Kristin Adler Contemporary Moral Problems December 15, 2009 End of Life I would like to start off by answering two questions: “What is a person? and “What is death? ” When I started looking up a definition for “person” it amazed me how many different variations there are. I feel that a person is one that is recognized by the law and has rights and duties. A person also has the moral right to make its own life-choices and to live without interference from others. Death is an eternal termination of all vital functions. The website death-and-dying. rg says “death is the cessation of the connection between our mind and our body”. I do agree with this statement with the thought that when death occurs our consciousness leaves the body to go on to the next life. Dying is the final portion of the life cycle for all of us here on earth. Providing excellent, humane care to patients near the end of life, when healing means are either no longer possible or, no longer desired by the patient, is an essential part of medicine. For physicians and health care providers to provide excellent care to dying patients and their families, they need expertise as well as compassion. Making excellent care for dying patients regularly available will require improvements in the professional education. There should be added teachings on the life of and the care of a terminal person. The care of the dying patient, like all medical care, should be guided by the values and preferences of the individual patient. Independence and dignity are central issues for many dying patients. Maintaining control and not being a burden can also be relevant concerns. I believe the patient “maintaining control” is the first concern of someone who has been given a terminal diagnosis. Sometimes the hardest part about dying is the effect it has on family and friends. Helping them deal with the pending death also helps the patient find peace and comfort. By maintaining control of medical decisions and helping others deal with the imminent death, helps the patient be at peace with his or her own mortality. As a member of the hospital Ethics Committee, I would like to say, there are many hospitals with poor end-of-life policies or inadequate palliative care training for their physicians. We live in a death denying culture and too often hospital policies cause the dying patients often to suffer needlessly with their pain and symptoms going uncontrolled or the doctors make the decisions on the treatment or care without first consulting the patient or family. I want to introduce programs to make doctors more comfortable caring for the dying, including respecting a patient’s wishes even if the physician does not agree with them. A policy of “patient-centered care” where the doctors consult dying people about their desires and priorities should be put in place. This policy should not allow doctors to contradict a patient’s wishes or make decision on their own, even when they think a bad choice has been made. The doctor should be able to discuss the options and alternatives with the patient but ultimately the patient makes the choice and the doctor follows through with the decision. If the patient is unable to decide for themselves the doctor should defer to someone with legal authority to make the decision on behalf of the patient and then follow this decision. I propose a project that teaches staff to recognize when a patient is within days or hours of death. It then instructs them to follow specific procedures, including counseling patients and families through decisions about end-of-life care. With the goal being to ensure more people spend their final days in comfort and dignity. What I want to see is people who are not experts in palliative care learn the skills and model them so that they become the standard for doctors. “By equipping more physicians with the skills to treat the routine cases, palliative specialists such as Dr. Bhimji say they can focus on patients with more complex needs. "The palliative care team doesn't need to see every dying patient in the hospital," she says. "Every physician should have a base level of competency in providing good quality end-of-life care. " (www. canada. com/ottawacitizen) I agree with caring for a dying patient however they wish. It should not matter if it is physician assisted suicide, extraordinary treatment, euthanasia or the standard hospice or palliative care. How the patient wants to spend their remaining days should be their choice not a doctor’s decision. The Utilitarian says that you should be free to do what you like as long as the consequences of what you do don’t harm anyone else. I’m struggling with the notion of the Utilitarian agreeing with ending someone’s life. On the one side I see where assisting in the person’s death upon their request will bring pleasure and relief but the family will be affected by the consequences also. The action of ending the patient’s life will be hurtful to the family by taking the life earlier than nature intended. This is then contrary to utilitarianism. Deontological argument is the simplest moral outlook on suicide and holds that it is necessarily wrong because human life is sacred. Therefore this moral theory is opposite to how I see things, I agree life is sacred but when death is imminent and the patient is in pain or no longer able to function and the person chooses to end their life, then I feel their wishes should be met. There are two main type of relativism. Descriptive ethical relativism claims as a matter of fact that different people have different moral beliefs, but it takes no stand on whether those beliefs are valid or not. Normative ethical relativism claims that each culture’s beliefs are right within that culture, and that it is impossible to validly judge another culture’s values from the outside. So what the norm is for our culture is what is accepted. So this does not agree with my views, since our society is a life driven culture and frowns on ending any person’s life. Ethical Egoism is a moral theory