Medical Care at the End of Life: A Catholic Perspective by David F. Kelly (end of life issues)
In the context of this book various ethical principles are analyzed with respect to the medical care at the end life of people and the support that people deserve at their end life. The book is broken into sections which try to expound on the principles guiding the healthcare at the end life of people.
In the context of chapter one, the issue of ordinary and extraordinary means has been reflected with respect to end life medical care ethics. This shows the dilemma facing the medical professionals and the health institutions with regards to end life ethics. This was mainly because of the fact that the policies in hospitals and health institutions varied greatly. It was clearly stated in this book that the physicians have always decided what to do with respect to individual cases in that the there were no actual rules governing the medical care in the end life. This makes it an area of medical profession which requires high attention. The decisions are always based on the fact the medical professionals or physicians concentrates on aggressive treatment even if the human life benefit involved is small (Byock, 2012 pg 24). This requires that both ordinary and extraordinary means are required in order to ensure that the lives of human beings is given priority therefore the end life care is encouraged. The life of human beings should be given much focus and attention even at circumstances that shows that they are about to die.
In 1960s and 1970s an issue arose on the bioethics discussion which revolved around the court cases as well as the medical issues relating to the suicide facilitate by the physician. This physician assisted suicide was facilitated took place in the year 1997 leading to the controversy in the field of medical practice. The decision relating to this controversial issue was facilitated by both the government committees and the commissions. It was found that it was very difficult to come up with a universal way to handle the medical dilemma in relation to the end life medical care since it led to a debate on whether to use some medical substances or note especially those which may even kill the patient in their end life. The issues relating r supporting euthanasia and physician assisted suicide were given much focus due to the fact that they are the main threats to the end life of the patients. This is mainly meant to discourage the decisions relating to the end life medical care.
The decisions regarding physician assisted suicide and euthanasia are under great attack by the claims that the life of the patient still requires much attention and care even at that point at which their life is at very loose end. At the end life it is still morally required that the patients be taken good care of with respect to medical nutrition as well as the hydration means even if the benefit to the patient is seen to be slight or minimum (Byock, 2012 pg 36). This requires that they should be taken good care of through the feeding tubes to ensure that they have access to the nutrition. The life sustaining treatment is also given much focus in order to prolong the lives of the patients at their end life.
In this book, it is considered that among the processes used to prolong the life of an individual some are not beneficial to the patient therefore they may not be worth taking. This concept is highlighted with respect to both the ordinary and extraordinary means of prolonging the lives of the patients. These are all aimed at preserving the life of a person or patient at whatever cost so long as the life can be preserved or prolonged.
The second pillar entails the controversial issue with respect to legal difference between allowing dying and killing someone in form of euthanasia. This dilemma is covered in the US legal system with respect to the right to privacy, autonomy and liberty. These principles give the legality and the morality of foregoing treatments in the end life medical care. These principles are laid under the traditions of the Roman Catholic making them compatible with the religious views regarding the morality of the various end life practices an means of handling the patients at their end life as well as prolonging their lives with the possible costs. The life of an individual is given priority even when the benefit associated to the medical care is considered less valuable against the cost (Caplan, 2006 pg 18).
These principles relating to end life medical care have also been given consideration by the medical ethics such that the medical professionals know ways and means to handle the lives of the people at their end life. The Jewish medical ethics were also taken into consideration in relation to the consensus of formulating the ethical code of conduct of the medical practice. This was mainly aimed at facilitating the preservation and prolonging of lives of the individuals. The concepts in the catholic theology have therefore facilitated many principles in the medical field and profession. It is clearly agreed that not all medical means to prolong life are beneficial since some may not be useful but can even be harmful. It therefore advisable to forgo some of the life sustaining treatments at some circumstances depending on their essence or importance of the process.
The catholic tradition has provided a clear distinction between the optional treatment and the mandatory treatment as provided thereafter in the ordinary and extraordinary means of preserving life. The distinction in the catholic tradition was basically based on the philosophical, theological and human understanding of life rather than the medical aspect of life. This has been regarded as a dilemma of human burden and human benefit (Caplan, 2006 pg 23).
The treatment was regarded as extraordinary if it resulted in a lot pain or hardship as well as heavy expenses in curbing it. In this situation the outcome of the patient after treatment was not given attention. The burden of treatment and the benefits of treatment should be weighed in order to propose a medical practice or consideration to be taken. The treatment is therefore considered beneficial if it involves less discomfort and pain while at the same time leading to more health benefits after treatment on the life of the patient. The catholic tradition dismisses medical procedures which are associated with discomfort and pain as well as more burdens on the patients when compared to benefits associated with such burdensome medical processes.
