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Bioethikos: Bringing Life to Bioethics

Posts Tagged ‘end of life’

 

Balancing Faith and Science at the End of Life

Tuesday, July 7th, 2015 by Dr. Dennis Sullivan

caduce

(by guest blogger Sam Franklin)

My mother, luckily, died in the presence of six of her closest relatives — all of whom were born-again believers. Other patients aren’t as lucky.

Consider “Ms. Ellen,” who spent her last days surrounded only by medical professionals — none of whom affirmed her Christian faith:

Ms. Ellen felt the lack of sensitivity and respect for her faith, but she wanted the entire medical team to know that she knew she would not be living much longer. Why? Because hope for her at this critical moment was not rooted in anticipating a miraculous healing of her body, but in a need for spiritual peace and physical comfort as she approached the end of her life . . .

Unfortunately, Ms. Ellen would be robbed of this opportunity as she quietly lay in her bed, now questioning those more than 21,800 hours of hope-filled moments that she had tucked away over the many years of her life for a time such as this.

 

In my mother’s case, every decision she made reflected her beliefs. Unfortunately, Ms. Ellen’s beliefs influenced none of her medical team’s decisions. Nonetheless, even when patients tragically die alone, a Christian healthcare professional can help final decisions affirm deeply-held beliefs, regardless of their religious background.

Let’s take time to ask patients about their faith and how it impacts their last few days. We shouldn’t force our faith on them, but hopefully, we may have an opportunity to share the gospel. Together, patients and healthcare providers can agree upon appropriate treatment, and in doing so, we address an oft-neglected aspect of patient care: the soul.

NY Times Opinion Piece

Remembering Spring in the Midst of Winter

Monday, March 9th, 2015 by Dr. Heather Kuruvilla

1280px-Colorful_spring_gardenPhoto Courtesy  of Wikimedia Commons

by Dr. Heather Kuruvilla

Just days ago, much of the nation was facing wind chill advisories and subzero temperatures.  But walking around my neighborhood yesterday, I heard the sounds of rushing water as the snow melted, the song of birds, and the honking of geese.  The sun was shining, and the smell of spring was in the air.  We knew it was coming.  For weeks now, folks I’ve encountered, whether in line at the post office or ringing up my groceries at Wal-Mart, have been encouraging each other with the hope that “spring is on its way”.

Even on the coldest day, no one doubted that spring was coming.  We’ve seen the seasons change again and again. The pattern of resurrection is woven throughout the fabric of nature.  For every winter, there is a spring.

The fact that we’re still talking about Brittany Maynard proves that the “winter” of our lives is often difficult.  Brittany  Maynard, diagnosed with terminal cancer, chose to end her life last November rather than face the certain pain that lay ahead of her.  I think any of us who has seen the ravages of cancer can empathize with what must have been an agonizing decision.

Her decision illustrates our very basic, human need for hope; the hope that winter will give way to spring.

As Christians, we hold to the hope of resurrection, knowing that the darkness of Good Friday gave way to the triumph of Easter Sunday.  Christ, then, is our ultimate hope.

 

But a terminal patient needs “short-term” hope, too.  What are some ways we can help suffering persons to embrace hope?  According to Cancer Research UK:

Everyone needs to have some sense of hope for their future. When you are dying, this hope may be that you can visit a place that you love. Or you may hope that you can enjoy being with your family and friends for a time. Some people believe that there is life after death and find that this gives them hope…many people hope for comfort, dignity, friendship and love to surround them in their final days.

 

That means every one of us has the potential to be a hope-giver.  For more information on helping the terminally ill, check out these resources:

Hospice Foundation of America

Get Palliative Care

 

Asking the wrong question?

Monday, February 2nd, 2015 by Dr. Heather Kuruvilla

health-care-md

 

(by guest blogger: Erica Graham)

How do we, as a society, decide when someone is mature enough to make their own healthcare decisions?  Recently, the Connecticut Supreme Court ruled that 17 year old Cassandra C. must undergo chemotherapy to treat her Hodgkin’s lymphoma, even though she does not wish to receive treatment.  While waiting for the court’s decision, Cassandra was taken into state custody, and confined to a room at Connecticut Children’s Medical center with a guard posted outside her door to prevent her from leaving.  This clear violation of Cassandra’s autonomy has sparked dialogue about when a teen is mature enough to make end of life health care decisions. Currently, teens can legally make some healthcare decisions, like whether or not to get an abortion, without parental consent.  Most of the discussion surrounding Erica’s case has focused on her age and maturity level. Personally, I know 17 year olds who are mature enough to make this decision, as well as some who are not mature enough. Maturity is not simply a matter of age.

