Bioethics in Faith and Practice, Volume 1, Number 1

Bioethics in Faith and Practice ⦁ 2015 ⦁ Volume 1 ⦁ Number 1 17 Finally, many healthcare givers recognized a need for better pain relief. Most care givers agreed, in principle, that “providing large quantities of narcotic analgesics does not constitute wrongful killing when the purpose is not to shorten patients’ lives but to alleviate pain and suffering”. However, most caregivers in a study conducted by Solomon, reported that “the most common form of narcotic abuse in the care of the dying is under treatment of pain”. viii Many physicians and nurses believed that “clinicians give inadequate pain medications most often out of fear of hastening a patient’s death. ix If care-givers have concerns about the appropriateness of care provided at the end of life, this creates an environment where it is difficult to have effective discussions concerning end-of-life decisions. Solomon recommends that attention must be given to the psychology as well as the ethics of moral decision making at the end-of-life. x Nurses are often the implementers of decisions in which they have not participated and with which they may not agree. Yet these nurses could probably play a greater role in helping patients and families understand the choices they face. Ethical Concerns to Consider when Discussing End-of-Life Decisions: Personhood Having discussed the many obstacles which impede meaningful participation for end-of-life decision making, the focus of this article turns to the ethical concerns which should undergird end-of-life decisions. Perhaps the most significant ethical consideration is not patient autonomy but the valuing the personhood of the patient. In this postmodern world where moral confusion has impacted every aspect of culture, clarity regarding the meaning of a person is crucial. The Christian perspective defines human beings as having inherent value. All human beings are a distinct substance that exists ontologically prior to any of its parts. A human being is intrinsically valuable because he is a particular type of substance: a person who is a rational moral agent. The substance view states a person remains identical to himself as long as he exists, even if that person is not presently exhibiting the functions or actions that we typically attribute to active and mature rational moral agents. In a 2005 national study almost all the respondents valued attributes associated with “being treated as a whole person” xi . In end-of-life discussions, the family needs the opportunity to express to the healthcare team the value of their loved one. They want their family member to be seen as a whole person: who he was; his strengths, his role in the family and what gave his life meaning and purpose. Thus it is essential to have a broad, holistic view of the patient’s entire life. To be treated as a whole person means that end-of-life discussions should center on high quality interpersonal care that affirms the patient’s personhood, resulting in the preservation of self. These decisions are founded in four principles: 1. Value people as persons 2. Treat people as individuals 3. Look at the world from their perspective 4. Provide a positive social environment