The concepts of vitalism and subjectivism are clearly brought out by the distinction between the morally extraordinary and morally ordinary ways of preserving life by creating a middle ground. Absolute vitalism does not allow cessation of efforts of prolonging life. Vitalism advocates that life has a greater value therefore must be sustained at all possible costs. In the context of vitalism, many medical professionals have faced situations where the relatives insist on saving the lives of their love ones at whatever costs making it difficult explain in theological terms since they expect a miracle to happen. The ethical foundations of the catholic tradition are against this kind of prolonging life therefore regarding it as not morally required. The biological life need not be prolonged using extraordinary means.
In the context of subjectivism, cessation of treatment is allowed as well as the active killing so long as it is based on the subjective choices of individuals. The idea of human life having intrinsic value is neglected or rejected. It is claimed that life only have value if given by an individual. There is too much of individualism in the US as well insisting on the subjective choice. The legal system of the US recognizes the fact that life has value it must be preserved as well as avoidance of subjectivity.
Roman Catholic has resisted both the principles of subjectivism and vitalism by recognizing the ethical importance of quality life as well the sanctity of life. It claims that life needs not to be prolonged at all circumstances. Lack of the quality aspects of life can give chances of letting the life go. Life loses its intrinsic value thereby terming it not very useful.
The moral distinction between extraordinary means and the ordinary means are very flexible as they applied in the Catholic traditions. The ordinary means gives the patient a greater human benefit without causing much discomfort or burden. Extraordinary means gives little human benefit to the patient while at the same time they are associated with a lot of burden and discomfort to the patient. Patients therefore have a moral obligation to use ordinary means in preserving life while they have no moral obligation to use the extraordinary means.
The other pillar of the American consensus was mainly based on the principles behind killing and allowing dying. This principle has also been given attention by the catholic tradition. The Catholic tradition claims that someone should not be killed innocently, but it is at times morally right to allow someone to die. Some people have argued that the direct killing in form of active euthanasia as well as assisted suicide is recommended for in particular and specific conditions. The legalization of this practice is useful in some circumstances.
Euthanasia refers to a good death or dying well. This is a means of terminating the life of a patient who is suffering hopelessly from a certain illness or other burdens related to the illness. The catholic tradition aggressively goes against the second pillar of the consensus claiming that it is wrong to kill an innocent person though at times it is reasonable to allow the patient to die. It is morally wrong to allow someone to die just because they have no money to access the medical services at the moment.
In a discussion of killing and allowing dying, five kinds of action arises in a mode to try curbing such illness or health challenges. The actions varies in the way in which the reason or mode of killing as well as allowing someone to die. One of the main actions is withholding life-sustaining treatment where medicines may decide not to use the any medical means of prolonging life. This refers to that act of allowing someone to die. This is not always morally right but it is at times considered morally right depending on the circumstances that surrounds the death of the patient. If the decision is morally extraordinary this is therefore accepted s morally right to allow someone to die. One may decide to terminate the means which already begun. This action is considered equal to withholding life-sustaining treatment by the catholic tradition. When the cost outweighs the benefits of outcome to the patient, this action is considered morally permissible in the hospitals of US. This action at times may attract the legal repercussions which may risk the lives of the patients since it is a simple act of either doing it or not doing it. The Supreme Court decisions shown that the withdrawal of treatment was just equivalent to withholding the case (Cohn, 2008 pg 26).This is mainly meant to avoid the unwanted treatment or reduction of waste in the medical field by the use of scarce resources. This will also ensure that the medical practice which turns out ineffective are usually eliminated. Both withholding and withdrawing acts are both acts of killing and may be morally not required or permissible. They may be both ethically and morally not required.
Another action in relation to killing and allowing to die includes pain relief which hastens death. This in the form that the patient’s suffering be reduced while at the same time should not cause death of the patient. The drug which is administered should not hasten or co-cause death. This dosage is basically meant to reduce pain such that the patient can die an easy or smooth death without having to pass through alt of pain thereby it is morally legal and right to a take these drugs as a means of reducing the burden of the disease. The medication is considered rightful as per the wishes of the patient therefore this act is considered ethically right and legal. The catholic also calls this kind of action a form of indirect killing which brings out the principle of double effect. The act must not be morally wrong, the bad effect must not cause a good effect and the agent must also not intent the bad effect (Lynn, 2000 pg 28). The bad effect should not outweigh the good effect.