So how should maturity be determined in cases like these? I propose an analysis of her reasoning, not her age, should be used to determine her level of maturity. Cassandra’s main reason for not wanting to receive chemotherapy, even though the odds of successful treatment in her case are high, was because she didn’t want to put poisons in her body. Her reasoning, not her age, shows her lack of maturity to make this decision. Her reasoning is not founded on carefully considered risks and benefits like that of a mature adult. It appears her reasons are built on fear and her lack of understanding of a treatment that will most likely save her life. While not every adult is mature enough to consider risks and benefits carefully, the law has the ability, in the case of a teenager, to prevent them from making poor decisions that they may not fully understand.

Certainly some adults refuse chemotherapy, but Cassandra’s case is a different set of circumstances. By undergoing chemotherapy she has an 85% chance of living for many more decades. Basic logic dictates that this benefit overrules the pain and inconvenience of chemotherapy treatments. Despite the fact that this decision violates Cassandra’s autonomy, I am glad the court can intervene when a lack of mature reasoning and logic is evident in a teen. I agree with the court’s decision on the grounds that Cassandra didn’t demonstrate mature moral reasoning.

CNN Article

NBC News Article

Ezekiel Emanuel is Wrong

Monday, October 6th, 2014 by Dr. Dennis Sullivan

Physician-ethicist Ezekiel Emanuel seems to love being at the center of controversy. One of the architects of Affordable Care Act, he is director of Clinical Bioethics at the NIH and chairs the Department of Medical Ethics & Health Policy at U Penn. He has frequently (and often unfairly) been criticized for pointing out the flaws in our current health care system, which he describes as  “truly dysfunctional” (Wash. Post). Worse of all, many think of him as a real utilitarian pragmatist, and have accused him of trying to ration health care. He has denied this.

So it comes as a bit of a shock to see Emanuel’s latest article in the Atlantic, “Why I Hope to Die at 75.” He claims that he will stop using the health care system at age 75. He puts it this way:

[H]ere is a simple truth that many of us seem to resist: living too long . . . renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic (source below).

Emanuel goes on to say that this is no death wish, but he feels that he may no longer be productive and enjoy things at age 75. So he hopes that will be the end. If he has cancer or develops pneumonia, he will refuse chemotherapy or antibiotics. His last colonoscopy will be at age 65. And when he hits 75, no flu shot.

Why this somber navel-gazing with 18 years to go?  What is Emanuel trying to prove? He is implying, I think, that there is no more to life than our contributions to society. He is subtly saying that older patients are selfish to use so many health care resources, and that we should all just forget about living long lives. Ah, but that of course is the ultimate lie that so many functionalists would have you believe. We are valuable because of what we do, not for who we are.

On the other hand, the Christian view of the human person teaches that we are valuable for our own right. Each of us was made “a little lower than God,” and our Creator has crowned us “with glory and majesty” (Psalm 8:5, NASB). The elderly deserve honor; they have the right to enjoy the fruit of their labor. Our value is intrinsic, and does not depend on our age or our abilities.

Don’t let a pontificating utilitarian make you feel guilty for living out the full lifespan that God has allotted you.

Article in The Atlantic

Death Panels Redux?

Tuesday, September 30th, 2014 by Dr. Dennis Sullivan

A recent report by the Institute of Medicine is entitled: Dying in America. Among other things, it documents how poorly Americans understand their options at the end of life. The IoM recommends that doctors get paid for having end-of-life discussions with their patients. This idea was unpopular back in 2009, and led some to accuse the government of trying to establish “death panels,” designed to limit treatment options and to ration health care.

But this is a distortion. According to the IoM report:

The [2009] provision would have reimbursed clinicians for the time spent in advance care planning with patients. Such conversations would have included discussion of the documents that can help ensure that patients’ wishes regarding care are followed in the event they become unable to express them (source listed below).

Recent polls have show that the majority of Americans strongly support such discussions, and a growing number have established advance directives for themselves and their loved ones. Nonetheless, a recent Forbes article makes the alarming claim that death panels are “on the rebound.” Why all this suspicion?

The main reason may be that advance directives (e.g., living wills or durable powers of attorney for health care) are not perfect, and they are not always honored. A patient’s prognosis is not always easy to predict. And families are sometimes reluctant to go along with their loved ones’ wishes, even when they are clearly stated.

Yet for all of these concerns, greater clarity in the face of serious illness is not a bad thing. In our technologically-advanced society, we are often able to keep the bodily shell alive, which merely prolongs the dying process. For people of faith, this is unnecessary, for a better life awaits us.

We should all have advance directives – and doctors should be paid for advising us about them.

