In medical field, life support connotes a set of therapies for preserving a patient’s life when crucial body systems are not functioning well or sufficiently to sustain life without being supported. Life support therapies employ a combination of numerous methods such as feeding tubes, intravenous drips, total parental nutrition, mechanical respiration, heart/lung bypass, urinary catheterization as well as dialysis. Life support is more often than not, used to stabilize a patient but not projected to allow full recovery from their condition (Smedira N, et al. 1990).
Advances in medical understanding and the new medical expertise have led to many questions concerning the very nature, meaning as well as value of human life far beyond the area of death and dying. Health care professionals more often than not are faced with conflicting ethical impasses in this area, due to lack of public consensus on what is morally suitable. Presently the West is undergoing cultural change whereby conventional feelings and thoughts concerning death and the dying process are being customized or rejected by many and the same development is happening in almost every society (Melltorp, 1996).
For instance in Thai society, which follows the teachings of Theravada Buddhism, a move from traditional medicine to high technological medicine has seen the upshot of new ethical issues that conventional Thai morality and conventional practices is unable to deal with effectively. Life support technologies seem to have distorted the line between prolongation of life as opposed to prolongation of the dying process, leading to questions relating to competence of the traditional description of death as the cessation of all vital signs.
When are we supposed to say death has occurred during the dying course? Should we go by the traditional definition of death or should we be guided by the new measuring devices upon their detection of the cessation of high brain activity (Smedira NG, Evans BH, Grais LS, et al. 1990)? Questions such as whether refusal of life preserving treatment through simulated methods is a morally acceptable option or does it amount to suicide. Is it immoral for doctors, nurses and families to withdraw life-preserving treatments or stop the same once they have begun?
Should such actions be construed the same as ‘killing’ patients or there crucial ethical differences to be made between letting go off life through withholding or stopping treatment as opposed to actual killing or causing death. The unavailability of public and professional compromise on these questions creates moral conflict within the general public, among families and doctors as well as between medical professionals themselves. Based on the above questions; should life support patients be allowed to stay on the medicine indefinitely?
The social obligation of the doctor is to maintain life and mitigate sufferings. Whenever the doing of one task clashes with another, the preferences of the patient independency demands that, physicians respect the decision to give up life continuing treatment of a patient who is capable of making a decision (Melltorp, 1996). As priory indicated life continuing treatment is any treatment that hands out to prolong life exclusive of reversing the fundamental medical situation.
It is imperative to understand that there is no ethical difference between withdrawing and withholding life-sustaining treatment (Smedira NG, Evans BH, Grais LS, et al. 1990). Current Procedure At any stage and before a patient is rendered incompetent to make any decision, he/she can formulate and provide a valid consent to the withholding or withdrawal of life support systems incase he/she is rendered incompetent by the illness. In US, a patient is also allowed to appoint a surrogate decision maker.
In the event that the patient is receipt of life sustaining treatment is inept, it is crucial that a surrogate decision maker be identified. Where there are no prior directives patient’s family acts as surrogate decision maker for the patient (Melltorp, 1996). In which case family comprises persons with whom the patient is closely associated. Situations arise whereby it happens that there is no one associated closely to the patient. This situation demands that people who both are and have sufficient relevant knowledge of the patient should act as his/her surrogate.
Physicians are supposed to avail all relevant medial information in addition to explaining to the surrogates that decision pertaining to withholding or withdrawing life sustaining treatment should be fooled on substituted judgement (meaning what the patient would have decided) when the evidence of the patients preferences and values is available. In making this kind of judgement, decision makers should be guided by the patient’s prior directive (if any) (Grenvik et al, 1978).
Patient’s observation of life, the way it should be lived, and his (patient’s) inclination towards sickness suffering medical procedures as well as death. In the absence of evidence of the patient’s preferences as well as values, the best interest of the patient should be taken into account in reaching any decision (what outcome would most likely advance the patient’s health). Physicians are bound to accept the decisions incompetent patient’s surrogate. However, four circumstances may involve either institutional or judicial review and/or intervention in the decision-making process.
