Ethics and the termination of life support (TLS)

The courts have in the USA ruled such action is legal - this does not mean there are not moral issues involved - not every decision to turn o life support is morally acceptable. If a person needs help from a ventilator to aid recovery, or if CPR will restart a persons heart, surely these should not be withheld? And, what of the cost of treatments which help cancer patients etc. - some of these drugs might only give a little extra time and are very expensive
Wednesday 21 September 2011

Withdrawing and withholding treatments - if it is ethically acceptable to withdraw a treatment then it is to withhold it - there appears no signicant moral dierence. But to withdraw treatment can be far more emotional for the family concerned - it can feel like the family are then causing the death by taking away the treatment. In removing treatment the doctor does not cause death - they simply allow a disease etc. To take its natural course (result = death).
Wednesday 21 September 2011

Removal of such support does not mean the family cause death - the disease does this, whether it is slowly or quickly. People who want no more treatment might not want to die, they just want to live out their life without medical technology interfering. Does this mean we are playing God by TLS - this could only apply if TLS is killing the person (which it is not) - so for example removal of a feeding tube is not starving a person, the disease is preventing them from feeding.
Wednesday 21 September 2011

Does it violate the idea of the sanctity of human life - life is sacred so as long as the person has breath we (medical science) should do all we can to keep them alive? Here a family could not make any decisions which would remove treatments keeping people alive - but is medical science obliged to keep people alive at all times and regardless of cost? Is it acceptable to humbly accept death is coming, but it is not the end, and so chose not to employ life support systems?
Wednesday 21 September 2011

In fact this view of the sanctity of life might suggest earthly life is the highest good. When we know eternal life with God is the greatest good - if this is accepted there has to be a time when it is ok to say it is ok to end life support and let death take its course. Some say we continue as long as possible hoping for a miracle to occur. Is this a failure to let go? If a miracle is desired should all support be removed anyway? Rae suggests the greatest miracle is the full healing as we enter into eternity with the Lord.
Wednesday 21 September 2011

Refusing treatments with time to live

What if someone declines treatment, such as kidney dialysis, which would give them longer life? Some say suering has redemptive value - James 1:2-5 - but this is usually about suering for your faith or suering that is unavoidable, and it will add to your character (which will be perfect in eternity) - 1 Pet 2:20-25 - if all suering is redemptive you should never go to a doctor or dentist!
Wednesday 21 September 2011

But we cannot terminate life support in every case - we should consider: 1. Does an adult suerer request it in writing or orally? 2. Is the treatment of no benet to the patient? 3. Does the burden to the patient outweigh the benet? Usually TLS takes place when support is futile or burdensome. In the US it is legal and a patient has the right to refuse any treatment they do not want.
Wednesday 21 September 2011

Doctors can say no!

The US has seen a legal battle fought over the right of a doctor to say no to patients, or more their families, who demand treatment thought to be of no benet to the patient. (Doctors have to try to nd another doctor who will do what the family ask). Doctors can refuse to give futile treatment - e.g. an antibiotic for a virus, or those which will not reverse an imminent downward spiral towards death. Also if the burden of treatment exceeds benet then this is now examined - not just for the patient, but family (e.g. costs) and even of society as a whole.
Wednesday 21 September 2011

Withdrawal of nutrition and hydration

Not giving food and water to a patient in a permanent vegetative state or with low brain function from Alzheimers - brain function is lost apart from the brain stem which controls lower involuntary actions (breathing, digestion etc.). If food/water provided the person might live to a relatively advanced age - added to which the person might not have a terminal illness. Medically provided food/water are medical treatment - as it is medically provided some say it is like a ventilator performing a function that the body cannot do any longer.
Wednesday 21 September 2011

Some say food and water are needed even in dying, they are a base level of care for the dying symbolising our care for them. It can then be asked if the person is held captive by medical technology? They are exiled from the human community but denied death. And, if they have no higher brain function, can a person experience pain? Most bioethicists, according to Rae, say withdrawal of food/water to people in a vegetative state is acceptable as it is a medical treatment
Wednesday 21 September 2011

Physician assisted suicide and euthanasia (PAS/E)

These issues are increasingly bringing life and death choices and situations into normal peoples lives. Rae says that the bible teaches that the taking of life is a prerogative that belongs to God alone - hence no suicide or murder. Should this apply to these issues - many (in the world) think no, but religious believers tend to think this violates moral ground protecting the life and dignity of the seriously ill.
Wednesday 21 September 2011

In the USA there are many state laws prohibiting PAS/E - but still increasing demand for it to be allowed - and in some parts of Europe it is already legal. Although PAS/E are dierent the same arguments are often applied to both . Rae suggests we have an imaginary conversation with Jack Kevorkian who tells us why he is so committed to the leagalisation of physician assisted suicide.
Wednesday 21 September 2011

Arguing for Mercy - the most merciful thing to do for a terminally ill person who is suering and wants to die is to oer PAS/E. Medicine aims to relieve suering - we readily do this for animals. The Golden Rule might be cited - who would want to suer needlessly at the end of life? So we should do to them what we would have done to us.

Wednesday 21 September 2011

Raes response: the number of people this would aect (with severe suering prior to death) is very low (there are some though) for most the pain can be controlled so there is no need for PAS/E. Also there are other options such as a does of painkiller which means the patient will sleep before they die - this is not killing as the disease still takes its course. It is also possible that the pain relief might aect the heart rate of the patient and hasten death - the law of double eect - this is acceptable as the intent is what is important and if intent was to relieve pain (not permanently) then it is ok.
Wednesday 21 September 2011

Arguing for utility [useful, protable, benecial] - if PAS/E is done at a patients request it is win-win - there is no downside - patients suering is ended - high costs are removed - family can grieve and get on with life - medical sta do not have to deal with the anguish of a long drawn out death process Rae counters saying: what of the long and short term impact on the public at large - are the eects good for people in society in general, esp. those thinking of PAS/E - should any utilitarian approach be countered by sanctity of life/prohibition of killing?
Wednesday 21 September 2011