties in diagnosing the brainstem death/ifficulties in diagnosing the brainstem deathE*amination otcome 1ossi"le cases

egati)e ?cclo )esti"lar refle* ?toto*ic drgs

@esti"lar spressor drgs1re)ios disease

o "reathing Respiratory arrest post )entilation

Mscle rela*ant drgs

o motoric acti)ities Mscle rela*ant drgs

oced in state

Sedati)es drgs

EE'# iso electric Sedati)es drgs

Ano*ia

0ypothermicEncephalitis

trama

Fi*ated ppil Anti cholinergic drgs

Mscle rela*ant drgs

1re)ios disease


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• The test needs to be repeated to prevent

the problems of observation and signalschange

• The time interval ranges in 2( )7

minutes to the related hospital in regard oftransplantationD other hospital is 2' hours

ma9imally

• 0f the retest remains negative, the patientis asserted dead though the heart beats


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• 5rainstem death determination in particular for theinterest of transplantation, the test is performed by3 competent doctors of which one of them isanesthesiologist8intensivist, and the other 2doctors;

•

• The 3 doctors ought to have no relation totransplantation

• The patient is dead when brainstem is dead, not

when the dead body was e*ected from the ventilatorand the heart stops beating, then immediatelyconsult it to the transplantation team


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• Cotice that normally the cause of death is

the primary disease of the patient, not

from the withdrawing or re*ection of life

supports


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• The withdrawal means to stop the given

therapies

• The supports may be more comfortable by

withdrawing the therapy8life support than

re*ecting new therapy owing to its ineffectivelyproven to the patient

• They ensure that withdrawing may cause the

primary disease inflicting the patient


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• "hen the machines turned off, attempted

to return the patient&s spontaneousbreathing

• 0f fails, the ventilator therapy may no

longer be installed

• 0f unpredictably, patient breathes

ade#uately spontaneous, then the attempt

to secure patient continued


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4riteria of the termination8delay of4riteria of the termination8delay of

life supportslife supports1 0rreversible abnormality8disease

2 %oor prognosis in the aspect of medical

and #uality of life


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E9traordinary treatments to life supportsE9traordinary treatments to life supports

+. $reated in IC!

-. C1R

. Disrythmia control

5. $racheal int"ations

3. Mechanical )entilation


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;. Strong )asoacti)e drgs

B. $otal parenteral ntrition

2. Anti"iotics

8. Enteral t"e feeding

+/. I@ line flid 6DS,S,R7


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