These situations include a position where there is no willing family member to act as the patients surrogate decision maker; where the family is involved in a dispute over the issue as well as in circumstances where the health care provider believes that the family’s decision is clearly not what the patient would have decided if he/she were competent Euthanasia: When is it right? Euthanasia varies from country to country. For instance if one attempts to take away his/her life in US, if he does not succeed, he is faced with options of jail.
Regrettably, there are many instances in which people suffering from terminal and/or going through an unbearable amount of pain that may need to seek euthanasia are not permitted the option (Grenvik et al, 1978). Euthanasia commonly referred to as mercy killing happens when terminally ill patients request their physicians or may be even a friend or family member ot put them to death. Euthanasia can either be active or passive. This distinction between the two types is significant in medical ethics (Grenvik et al, 1978).
The thought is that it is acceptable atleast in some situations to withhold treatment and allow a patient to die, however it is never acceptable to take any direct act calculated to kill the patient. Active euthanasia is prohibited in America, Canada as well as some other parts of the world. it involves lethal injection. It is considered by many religious denominations as immoral since they view it as suicide or murder. Conversely, many supporters argue that it lets a person to die with self-respect as an alternative to being kept barely alive by machines.
Passive euthanasia encompasses the withholding of most types of medical treatment. This method is considered legal as it allows the patient to die naturally. In moral sense, actual killing and allowing the person to die makes the perpetrator guilty. Euthanasia is an issue full of controversy since it has no limitations regarding the people who will embrace it as a form of death. Euthanasia is intended for people who are inflicted with ‘an incurable, painful or distressing disease or handicaps’.
When a person is considered more dead than alive the status of euthanasia becomes more apparent (Grenvik et al, 1978). Where there is no possibility of the person recovering to normal life, the idea of putting him/her under life support indefinitely becomes debatable (Grenvik et al, 1978). A patient with 90% chances of dying has still 10% chance of recovering. The 10% indicates that the person is still alive. Sustaining such a person alive through life support has its costs when it is crucial to make the significant decision whether to pull the plug.
The option would either be to sustain respiratory support indefinitely or to halt the paralyzing drugs first and wait for any effects to show off completely prior to withdrawing exposure to air (Slomka J, 1992). There are occasions when continued treatment is no longer in the best interest of the patient. To hold on, on a dying person indefinitely should not be the best option. Euthanasia should be considered as the right answer for many terminally ill patients.
Despite the fact that there is no sure way of knowing what the right thing is, “offering mere liberty from pain as well as discomfort and allowing nature to take its course to a natural death and infact intervening particularly to end life itself might be the way”. It appears that most people who are ill and near to die only require one thing and that is eternal peace. This is evidenced by the many prior conditions people express incase they become terminally ill not to be placed under life support machines.
At the same time physicians are willing to acknowledge such requests in the event it is shown that the patients were well thought of. It is the same as playing God if one decides to terminate another person’s life. Moreover, it is also playing God when one decides to treat and prolong a life that without intervention would not be maintained. Even though it is in the interest of the doctor to ease suffering as well as sustain human dignity through withholding treatment helps to achieve the above objective.
Why should one strive to prolong life that in the opinion of many has no hope of recovery? We should leave the matter before God and where there is a possibility of recovery, it will be attained. If God has declared that it is the right time for a person to die, why do physicians try to prolong it (Slomka J, 1992)? Considering the costs incurred through sustaining a person in life support indefinitely, one finds that in fact it is a waste of resources as well as energy as the patient has no indication of recovering to normality (Slomka J, 1992).
Conclusion While withdrawing life support the families emotional reactions as well as needs, need to be expected. Family may consider they are causing the patient’s death by approving to withdraw life support. Positions of guilt should be look at directly and discussed openly. It is less burdening to the relatives if physicians strongly propose that life support be withdrawn rather than asking the family to make the choice. Directing the family on what the patient would want as opposed to what the family wants may also reduce the family burden