End of life decisions

My grandfather passed away almost two years ago.  He was 90, had a healthy life, happy family and some fantastic grandchildren :).  He was survived by my grandmother, who is now 94, two sisters and four children.

I was blessed to be with him and my mother when he passed.  What is was fortunate is that none of his next of kin, nor the hospital (one nephrologist aside) argued to keep him alive and on machines.  We all knew he wouldn’t have wanted to live that way…. and, we knew that if haunting actually is possible, we’d all be in for a good stern haunting-to if we kept him hooked up too long.  It’s one thing to say something liberalish and make Grandpa mad in life and it’s quite another to incur his everlasting wrath — none of us wanted any part of that.

I’m thinking about Grandpa and my family because I read this story about a woman who is refusing to let her husband go.

The gist of the story is that three metro area hospitals have told the woman that treating her husband is no going to produce positive results or extend his life.  He has significant dementia, kidney failure and infections.  The medical community calls this futile treatment.  The wife is sure that if they treat him, he’ll recover and be able to return home.  He’s 86 and she’s 57 — they’ve been married for 27 years and she has the legal right to make his medical decisions.  His care is paid for by medicaid and supplemental insurance.

The main philosophical question is who should be allowed to make the decision to withdraw treatment?  With the secondary question of whether extending treatment in cases like this is cruel?

First of all, it seems to me as if the wife isn’t using the best judgment.  Clearly, her husband isn’t doing well and probably doesn’t have a meaningful biographical life.  A “biographical” life is the aspect of life in which we have relationships with others, have memories and experiences that make us happy etc.. it’s essentially a life of the mind.  It also seems to me that caring for her husband is beyond her capabilities.

I’m quite divided over whether it’s permissible for the hospital and doctors to substitute their judgment for hers.  She knows him best,  he trusted her with his medical decisions and it seems to me that the hospital should do what she wants.

On the other hand, the hospitals and doctors have moral duties as well.  They cannot act in ways that are harmful to the patient — it’s a violation of the Hippocratic Oath to do so, the central premise of which is “physician, do no harm”.  The thing is, it seems unclear to me as to whether treating him is actually harming him.  Granted, it’s expensive and resource intensive to treat him, but I don’t think it’s a good idea to use those criteria to make end of life decisions.

I suppose, especially in this case, it’s a good thing we have a legal system that can resolve these issues.

 

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