Dying in America

Forbes Online Article

Physicians and Lethal Injection

Tuesday, June 24th, 2014 by Dr. Dennis Sullivan

Our justice system is embroiled in controversy in recent years, over a procedure that a majority of Americans support: the death penalty. Older methods, including firing squad, electric chair, or gas chamber, have been supplanted by lethal injection. This is thought to be more humane, and therefore less in conflict with the Eighth Amendment proscription of “cruel and unusual punishment.”

But the use of lethal injection has brought with it a whole new set of issues, as revealed by several “botched executions” in recent months. In Ohio last January, Dennis McGuire’s execution took 25 minutes, called by one defense attorney “a failed, agonizing experiment.” In April, Clayton Lockett’s lethal injection procedure by Oklahoma officials lasted 43 minutes, and only ended when the condemned suffered a massive heart attack.

Most Americans support the death penalty in the United States, though the margin has become much smaller in recent years. In 1996, 78% were pro-death penalty; in 2013, that had dropped to 55% (Washington Post). This is a huge shift in public opinion, and these recent events may have a further impact.

In response, there has been a renewed call for physicians to get involved. After all, properly applied professional medical judgment could ensure that the condemned prisoner is truly unconscious before injecting agents to stop the heart or suppress respirations. This would greatly reduce fears of violating Eight Amendment safeguards. A recent legal committee on death penalty reform has recommended that “Jurisdictions should ensure that qualified medical personnel are present at executions and responsible for all medically-related elements of executions” (source).

But this is a truly dangerous recommendation. For over 2400 years, the Hippocratic tradition in medicine has expressly forbidden participation in killing, and this violates the codes of ethics of both the American Medical Association and the American Nurses Association. Even the practice of assisted suicide is forbidden in both codes, and at least that has the goal of relieving suffering.

No, healthcare professionals should strongly resist this idea, and refuse to have anything to do with state-sanctioned killing. Regardless of concerns about the comfort of the procedure, the death penalty is not intended to be therapeutic. For all of the recent controversy, this is not a problem that doctors or nurses can solve.

Quick Decision to End Life Support: Cause for Concern?

Tuesday, December 10th, 2013 by Dr. Dennis Sullivan

Timothy Bowers was 32 years old, and enjoying life. The Indiana mechanic was recently married, and he and his wife were expecting a baby. All of that changed suddenly, tragically, and permanently on November 2nd, when Tim fell from a tree stand while hunting. The 16-foot drop left him with a crush injury to the 3rd, 4th, and 5th cervical vertebrae of his neck. He was suddenly and severely paralyzed, unable to move his arms or legs, and unable to breathe without a ventilator.

As is common after a severe injury, Tim was surrounded by family in the hospital, where he was heavily sedated. When the family learned of his prognosis, that made the unusual request to immediately discontinue the sedation, so they could apprise him of his injuries, and so Timothy could make his wishes known. When he awoke and learned his diagnosis, according to his sister:

“We just asked him, ‘Do you want this?’ And he shook his head emphatically no.”

And so the medical team agreed to discontinue Timothy’s ventilator. Surrounded by family and friends, he died later that afternoon, one day after his accident.

Even Arthur Caplan, the celebrated director of medical ethics at New York University, seemed a bit conflicted about these events. On the one hand, he said:

Patients often change their minds after they have had time to meet with spiritual advisers and family.

On the other hand, Timothy had previously made his wishes clear to his sister about not wanting to be machine-dependent if ever he was in such a debilitated state.  So this decision appears to be in line with his values.

Nonetheless, I am worried about the rapidity here. What’s the rush? In Ohio, there is a law dictating a 48-hour waiting period before removing life support in hopeless cases. Are we so utilitarian in our thinking that we must urgently forgo a few days of further counsel, therapy, and prayer?

I am all in favor of patient autonomy, but I wonder if Timothy Bowers was pushed to make such a monumental decision on short notice.

CNN News Report
Fox News Report

Euthanasia: Is the Reality Worse than Fiction?

Wednesday, September 25th, 2013 by Dr. Dennis Sullivan

By guest commentator Michelle Frazer:

In his recent commentary, writer John Stonestreet has described a new development in Europe as “worse than fiction.” Some patients suffering from certain unbearable disorders have asked for euthanasia, coupled with organ donation to save the lives of others.

Now don’t be carried away with the redemptive value of euthanasia until considering the following facts. At last May’s 21st European Conference on Thoracic Surgery, a paper by a group of Belgian doctors described “Lung Transplantation with Grafts Recovered from Euthanasia Donors.” The abstract describes something unheard-of here in the United States: six patients who received new lungs from euthanized donors between January of 2007 and December of 2012.

