Carolyn’s Online Magazine (#COMe)
A TIME TO BE BORN and
A TIME TO DIE:
Medical Technologies at the
Beginning and End of Life Cycle
Part 3 of 3 Parts: Living Wills
NOTE: This is the last post in a series of three that are an edited version of the first two articles I wrote, launching my work as a freelance photojournalist. They come from a two-part article from a public round-table discussion on the topic in the title. Panel participants included medical, professional, religious, and community members.
Click on the links to read parts 1 and 2:
It was suggested I update these articles written 24 years ago. I decided not to, in order to show that issues we were wrestling with at the beginning of the electronics age still remain—although the struggle may have intensified.
Questions today surrounding the preservation of life are different today than in the past. Formerly, “not breathing” was the criteria for determining death. Today, breathing can be maintained for decades in an otherwise vegetative body. Thus, technology has created a struggle in the redefinition issues of life and death.
One issue arising out of this milieu is Who has the responsibility to make decisions in life and death situations?
Consider medical practices surrounding life support systems. What is the right of the patient? Does he have the right to determine his medical treatment, even to the point of deciding to terminate the life support system? Are there any restrictions on his decisions? If he does not have this right, who does—the family, the medical establishment where he is a patient, the state?
Underlying the patient’s rights question is the issue of competency. The question of competency is tricky. It can be defined as the usual state of self. A fully competent person can decide a method of treatment ahead of time, e. g. via a Living Will. However, in the midst of a medical situation three things can occur.
First, in the midst of an actual medical situation the patient might see things differently and change his mind. One physician stated, I have yet to see a patient refuse life saving skills regardless of what is said in the office or in a Living Will. Second, under the effects of the medical situation the patient may become incompetent to participate in medical situations. Third, the medical situation might vary sufficiently from that defined in the Living Will that the document cannot or will not be applied.
Consider the patient has, while still competent, defined his treatment in a Living Will. A medical situation arises concerning use of life support systems. Should his wishes be honored? Assuming the patient’s decision doesn’t cause harm to others he can refuse some treatment but he cannot define treatment. Neither can he expect his physician to follow his decision if the physician chooses not to. Court’s are currently battling the legality of Living Wills and what effect they should have on medical treatment.
Consider the patient without a Living Will who’s expressed his wishes to his family. How should the medical community decide what treatment to follow? Should physicians be influenced in their treatments after conferring with the family?
Living Wills are often ineffective in emergency cases. What about the patient having a Living Will that excludes the use of a life support system, yet that life support system is begun either without or in spite of this knowledge? In medical practice, once life support has started it’s not stopped short of the death of the patient. Under what conditions could stoppage of life support, short of death, be considered?
A patient is in a persistent vegetative state. According to current medical opinion s/he is “brain dead.” However, s/he’s on life support, and could “survive” as such for many years. One comment was I’d feel very uncomfortable with actively helping someone to end life, or turning off the respirator.
Christian values are in conflict about ending life in these situations. If life support is removed, God will still determine continuance of life. “Physicians can’t tell how long a life will be—they are wrong in a vast majority of cases…”
While a patient is being maintained on life support, but defined as “dead,” where is the soul? Is it in limbo due to technology? “I don’t want you to keep my soul in limbo—,” and this can only be accomplished “if I’m completely dead.”
Is there a moral difference between starting and stopping life support?
A panel member wondered “Why are people with Living Wills seeking medical care?” For example, if a family wishes to follow the patient’s request why don’t they remove the patient from the hospital? “Why is a health care institute required to care for a patient not wishing care?”
Who, then, is to decide these issues? Desires of the patient and/or his family may not be compatible with sound medical or moral practices. A patient’s viewpoints may not be known, or medical treatment begun without knowing his wishes.
Families are often traumatized by a medical situation, in conflict with each other, or don’t care. Unethical medical professionals may decide to sustain persons in order to maintain an income or because they may not want to “give up.”
In general, decisions today are made by prior communication with the doctor. If this communication is absent, the family is contacted. This can be problematic if the family is at odds with the patient or the patient views are unknown. A hospital ethics committee, comprised of medical personnel, clergy, and community residents, can step in with input unbiased by emotions, financial consideration, bed-filling, etc.
The court system is the ultimate source of decisions in the struggle over life and death. The state, to whom life is an absolute value, must decide whether this value can be overridden.
No individual has absolute rights in the struggle with medical issues, but each must work in concert within a medical and legal framework in medical decision making.
The panel discussion was meant to raise and discuss issues surrounding life at birth and death. This article shares some of the thoughts and ideas from the panel. I invite you to make comments in the comment box at the end of this post.