Saturday, September 27, 2008

Research Topic 1: Laws on Assisted-Suicide

It comes as no surprise that assisted-suicide is widely controversial. While many states have tried to pass laws making assisted-suicide legal, Oregon has been the only state to successfully pass such a law. Only four such laws exist in the world. The Netherlands, Belgium, Switzerland, Luxembourg and Oregon are where assisted-suicide is legal. (Luxembourg just passed the legalization this year). Even than it's much more complicated than that. To understand what is legal one must understand assisted-suicide.

Assisted-Suicide: The deliberate hastening of death
by a terminally ill patient with assistance from a doctor, family member, or another individual.

Euthanasia: The doctor deliberately hastens the death of a terminally ill patient.

Terminally-Ill Patient: When a person is not expected to
live more than 12 months.

Currently Euthanasia is only legal in the Netherlands. I
am here to explore assisted-suicide for the terminally-ill.

Opponents of assisted-suicide believe that there is
no reason for anyone to choose to die. They believe that pain is always controllable. They believe that sometimes patients may be coerced to do so. Also, the patient loses the last moments with their families or the chance for a change of heart.

Proponents of assisted-suicide believe that a ch
ange in the law is necessary based on reasons of compassion. Pain is not always controllable. The patient deserves freedom of choice in the face of intolerable suffering.

I believe we should alw
ays have a choice. Because we are given a choice does not mean that we will take advantage of that choice. Based on religious and moral reasons, many people would never think to consider asking someone to help them end their life. It is estimated that some 10% of deaths would be effected by a change in this law. Looking at the statistics available for Oregon, if you compare the number of deaths to the number of deaths by assisted-suicide, it is only 0.2% between 2003 and 2005. It is far less than the estimated 10% that "might" use it. A higher percent asks for the prescription. Having the choice for many patients is enough.Laws Around the World:

United Kingdom

England and Wales: possibility of up to 14 years imprisonment for anybody assisting a suicide.

Scotland: there is no Scots authority of whether it is criminal to help another to commit suicide. This has never been tested in court.

Europe

Germany: no penalty for the action since 1751, although it rarely happens there due to the hangover taboo caused by Nazi mass murders, plus powerful, contemporary, church influences. Direct killing by euthanasia is a crime.

France does not have a specific law banning assisted suicide, but such a case could be prosecuted under 223-6 of the Penal Code for failure to assist a person in danger. Convictions are rare and punishments minor. France bans all publications that advise on suicide

Denmark: no specific law banning assisted suicide.

Italy: the action is legally forbidden.

Four European countries today openly, legally, authorize assisted dying of terminal patients at their request:

  1. Switzerland (1941)
  2. Belgium (2002)
  3. Netherlands (as well as voluntary euthanasia, lawfully since April 2002, but permitted by the courts since 1984).
  4. Luxembourg (2008)

Two doctors must be involved in Belgium, and the Netherlands, plus a psychologist if there are doubts about the patient's competency. But that is not stipulated in Switzerland, although at least a doctor usually is because the right-to-die societies insist on medical certification of terminality before assisting.

Belgium and the Netherlands permit voluntary euthanasia, but Switzerland bans death by injection, and all have 'residents only' rules, except Switzerland which alone does not bar foreigners provided they are critically, terminally ill. In 2001 the Swiss National Council confirmed the assisted suicide law but kept the prohibition of euthanasia.

All three right-to-die organizations in Switzerland help terminally ill people to die by providing counselling and lethal drugs. Police are always informed. But only one group, DIGNITAS, in Zurich, will accept foreigners who are either terminal, or severely mentally ill, or clinically depressed beyond treatment. (Note: Both Dutch and Belgian euthanasia laws have caveats permitting assisted suicide for the mentally ill in rare and incurable cases.)

Scandinavia

Sweden: no law specifically proscribing assisted suicide, the prosecutors might charge an assister with manslaughter - and do.

Norway: has criminal sanctions against assisted suicide by using the charge "accessory to murder". In cases where consent was given and the reasons compassionate, the courts pass lighter sentences


Denmark: no laws permitting assisted suicide, despite reports that it does.