According to the European Institute of Bioethics, euthanasia is a common practice in Belgium, with over 5000 cases since 2002, and a steadily increasing number each year. What could be the implications of promoting organ donation in such a context? Peter Saunders, writing for LifeSite News, sees an ugly future:

I wonder how long it will be before elderly people who have ‘already had a good life’ start being eyed up by those with organ failure who are not yet ready to die and being accused covertly, or overtly, of selfishness for being unwilling to hand their fresh healthy organs over.

Given that one third of euthanasia cases in Belgium are already involuntary, I wonder if any patients have yet had their organs harvested without their consent because someone had ‘greater need’ of them?

Organ donation could add even more complexity to the already-difficult subject of terminal illness and ethical decision-making. The debate certainly highlights a marked contrast between Christian and humanist worldviews. Christians believe that every life has dignity and equal worth, while humanists place relative value on life due to its perceived quality or potential for longevity.

Furthermore, giving one’s life for another is a very Christian thing to do, modeling Christ’s sacrificial love. On this basis, organ donation after euthanasia might seem justified in this self-sacrificial way, but only if one freely decides to give up his life for another. But currently, organ donation is seemingly just an added benefit of euthanasia, not its goal. If organ donation becomes a standard purpose of euthanasia, then will it be a free act of self-sacrifice or a result of utilitarian pressure?

Christians believe that God is ultimately sovereign over life, not doctors or even patients. And the Christian and humanist worldviews differ in how one finds worth and happiness. The desire for euthanasia suggests that maximizing pleasure and minimizing pain are the supreme considerations. From a Christian perspective, worth comes from being a child of God and finding joy in Him, sacrificially loving others as we wait for eternal life in a better world.

(Michelle is a senior physics major at Cedarville University)

European Institute of Bioethics report

BreakPoint Commentary

LifeSite News Report

Assisted Suicide – Legal in Hawaii?

Monday, June 18th, 2012 by Dr. Dennis Sullivan

In Hawaii, a group of five doctors is pushing the envelope on medically-assisted death. Led by retired general practitioner Dr. Robert “Nate” Nathanson, the physicians plan to prescribe lethal drugs to help terminally ill patients end their lives. This is despite the opinion issued by the state’s attorney general, who said he would bring manslaughter charges against any doctor assisting with suicide.

Dr. Nathanson is defiant:

That’s the thing – I’m retired. I think the worst that would happen is that they’d take my license away. I don’t think I’m going to put in any jail time … My livelihood doesn’t depend on it, so I can be very brave.

Physician-assisted suicide is legal in two states, Washington and Oregon. In Montana, the state supreme court ruled in 2009 that physicians who engage in the practice are exempt from  homicide charges, though the lack of further legislation has left the issue in legal limbo.

The American Medical Association opposes assisted suicide, claiming it is “fundamentally inconsistent with the physician’s role as healer.” The Hawaii Medical Association has a similar view, and has fought attempts to legalize the practice in the state. At least 39 states have laws that implicitly or explicitly criminalize physician-assisted death.

It appears that all that is needed in Hawaii to push this agenda forward is a test case.

(contributed by Dr. Charles Dolph)

AMA News Article

A New Kind of House Call

Tuesday, June 5th, 2012 by Dr. Dennis Sullivan

When I was a kid growing up, we had a practice that is almost nonexistent today – doctors making house calls. One time when I was about ten years old, I had a sore throat and a high fever, too sick to get out of bed. Dr. Huston came to our house one afternoon, examined me, and gave me an injection of penicillin. I may not have liked getting a “shot,” but I never doubted that Dr. Huston came to make me well.

Fast forward to modern-day Netherlands. In March, a new service began, featuring mobile euthanasia units, with their own trained doctors and nurses. The teams will go “to the homes of people whose own doctors have refused to carry out patients’ requests to end their lives.” The new entities are called  Levenseinde (“Life End”) house-call units, and their services are free of charge to Dutch citizens.

Euthanasia has been officially legal in the Netherlands since 2001, though it was practiced unofficially for many years before then. The argument of a “slippery slope” dominated the debate at the time. Right-to-die proponents argued that there would be many safeguards, and that only those truly desiring the service would be offered it.

Yet the slippery slope predictions may have been warranted. By some estimates,2,300 to 3,100 acts of euthanasia take place in Holland each year. In fact, this is surely an underestimate, because many cases are simply not reported. Now add “Life End” units, which seem to be promoting an agenda. No wonder even the Royal Dutch Medical Association has distanced itself from the practice. Could it be that someday soon, there will be an “expectation to die” for the elderly and infirm, so that social pressure will make “euthanasia house calls” an everyday occurrence ?

Whether at life’s beginning or life’s end, when you devalue the sanctity of human life, you only reap what you sow.

News article