Ethical Debates: End of Life Issues – Who Chooses and When and Why?

Of all of the ethical debates, there is none more basic and more troubling than end of life issues. It is an age-old debate, only exacerbated by modern medical science and a blurring of societal attitudes toward spiritual belief.

End of LifeIt is an issue that seems increasingly clear to us, the younger the patient. If our 104 year-old great-great grandmother is about to face imminent death, our attitude might be:

“She has lived a wonderful and long life. Let her gently pass away.”

However, if a four year old child in our lives is in an extreme situation, most of us would take on an attitude of: “How can we help? What can we do?”

Both reactions are natural. However, suppose the ethical playing field was level? Suppose a hospital or a physician or a committee of physicians was to judge that the child in extremis, and the old woman near death were the same? Would that be acceptable? Suppose they could decide without your input?

The New York Times, reported (March 30, 2013) on the debate concerning end of life issues in an online article entitled: “A Texas Senate Bill Would Revise the State’s End of Life Procedures.” The debate sets the stage for an intriguing ethical wildfire.

Briefly, the State of Texas now allows physicians to immediately discontinue treatment if there is no hope. However, they don’t have carte blanche to do so; if a patient has made provisions (or what they call advanced directives) or if the patient’s appointed “surrogates,” for example a spouse, disagrees with the discontinuation there is recourse. The surrogates are given 10 days to seek another opinion. Unfortunately, 10 days is often too brief a period of time in which to navigate the system; to understand the situation and to determine if there are any alternatives.

One bill currently before the state legislature was introduced by State Senator Robert Deuell, himself a physician. Senator Deuell has introduced a bill to extend the 10 day period to two weeks; it has the support of medical and church organizations including the prestigious Texas Medical Association.

I am sure Senator Deuell means no ethical or medical harm; as a physician he understands that often last-ditch efforts are painful and unnecessary and often harm patients and subject them to demeaning pain and suffering. He also understands the expense, time and futility of last-ditch efforts and therein may lay the problem.

While it all sounds magnanimous enough, organizations such as the Texas Right to Life people see real problems with Dr. Deuell’s bill (SB 303), because in the end, and whether a 10 or 14 day period, the hospital would still have the ability to overrule the advanced directives and surrogates. Instead, the Texas Right to Life organization supports two other bills; a bill that would eliminate a specified time period altogether (the surrogates have as much time as they need in which to decide) and another bill to prohibit physicians from withdrawing medical assistance no matter how long a patient clings to life.

Worth Noting

In reality, the current end of life legislation in Texas is not an issue that comes up for actual debate all that frequently. In a study made of about one-third of the private hospitals in Texas between 2007 and 2012, it was found that the end of life debate went from theoretical to actual in only 30 cases. In 10 cases, the patient passed away within the 10 day period.

In only a few cases did the physicians reviewing the remaining cases see any merit in prolonging life beyond the established period. Nevertheless, the very small percentage deserves a better ethical framework in which to make the life-ending decision. The “small percentage” number is wonderful from a distance, but if your child, what then?

Haven’t thought about it? Maybe this is a good time to start.

We are in a strange period in our history. We celebrate youth and “young things,” with abandon. Some believe there is no end point. Though the expression, “Youth will be served,” has been in use since the 1800s, it is never been more relevant it seems, than today. Many will take every option open to them to appear forever young. Unfortunately, the Fountain of Youth has still gone undiscovered.

End of life debates are hard, and so are end of life issues on family, friends and associates. I cannot imagine a more difficult ethical choice than having to say good-bye to someone who is unable to convey his or her wishes. End of life discussions are discussions we must all must have – sooner rather than later. No one wants to have it, no one looks forward to it, must it should be discussed.

Who Chooses and When?

We can all take our scientific and spiritual high-ground. We must also take the ethical high ground as well. For ultimately, it is not about us, it is about the patient.

If we are “surrogates,” ethically, we must understand what the patient would want. If we are the patient, what would we want others to do for us? How do we know these things in advance? We can gain ethical insights by talking to one another, by sharing with one another.

We must then come to the question of “why?” Why do we have such a hard time finding common ground on these ends of life issues?

I do not believe that anyone on either side of the argument is evil. While you may disagree with someone on this issue, it does not make them evil or crazy or people who are spiritually corrupt or spiritually superior.

For ultimately, the worst decision to make is that anyone not of our opinion is automatically wrong. We can go nowhere with such a belief. We must allow compassion to follow in the footsteps of a strong ethical compass.

If, in this discussion, we also have room for compassion, we will find our way through the ethical maze and eventually reach common ground.



Posted by Chuck Gallagher in ethics and tagged , , , , , , , .

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