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Ethics and the terminationof life support (TLS)
The courts have in the USA ruled such action islegal - this does not mean there are not moral
issues involved - not every decision to turn off
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 helpcancer patients etc. - some of these drugs might
only give a little extra time and are very
expensive
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Withdrawing andwithholding
treatments - if it is ethically acceptable to
withdraw a treatment then it is to
withhold it - there appears no significant
moral difference. 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 doesnot cause death - they simply allow a
disease etc. To take its natural course
(result = death).
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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 forexample removal of a feeding tube is not
starving a person, the disease is
preventing them from feeding.
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Does it violate the idea of the sanctity of
human life-
life is sacred so as long as theperson 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 treatmentskeeping 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?
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In fact this view of the sanctity of life
might suggest earthly life is the highest
good. When we know eternal life withGod 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
ulhealingas we enter into eternity
with the Lord.
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Refusing treatments with time to live
What if someone declines
treatment, such as kidney dialysis,
which would give them longer life?
Some say suffering has redemptive
value-James 1:2
-5
-but this isusually about suffering for your
faith or suffering that is
unavoidable, and it will add to your
character (which will be perfect ineternity)-1 Pet 2:20-25- if all
suffering is redemptive you should
never go to a doctor or dentist!
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But we cannot terminate lifesupport in every case - we
should consider:1. Does an adult suffererrequest it in writing or orally?
2. Is the treatment of no
benefit to the patient?3. Does the burden to thepatient outweigh the benefit?
Usually TLS takes place when
support is futile orburdensome. In the US it islegal and a patient has theright to refuse any treatmentthey do not want.
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Doctors can say no!
The US has seen a legal battle fought overthe right of a doctor to say no to patients,
or more their families, who demandtreatment thought to be of no benefit tothe patient. (Doctors have to try to findanother doctor who will do what the
family ask).Doctors can refuse to give futiletreatment - 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 exceedsbenefit then this is now examined - notjust for the patient, but family(e.g. costs)
and even of societ as a whole.Wednesday 21 September 2011
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Withdrawal of nutrition and hydration
Not giving food and water to a patient ina permanent vegetative state or with low
brain function from Alzheimers - brainfunction is lost apart from the brain stem
which controls lower involuntary actions(breathing, digestion etc.). If food/water
provided the person might live to arelatively advanced age - added to whichthe person might not have a terminalillness.
Medically provided food/water aremedical treatment- as it is medicallyprovided some say it is like a ventilatorperforming a function that the body
cannot do any longer.Wednesday 21 September 2011
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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, saywithdrawal of food/water to people in a
vegetative state is acceptable as it is a
medical treatment
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Physician assisted suicideand euthanasia(PAS/E)
These issues are increasinglybringing life and death choices andsituations into normal peopleslives.
Rae says that the bible teaches thatthe taking of life is a prerogativethat belongs to God alone - henceno suicide or murder. Should this
apply to these issues-
many(in theworld) think no, but religious
believers tend to think this violatesmoral ground protecting the life anddignity of the seriously ill.
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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 different the same
arguments are often applied to
both .
Rae suggests we have an
imaginary conversation with JackKevorkian who tells us why he is so
committed to the leagalisation of
physician assisted suicide.
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Arguing for Mercy- the most
merciful thing to do for aterminally ill person who is
suffering and wants to die is to
offer PAS/E. Medicine aims to
relieve suffering- we readily do
this for animals. The Golden Rule
might be cited - who would want
to suffer needlessly at the end oflife? So we should do to them
what we would have done to us.
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Raes response: the number of people this
would affect (with severe suffering 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 theydie - this is not killing as the disease still
takes its course. It is also possible that the
pain relief might affect the heart rate of the
patient and hasten death - the law of doubleeffect - this is acceptable as the intent is
what is important and if intent was to
relieve pain (not permanently) then it is ok.
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Arguing for utility[useful, profitable,
beneficial]- if PAS/E is done at a patients
request it is win-win - there is no downside- patients suffering is ended
- high costs are removed
- family can grieve and get on with life
- medical staffdo not have to deal with theanguish 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 effects good for peoplein society in general,esp. those thinking of PAS/E - should any
utilitarian approach be countered by sanctity of
life/prohibition of killing?
W d d 21 S t b 2011