that states that each person ought to act in his or her own self-interest. This is the view that best fits my ideal recommendation on the issue of early termination of life. By letting the dying patient decide what is best for them and giving that person total control of how and when they will die goes along with the ethical egoist’s position. An article from “The Honolulu Advertiser” dated December 13, 2009 “Attempted killing puts issue of terminally ill back in spotlight” shows to what extent a dying person or a family member will go to. When someone you love is in extreme pain and does not want to suffer any longer, you no longer consider “Is this legal? ” or “What are the consequences of what I am doing? ” “Court documents say Yagi shot his wife shortly after 6 p. m. Tuesday at Castle Medical Center. He used a shotgun round from a flare gun, police said. Yagi has no criminal record in Hawaii and he has been released on bail. ” Dennis Arakaki, a former legislator who serves as executive director of the Hawaii Family Forum and the Hawaii Catholic Conference, said the shooting at Castle should be seen as a case of a lone individual who apparently wasn't getting the help he needed. Here is an example where further education of the medical staff and policies in place in caring for dying patients may have kept her husband from going to such extreme measure to relieve his wife of her suffering. I am trying to put myself in the position of a terminal patient and from my own life experiences look at things from the family’s side as well. I am having a hard time coming up with discussion against my point of view. I know there is more than one side to this debate but it is hard for me to believe anyone would want someone they love to suffer. I know we always want to hope there will be a miracle cure that will come before our loved one dies, but we must not let them suffer any more than necessary. I am a Christian and know murder is a sin, but I feel that watching someone suffer is also a sin. Why would God want someone to suffer extremely before death? How can family and friends standby and wait for the end to come? How long will the family keep coming around to see the dying person in this state? They usually want to remember them in happier settings and do not want to deal with the end. So by letting the patient make the decisions and keep control of their medical treatment, it alleviates the family of this tremendous responsibility hanging over them about letting their loved one go. I know active euthanasia is illegal in the United States but the passive euthanasia is legal. So we can remove life support and let the patient starve or dehydrate and give large doses of morphine but we cannot legally be justified in ending it quickly for them. To me this is confusing, but I do understand as I stated earlier we live in a death denying culture (death by any means except natural is not acceptable). The physician assisted suicide (PAS) which is legal in Oregon and Montana seems to me a good option available to dying patients. Just having the option to choose how and when to die gives the patient the control we all strive for in life. So taking it from us at the end of our life seems cruel. Physician assisted suicide allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. The statistics show that in 2008 physicians wrote 88 prescriptions and only 54 of the patients took the medication to end their life. Others died naturally of their disease and some were still alive at the end of 2008. So just because the person decides to make this choice it is still up to them when they take the medicine, the patient has ontrol. This cannot be an easy request to make of your doctor no matter how much you want to end the pain. A patient must make sure they go through counseling and psychiatric evaluations and consider all medical options available before making this decision. Many patients in the United States opt for hospice care or palliative care when diagnosed as terminal (6 months or less to live). Hospice and palliative care both provide physical, emotional and spiritual comfort care for the patient and their family. So, when does someone choose palliative care or hospice care? Upon a persistent, debilitating and life-limiting illness, a person can include palliative care in the treatment plan. This will clarify goals and ensure that they will be followed, no matter who is providing the care and where it is delivered. With palliative care the patient will be allowed to have any treatment the patient wants. It is the patient’s decision and terminal sedation is allowed. The palliative care gives the control back to the patient. In the later stages of the illness the patients and caregivers needs increase and it is then time to change to hospice care. With hospice care all treatments are stopped and the focus is on comfort only. I have always liked a saying by Albert Einstein “There are only two ways to live your life. One is as though nothing is a miracle. The other is a though everything is a miracle. ” I try to think each day is something great and I would like to be able to continue to have this outlook even at the very end of life. By allowing people to have choices at the end of their life and let them be in control of the final decisions may help keep the outlook that everything is a miracle, even death. End of Life – Resources http://www. ospicenet. org/html/dying_guide. html www. merriam-webster. com/dictionary www. death-and-dying. org www. hospicenet. org A Dying Person’s Guide to Dying by Roger C. Bone, M. D. www. canada. com/ottawacitizen By The Ottawa Citizen April 26, 2005 Dying in hospital: Care in a culture of cure http://deadpanthoughts. com/2009/01/euthanasia-justified-according-to-utilitarianism http://ethics. sandiego. edu/LMH/E2/Glossary. html http://www. oregon. gov/DHS/ph/pas/index. shtml http://www. americanhospice. org Hospice Care or Palliative Care: What's the Right Care for Me? By Johanna Turner | |
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