Bioethics in Faith and Practice, Volume 1, Number 1

Bioethics in Faith and Practice ⦁ 2015 ⦁ Volume 1 ⦁ Number 1 19 Closely related to the first distinction, the second distinction is between actions of killing and allowing to die. For example, some believe that withdrawal of mechanical ventilation from a patient is unethical, because it would kill the patient. They would argue that since killing is defined as an act that is the proximate cause of a death, then withdrawal of life support is indeed an act of killing. However, legally, the withdrawal of life-sustaining treatments is not considered a killing, and the actions in this regard are simply “allowing the patient to die” from the underlying illness. xv In these end-of-life discussions, it is important that the family understand the distinction between the withdrawal of life-sustaining interventions and the withdrawal of care. While the withdrawal of interventions is common, the withdrawal of care should never occur. Helpful in making termination-of-life decisions is the distinction between consequences that are intended and those that are merely foreseen (doctrine of double effect). In other words, there is a difference between giving medications with the intention to kill the patient as opposed to giving medications with the intention to make the patient comfortable, but with the foreseen consequence of potentially hastening the patient’s death. The law defines the line between euthanasia and acceptable palliative care. Former U.S. Supreme Court Chief Just Rehnquist writes: “It is widely recognized that the provision of pain medication is ethically and professionally acceptable even when the treatment may hasten the patient’s death if the medication is intended to alleviate pain and severe discomfort, not to cause death”. xvi Conclusion The main objective of end-of-life discussions should be to prepare patients and their families to work with the medical team to make the best possible “in-the-moment” care decisions. These discussions should focus on outcomes, not treatments. These expected outcomes should respect the personhood of the patient, their values and priorities. “ What would you like your physician to know about you as a person to give you the best care possible?” would be good starting point for these discussions. Questions like, “If you were in this situation, what would you hope for? Or “What worries you the most? should be discussed. Other questions may include: “What if your health changes and your doctors recommend against further treatment?” and “What if it would be too difficult for loved ones to provide care for you to die at home?” The transition from “cure to comfort” is one of the most difficult and important medical care decisions the patient and family have to encounter. Our society has struggled for several decades to define appropriate end-of-life medical care which promotes life and does not simply prolong a person’s natural death. All parties should focus on clarifying the goals of care. Patients and their families should determine what they hope to achieve – restoring health, extending life, or relieving pain and suffering. Physician should provide information about the patient’s prognosis and what outcomes can be accomplished by the use of specific interventions. However, physicians should not offer treatments that cannot achieve the goals of care defined by the patient and family. We still have far to go but perhaps this article has offered an ethical foundation to provide a framework for these discussions. i Robert D. Truog, MD, MA, Margaret L Campbell, PhD, RN, FAAN, J Randall Curtis, MD, MPH, Curtis E Haas. PharmD, FCCP, John M. Luce, MD, Gordon D. Rubenfeld, MD, MSc, Cynda Hylton Rushton, PhD, RN, FAAN,