The use of medicine to relieve pain in the dying patients will also hasten the speed of death while at the same time meeting the requirements of double effect. The act of reducing pain in itself is not killing thereby meeting the conditions above but the administration of medicine that relieves the pain. It is medically possible to reduce the effect of pain. It is also legal to eliminate the pain from the dying patient (Oliver, 2013 pg 14).
In the context of the actions f killing and allowing dying, the physician assisted suicide in case the patient wants to die where they are assisted by the medical doctor to perform an active euthanasia. The necessary means are provided to the patient so as to facilitate his death. The patient therefore consumes the drug or initiating the suicide. It is a direct way to kill oneself. It is usually assisted suicide in a strict sense. This act is judged to be a wrongdoing and it is also illegal to perform suicide according to the legal system of US.
In relation to Euthanasia, the healthcare or medical practitioner may also take action that causes the death of the patient. It is a form of direct killing according to principles of double effect therefore considered a first degree murder in almost all the jurisdictions.
The conclusion by David Kelly in this book showed that Catholic tradition on moral theological studies among the bioethics studies in America relating to the end life healthcare. The Catholic tradition therefore seems to have an overlapping effect with the purported consensus. The basis used by the Catholic traditions to reach its decisions in relation to the end life healthcare was not clearly shown but it was just shown that they age or not agree with the principles (Nolan, 2011pg 18).
The competent legal interpretation of the cases was given in order to elaborate the facts of such cases. This enabled the legal interpretation of the cases with regard to the medical rules and principles. This facilitated the evaluation of both the legal and ethical grounds.
The insight provided by Kelly in his book does not correlate with the Catholic tradition with respect to principles guiding the killing or allowing dying. This gave a contradiction on what basis or standards to follow. The ethical principles relating to autonomy, liberty and privacy were reflected and explained in details. This facilitates the relationship between the morality and legal foundations that surrounds the medical ethics and practice in the health institutions.
Kelly also gave an elaborate explanation regarding the ordinary moral grounds as well as the extraordinary moral grounds giving the best basis or grounds of decision making regarding treatment of the patients. This will also help in deciding the morality of the decisions.
Chapter eight exclusively dealt with medical futility. Kelly termed the treatment to be physiologically useless since it may fail to achieve the physiological goal which was intended. He also referred to the real situation of a dying person. He therefore defined medical futility as physiological uselessness and irrelevance. Kelly also gave more emphasis on the burden-benefit analysis irrespective of the likes or desires of the patients.
In relation to the legality of the medical principles and cases, they are based on whether they are reasonable or unreasonable. This gave them a chance to assess the legal applications and the judgments of the cases relating to the practice of the medical profession with regard to values and principles governing the code of conduct.
The US legal system and the constitution were very useful in solving a variety of problems relating to the medical dilemmas and complications formed laws which are universally accepted. The unwritten law from the case made them accepted by the whole medical fraternity. This made the code of conduct clear and applicable to the day to problems in the medical field and profession as a whole.
In this the ethical conduct and principles have been clearly elaborated such that the lives of people are protected and taken good care of by the regulations set. This enables provision of quality services in hospital and other healthcare institutions in relation to the end life of the patients. The precautions regarding medical healthcare in end life is clearly elaborated to facilitate this process.
Byock, I. (2012). The best care possible: A physician's quest to transform care through the end of life. New York: Avery.
Caplan, A. L., McCartney, J. J., & Sisti, D. A. (2006). The case of Terri Schiavo: Ethics at the end of life. Amherst, N.Y: Prometheus Books.
Cohn, K. H., & Hough, D. E. (2008). The business of healthcare. Westport, Conn: Praeger.
Lynn, J., Schuster, J. L., Kabcenell, A., Center to Improve Care of the Dying, & Institute for Healthcare Improvement (2000). Improving care for the end of life: A sourcebook for health care managers and clinicians. Oxford: Oxford University Press.
Nolan, S. (2011). Spiritual Care at the End of Life: The Chaplain as a 'Hopeful Presence'. London: Jessica Kingsley Publishers.
Oliver, D. (2013). End of life care in neurological disease. London: Springer.