Finland: nothing in its criminal code about assisted suicide

Asia & Pacific

Japan: medical voluntary euthanasia approved by a high court in l962 in the Yamagouchi case, but instances are extremely rare, seemingly because of complicated taboos on suicide, dying and death in that country.

New Zealand: forbids assistance under 179 of the New Zealand Crimes Act, l961, but

Northern Territory of Australia: had voluntary euthanasia and assisted suicide for nine months until the Federal Parliament repealed the law in l997. Only four people were able to use it. Other states have attempted to change the law, so far unsuccessfully.

North America

Canada: The law in Canada is almost the same as in England; it is a crime to assist a suicide, punishable by up to 14 years imprisonment. Rarely prosecuted.

Mexico: On April 22, 2008, the Mexican Senate voted 70-0 in favour of legalizing passive euthanasia. This concept allows doctors to withdraw life-sustaining medication from patients, but not to, for instance, administer poisons.

Central & South America

Colombia: Colombia's Constitutional Court in 1997 approved medical voluntary euthanasia but its parliament has never ratified it. So the ruling stays in limbo until a doctor challenges it. Assisted suicide remains a crime.

Uruguay: a person must appear in court, yet Article 27 of the Penal Code (effective 1934) says: "The judges are authorized to forego punishment of a person whose previous life has been honorable where he commits a homicide motivated by compassion, induced by repeated requests of the victim."




Laws in the US:

In Ohio, that state's supreme court ruled in October 1996 that assisted suicide is not a crime.

In Virginia, there is no real clear case law on assisted suicide , nor is there is a statute criminalizing the act, although there is a statute which imposes civil sanctions on persons assisting in a suicide.

Only Oregon permits physician- assisted suicide.

Oregon is not the only state to have voted on assisted-suicide. Many have tried and all have failed, so far. Here are the ballots that have been tried:

1991 -Washington State: Ballot Initiative 119, which would have legalized euthanasia and physician-assisted suicide, was defeated by voters by a vote of 54 to 46 percent.

1992 - California: Voters defeated Proposition 161, a ballot initiative which would have legalized euthanasia and physician-assisted suicide, by a vote of 54 to 46 percent.

1998 - Michigan: Measure B was overwhelmingly rejected by voters. The measure would have legalized physician-assisted suicide and was defeated by a vote of 70 to 30 percent.

2000 - Maine: The “Maine Death with Dignity Act,” patterned after the “Oregon Death with Dignity Act” which legalized physician-assisted suicide, was defeated by voters. The vote was 51 to 49 percent.

Since Oregon passed its assisted-suicide law in 1994—the only state to do so—numerous physician-assisted suicide and/or euthanasia bills have been introduced in 21 states, some multiple times. Not one has passed.

Seven states actually passed laws prohibiting assisted suicide: Iowa, Louisiana, Maryland, Michigan, Rhode Island, South Carolina, and Virginia


Sources for information on the legality of assisted-suicide:

A Chosen Death by Lonny Shavelson

Disability Rights Education and Defense Fund http://www.dredf.org/

Euthanasia Research & Guidance Organization http://www.finalexit.org/

Final Acts of Love by Stephen Jamison

Final Exit by Derek Humphry

Oregon State http://www.oregon.gov/DHS/ph/pas/index.shtml

Center for Disease Control: http://www.cdc.gov/nchs/PRESSROOM/data/state_profile_OR.htm

Friday, September 19, 2008

Great Idea for Patient Furniture

Not that I am anywhere close to this point but I just came across this product. It creates a more homelike and flexible hospital environment that promotes well-being. It provides flexible spaces for the family to visit or stay over. I think it would a great place to start when I start looking at how to integrate the medical aspects into the patient's cabins.


Saturday, September 13, 2008

Precedent- Cemetery/Sacred Space

Research and Readings

Spiritual Path, Sacred Place

What I learned most from this book, is the progression and ideas of path. The most intriguing ideas are in which the visitor experiences and chooses their way through the spaces. This book mentioned the Woodland Cemetery and the Brion-Vega Cemetery. I decided to further research these ideas (See later on in this blog) I will come back to this book and the way it references nature and spirituality.

