End of Life Decisiions

Many families have, or will soon have to make a decision regarding the treatment of an elderly loved one or another family member riddled with a deadly disease. Or perhaps, they have already had to make a decision involving the care and/or treatment of a family member. Sadly, many people refuse to acknowledge that a parent may be living in the final few years of their physical life or that some close family member is reaching the end of treatment for a terminal illness. Usually, if plans are made in advance, then the choices have already been made for them and all they have to do is carry out the loved ones final requests. In order to make ethical decisions involving our elderly population at the final stage of life and the terminally ill, we must examine the alternatives involved and strategies necessary to make moral end of life decisions so that we have peace of mind while easing their suffering.

As stated in our text there are three traditional theories that have a long history to provide a great deal of guidance in struggling with moral problems. Generally, people will use one of these theories to guide them when they make a decision involving a terminally ill loved one. The three theories, utilitarianism, which evaluates a moral act on the basis of whether it produces the greatest amount of good for the greatest number given the available options, deontology, which employs rules whether a guideline such as the Golden Rule or more complex directives about respecting others and being able to universalize the act in question, whether the act is moral or not and virtue ethics, which focuses on the character of the person in evaluating morality ??“ often it is impossible to prepare to discuss a natter in advance and then a hasty decision must generally be made and the outcome sometimes is not the desired outcome.
Every living soul will face death at one point or another. For those unfortunate to face the end of life in pain and suffering, their family may have to come to terms with how they are willing to watch their loved one suffer and for how long. The individual who is ill may beg and plead to have their pain and suffering ended by assisted suicide or euthanasia. This holds true not only for the elderly but also for those terminally ill people battling a fatal disease, such as cancer or Lou Gehrig??™s disease.
Some people believe it is both ethically and morally proper to end the suffering of someone they love. One such person was Dr. Jack Kevorkian, also known as Dr. Death. Dr. Kevorkian brushed aside criticism by other supporters of medically assisted suicide that his tactics were reckless and harmful to their cause. Dr. Kevorkian came on the scene in 1990. At that time, he “hooked up a fifty four year old Alzheimer patient to his homemade suicide machine and watched as she pushed a button to release lethal drugs. This machine known as the “Thanatron” became the suicide machine Dr. Kevorkian used to assist others wanting to die in order to end their suffering. To many, this made the act of ending ones own life not only clean, but painless as well. To Dr. Kevorkian, his machine made perfect sense because he didnt actually kill the patient (one major hot point in the euthanasia debate): the Dr. simply enabled the patient to do the job. The machine would allow the patient to be hooked up to an IV solution containing a lethal dose of medicine. When the patient was ready, they would simply push a button to release the medication into the IV tubing which would release the medication into their bloodstream, thus causing them a painless, and what they believed to be dignified way to die. Dr. Kevorkian, by his own admission, assisted more than one hundred terminally and/or chronically ill people in terminating their lives using this machine. The problem with Dr. Kevorkian was his inflated ego and his limitless appetite for publicity. Ironically, what he did was not legal and was viewed as unethical and immoral by many of those who supported assisted suicide. He actually sabotaged the cause that he had hoped to promote. His actions did not provide anything valuable to the cause and were harmful to those that believed in the need for sane and humane laws allowing carefully regulated assisted suicides.
For many, the main concern with end of life care is that the patient does not suffer and is comfortable. Whether an elderly person or terminally ill person, they will receive medication and treatments to control pain and other symptoms, as well as ease their suffering. Many terminally ill people choose to die at home, while others choose hospice. Hospice care assists the patient and families in their final days and makes the transition from life to death as painless and easy as possible. Whether a person chooses to die at home or in hospice, there is palliative care available to help patients and their families deal with the issues surrounding that final act we all must face at one time One might ask then, how would society go about providing relief to those elderly people and those terminally ill who are suffering and dying According to Dr. Kenneth Prager, pulmonologist and chairman of the Medical Ethics Committee at Columbia-Presbyterian Medical Center, doctors get a bad rap more often than is appropriate, at least in his experience. He states that part of the problem is that our own societal values and our own education have not kept up with the technology. He believes its true that everybody would like to die peacefully, but the question is, when is it time to die Theres always the hope that something else can be done that may help the patient, so we dont know exactly when weve crossed the line between prolonging dying and prolonging life. He also says he thinks there is still a problem with people elucidating their desires. People still have a lot of hang-ups about thinking about their own death; they have a fuzzy idea they dont want to be a vegetable on a respirator. Its not very helpful, though, to physicians when theyre dealing with complicated issues at the end of life. All of what has been said is true, but Dr. Prager thinks theres got to be more education of the public. He believes there ???has to be greater interaction indeed between patients and their physicians.
