blog.bioethics.net

Just as in the debate over where life begins, I believe there will remain an ongoing debate over when and how life should end & over whose rights take precedence in the decision making. Euthanisia acording to Webster's Dictionary is a "painless and happy death" or "an act or method of causing death painlessly." If the patient is able to tell the doctor to stop or to only medicate for pain and the doctor refuses..whose rights are lost? If a patient does not have written legal directions and the family wishes them to be left go, whether for reasons known or not known, whose rights are lost? If the doctor, following the letter of the law, does everything irregardless of the futility and comfort of the patient, to safeguard their license,due to no known or written living will, whose rights are lost and what are we doing by putting the physician in this position? Just because we have the ability to sustain life much longer then before, (even in what many may deem of 'no quality' life) should we always do it? Who decides..whom among us has the right and ability to see the whole picture and determine what is best for us? Will they determine by the cost, the pain, the odds of improvement or longevity? By choosing not to continue treatment, that may not have been available previously, am I committing suicide or allowing nature to take its course? Where do our rights begin and end? Where is the protection for the physician who follow my wishes? If I choose to halt aggressive treatment, will there be an ACLU person jumping in and saying that I am depresseed and don't know what I am doing or that the physician will be held accountable for following my wishes? I work with many physicians and we have often talked about our own demise and the one overriding agreement is...there are worse things then death and when we are done fighting to live...let us die...comfortably. And keep those who think they know better then us, out of our room!! I think people would be surprised to know how often in the USA decisions like this are made. So the question becomes: is it euthanasia or simply my right to say "Stop and keep me comfortable!" Just points out the need for self-determination (written or video- taped) that negates any attempt to override our wishes!! (Even this doesn't always work with our legal system but gives us, our physicians and family a fighting chance!)

- by B.Bartley on Feb 26, 2006 at 10:08 AM | link

The line is not that difficult - don't act with the intention to cause death, but it is permissible to allow death. (Or, as Meilander and others have put it - we don't intentionally act to end suffering by killing the patient.)
The old double effect has been laughed at on this forum, but it is a useful principle that can be used for a guide for our actions on an individual basis.

- by Beverly on Feb 27, 2006 at 12:37 PM | link

This story is a strong case for the writing of living wills. People, when they are healthy and in their right frame of mind need to put in writing what their wishes are. All too often, families and doctors are put in the position of deciding when enough is enough for a terminally ill person. I truly do not believe that there are many of us who would enjoy laying in a vegetative state with every need being anticipated and met by others. A state where you cannot even make your own needs known and even the basic activities of daily living are performed by others. What about the terminally ill who are in constant pain. Sometimes, there is a fine line between pain control and anesthesia. If the person is alert and awake they are in pain. If they are pain free, they are lethargic or obtunded. I don't think that clear guidlines of ethical behavior in these situations can be developed by governing bodies or anyone but the person who is affected. I cannot believe that any ethical doctor would withhold treatment solely on the basis of age, or perform deliberate euthanasia of terminal patients. I do believe that at times euthanasia is a side effect of comfort care in the end of life. We do it to our pets and view it as humane to put them out of their suffering. While I do not think that families or doctors should be directly involved in actively hastening the death process. I do believe that there is a time and a place to provide comfort and allow nature to take it's course.

- by Judy Northrop on Feb 27, 2006 at 11:15 PM | link

I think the story is blurring the moral distinction between removing unwanted treatment and killing.

- by Wesley J. Smith on Feb 28, 2006 at 3:53 PM | link

To Judy:
The problem with the "we kill our pets" analogy is that we kill them because we *can*. Many pets are killed because they're incontinent, gone blind or deaf, or are too expensive to treat. Many pet owners don't even take them to the vet - they abandon them at shelters where after a waiting period they'll be killed.
I was always intrigued by the story of Max Bell, an Australian man with terminal illness who tried - unsuccessfully - to obtain euthanasia for himself. Before seeking euthanasia, he "put down" his pet dog and cat. That's all the news accounts said. Either they were both, by a staggering coincidence, suffering from painful terminal illnesses OR Bell would rather have them dead than placed in someone else's home. Not sure what lesson we were all supposed to get from that.

- by Stephen Drake on Mar 1, 2006 at 1:07 PM | link