The Woodland Cemetery

Okay, after this book I no longer feel anything toward this project. I have decided to no longer pursue it as a precedent. The progression of the design ideas between the two architects seemed haphazard and unrelated. The only features that I liked were the meditation knoll and the placing of the graves under the trees. I have decided to focus my studies on the Brion-Vega Cemetery

At this time, I just checked out a book on Brion and will begin my further research on it. The Spiritual Path devoted an entire chapter to and has provided me with a lot of ideas. The use of symbolism through out the space is intriguing. I like that is very personal to the family yet the visitors still want to come.


On Death and Dying

The ideas that I pulled from this reading were:
Prepatory depression versus reactive depression
Acceptance is almost void of feelings. The final rest before the long journey, it's the time the family needs the most help.
The patient reaches a point where death comes as a great relief.
Monumental task required to achieve this stage of acceptance, leading towards a gradual separation (decathexis) where there is no longer two way communication.
Death is not the problem. Dying is feared because of the accompanying sense of hopelessness, helplessness and isolation.
Death is just the moment dying ends.
And this poem from Stray Birds CLXXVI by Tagore:
The water in the vessel is sparkling;
the water in the sea is dark.
The small truth has words that are clear;
the great truth has great silence.

Last Wish by Betty Rollin

This is the story of a terminally-ill woman. It is written by her daughter. It does a wonderful job chronically her life all the way to her last moment. It discovers the pain and torment of both the patient and the family. It was written in the early 80's when even less knowlege was available than today. One of the best lines from the book took place in a dialogue between the daughter and her husband:
"I can't imagine her actually doing it, can you?" "Yes, but in a way that's not the issue. The issue is choice."
I found this to be so compelling. Why don't more places allow someone to help these people that so desperately want help.

A Chosen Death by Lonny Shavelson

I think this is my favorite book I have read on the issues so far. It provides the accounts of five different terminally-ill patients and their struggles to find help. It references the books I have already read as well as the ones on my nightstand. The insight from this book is what I was looking for. If I had to recommend only one book on the topic, it would be this one. The author remains objective through out the interviews. He provides stories on the elderly, the young, the disabled and the depressed. It provides summaries of the other books I have been reading and pointing out the relevance to each case.

Next up on my reading list:

Derek Humphrey's list of books: Final Exit, Jean's Way and Let Me Die Before I Wake
Final Acts of Love by Stephen Jamison
Icons of Twentieth-Century Landscape Design by Katie Campbell (features Woodland Cemetery)

I also found a great website devoted to Scarpa's work that provides many useful drawings and images.

Schedule



Instructor Feedback Intensive

Annie Kemp, August 08 Intensive
Feedback by Heinrich Hermann following final review on Aug 23, 08

Hello Annie,

As I look at my notes from the review and revisit the paper copy of your proposal, the following thoughts come to mind:
· Your work thus far was well done and it is both a very stimulating and valuable topic that should allow you to make an unusually rich, timely contribution
· The comments on the architectural strategy for researching, i.e. which focus might be particularly helpful, were constructive. The suggestions for focusing on paths [including tacticle and sound sensations, and including doing it both in plan, section], or on spaces close to the body
· The role of light and a systematic investigation of understanding it also in relation to materials, or the revelations it might bring when the person washes his/her face and sees close-up
· The concerns of those left behind you have already dealt with, but it certainly warrants further exploration
· One writer coming to mind about death is Elisabeth Kuebler-Ross, see
http://en.wikipedia.org/wiki/Elisabeth_K%C3%BCbler-Ross , whose most famous book was On Death and Dying, and she formulated the famous ‘Five Stages of Grief’. Other books by her may offer insights or references to your subject matter
· The treatment of the arrival/departure points is relatively clear in your mind but warrants more investigation (e.g. formulate the extreme poles between which the work happens and settle on fundamental choices in between)
· Again, I think that finding reports from people from just before they went through this, or their relatives, might be extremely important.
· Re the various designs of the rooms it would be interesting to see what happens if everything were understood as ‘patient-centric’, i.e. that if a curtain needs to be drawn, the patient still has’ the views s/he can enjoy otherwise, and rather the relatives’ spaces get smaller, etc.

Preliminary Thesis Proposal