According to Dr. Stephen Mayer, neurologist and Director of the Neurological Intensive Care Unit at Columbia-Presbyterian Hospital, sometimes, in spite of treatment, a condition or illness will still cause death. In those cases, patients can decide what they do and do not want done. They can decide whether they want aggressive treatment that might prolong life or whether they prefer to stop treatment, which could mean dying sooner but more comfortably. They may want to plan their own funeral. Advance directives can help make the patients wishes clear to families and health care providers.
For many, the main concern with end of life care is that the patient does not suffer and is comfortable. Whether an elderly person or terminally ill person, they will receive medication and treatments to control pain and other symptoms, as well as ease their suffering. Many terminally ill people choose to die at home, while others choose hospice. Hospice care assists the patient and families in their final days and makes the transition from life to death as painless and easy as possible Whether a person chooses to die at home or in hospice, there is palliative care available to help patients and their families deal with the issues surrounding that final act we all must face at one time.
An example of this would be from my own, personal life experience. My husband received a liver transplant in 2004. He had a very badly diseased liver that was quickly robbing him of life. The success of this transplant was immediate. He not only regained his health, he was now able to enjoy all those things he liked. The anti-rejection medication worked very well and his body accepted this new liver as if it had always been a part of him. Then, an unrelated incident happened that my family was not prepared for. He took a trip to San Francisco to visit family members and was there for a week. Upon his return, he was unable to breathe very well. So he made an appointment with his doctor, who sent him to a Pulmonologist. Unexpectedly and out of the blue, the pulmonologist told us he had Pulmonary Fibrosis, a progressive, deadly lung disease and that he did not have long to live. Needless to say, we were devastated, but began making plans for his final days. As the disease progressed, so did the symptoms associated with it. As a family, we talked about what would be ethical and moral, taking into consideration my dad??™s wishes. At the end of the day and after much discussion, we all agreed, no more suffering and pain. We agreed to ask the doctors for their advice and ask what could be done to make him comfortable yet hasten the dying process. The Pulmonologist in charge gathered us all into a conference room and told us that the outlook was grim. He said my husband was too weak to be moved and his vital signs were deteriorating. His advice at this time was to remove the respirator and see if he could sustain a reasonable amount of oxygen in his lungs to continue living. Based on his words, we made the decision to take him off the respirator to see if he could indeed breathe on his own. If he could, that would be the miracle we all expected. But if not, he would die. Unfortunately, my husband was unable to maintain life without help from the respirator. So with his family standing beside his bed, he took his last breath at 1:00 p.m. on Monday, February 12, 2009. Although difficult, as a family we had decided the only logical solution was to make this end of life decision with a clear conscience. I believe we acted from the motivation that required that we not want any further suffering on my father??™s part. Deontological moral systems are characterized primarily by a focus upon adherence to independent moral rules or duties. Thus, in order to make the correct moral choices, we simply have to understand what our moral duties are and what correct rules exist which regulate those duties. When we follow our duty, we are behaving morally. When we fail to follow our duty, we are behaving immorally. Therefore, I believe my family behaved morally and made a virtuous moral decision involving taking my husband off of the respirator.
Euthanasia is described as the intentional killing by act or omission of a dependent human being for his or her alleged benefit. If death is not intended, then it is not an act of Euthanasia. Many arguments exist regarding the rights and/or wrongs of euthanasia. Some argue euthanasia is a way to provide relief from extreme pain and when the persons quality of life is low; frees up medical funds to help other people and is another use of freedom of choice. Those who argue against the practice of euthanasia say that “it devalues human life, becomes a means of health care cost containment and physicians and other medical care people should be involved in directly causing death. In the beginning, euthanasia was intended for the terminally ill. Now, the laws have been changed to allow it for other people, or to be done involuntarily as was the case of Nancy Cruzan. In 1983 she was involved in an auto accident that left her in a permanent vegetative state for seven years. Although able to breathe on her own, she was kept alive by a feeding tube. The Missouri Supreme Court refused her parents request to withdraw the feeding tube. The case moved on to the United States Supreme Court where the decision of the Missouri court was upheld. Then miraculously, the family lawyer discovered new evidence regarding her personal final wishes and the parents removed the feeding tube. She died twelve days later, seven years after the accident. Many people trick their minds into believing that what they feel is right, is right and what they feel is wrong, is wrong. They believe if it feels right, then it is right. However, when making an ethical decision, one should never base their decision on feelings because feelings are not the same as ethics. Feelings, desires and preferences need to be evaluated and judged. They need to be measured against an impartial standard that will reveal their quality. To make them the basis of our moral decisions is to ignore those needs and to accept them uncritically as the measure of their own worth. I think in order to make ethical decisions involving our loved ones, including the elderly population at the final stage of life and the terminally ill, we must examine the alternatives involved and strategize to make moral end of life choices for those we love to ease their suffering, yet remain within legal and moral boundaries. If we make an honest decision based on what is both moral and ethical, then we will be able to live with our decision.

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