Ethical issues at the end of life
A very short introduction
Individual care-givers or institutions who care for terminally ill patients are inevitably confronted with serious ethical questions. Important decisions must be taken regarding the respective roles of the patient, the family and the care-givers in the decision-making process. What should the patient know? What should family members or friends of the patient know? To what extent can scientific research on terminal patients be justified? Can a patient be allowed to refuse life-prolonging treatment? How can the limited available resources be fairly distributed? The aim of this chapter on end-of-life ethical questions cannot be but modest. In view of space limitations, rather than merely summing up the wide range of ethical questions that arise at the end of life, I would like to try to delve more deeply into one specific issue – the important matter of life-shortening (or non-life-prolonging) treatment of terminal patients.
Dorothy is 82 and suffering from advanced dementia. She stopped recognizing her husband and children more than three years ago. In the past few months, she has spent a large part of each day in bed and lost virtually all her capacities to interact with the world around her. Three days ago, swallowing became totally impossible for her. The physician who has been treating her during the many years she has already spent in the nursing home decided not to start artificial nutrition. Although she thought artificial nutrition would probably lengthen the patient's life, in this case she considered it to be futile treatment and thus decided not to start it. A nurse who has known the patient for many years felt very uncomfortable with this decision and talked to the local newspaper. In a front-page article, the physician was accused of performing euthanasia.
At first sight, life-shortening medical treatment – whether it is a matter of withholding artificial feeding (as in the above example) or administering medication that could possibly shorten life – seems, to put it more mildly than the nurse in the case example, a bit strange. Of course, we can accept that there exist situations where medical treatment no longer brings about a