Withdrawing medical treatment from a terminally ill person who is about to die (Full Version)

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cih92 -> Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 12:59:13 AM)

I was listening to a lecture by Scott Rae about biomedical issues. Scott Rae is a Biblical Studies and Christian Ethics professor at Talbot School of Theology. He said that there are three conditions where would it be okay to withdraw medical treatment from a terminally ill person who is about to die and those conditions are 1) If the terminally ill person desires to not have the treatment any more and is competent to decide, 2) If the proposed treatment carries a net burden than a net benefit, and 3) If the treatment is futile (i.e. will not reverse an irreversibly downward spiral to death.

Do you have any thoughts about this?



solo_soprano22 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 1:12:47 AM)

Well...since I love bioethics and dedicated a small portioni of undergrad to it, I seem to be drawn to stuff like this. I pretty much agree, but that seems to be the way that most bioethicists think about it. If a person is competent and can decide, then that is what should be done. If the treatment is medically futile, it should be ended (I lump that in with burden/benefit). Problems arise more (that I see) when people don't agree on what should be done, and when people don't want to get go.



rcjames -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 8:31:57 AM)

quote:

ORIGINAL: cih92
2) If the proposed treatment carries a net burden than a net benefit,


I do not understand this one, could someone help me out a bit?

Thanks
RC



drmark -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 9:17:25 AM)

quote:

quote:

2) If the proposed treatment carries a net burden than a net benefit,

I do not understand this one, could someone help me out a bit?
Sure, Brother James. This is another way to disguise moral relativism. Just make up your own value system and apply it to "burdens and benefits". The extreme example is that you and I are too old to be of much future economic benefit to society, so if we become comatose from a head injury, the burden in health care costs to society far outweighs the meager benefit we would provide if we are maintained on medical treatment and make an eventual recovery. On the other hand, solo_soprano has her whole life ahead as a promising young physician, so the net benefit to maintaining her treatment is far greater than the probable burden. I think we all can figure out who gets the plug pulled!

Here is an insightful article on A GOOD DEATH from a very helpful website for understanding Christian perspectives in medical and scientific issues. I trust this will assist your search for wisdom, cih92.



stellaluna -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 9:43:08 AM)

You are assuming that the burden is on the family and not on the patient. Sometimes the treatment is more painful than the disease itself.

Many people have DNRs; my great-grandmother was one of them. She actually did not die of a disease, but from an injury. We did not want her to die, but we honored her wishes and let her die without intervening medical care.



car2ner -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 1:23:29 PM)

Having watched my share of family pass, I saw that they were "blessed" with deciding that it was time to go. They refused to eat, asked to have no more than pain killers for meds, etc. They were all mentally healthy, though. It would have been a much more difficult decision if the family had to make that choice. With this inmind I have let my family know my wishes.

If strangers had to make those decisions for me, it would fall on the legal system to draw the line. IMHO that is asking too much of the state, but I have no better ideas on how it should be dealt with.

quote:

so the net benefit to maintaining her treatment is far greater than the probable burden. I think we all can figure out who gets the plug pulled!

This is another sticky issue. I wouldn't want to see an elderly person, lonely and not wanting to be a burden refuse care or be refused care because they were emotionally down and feeling like they had nothing left to contribute to those around them.



Covaan_Meshuga -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 3:45:34 PM)

When my time comes, it will do no good to attempt to prolong my life through the use of drugs. At the time of the end of my life, my problem will be this: will they recognize that I am making an informed decision, or will they consider that one of the symptoms of the end of life is confusion and ignore my wishes?

I absolutely Do Not want any heroic enacted in order to prolong my life. I have had a really decent life, I will be with the L-rd I love when I die, and my family knows that I have no desire to prolong my suffering, which will be occurring. Worse yet, I Do Not Want to add to my family's financial burden by such heroics.

Send me home, give me enough pain killers so that I am not hurting rteal bad, and let me die in my own environment -- [:D] with my Bible, study materials, and Crosswalk at hand! Hey -- we'll party as I go!

Oh. I guess that may not read well to some.

And I guess I need to actually look into making a "living will."

By the way, if I am dying, I sure feel good! I have a real tough time really believing the stuff they say about the disease.



drmark -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 3:59:45 PM)

quote:

Sometimes the treatment is more painful than the disease itself.
Is experiencing pain and suffering always a "burden"?



Kat_D -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 4:59:48 PM)

quote:

Withdrawing medical treatment from a terminally ill person who is about to die


Please define "medical treatment."



drmark -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 5:14:08 PM)

"Life-sustaining medical treatment" means treatment that sustains or prolongs the operation of vital bodily functions that are incapable of independent operation, such as assisted ventilation, cardiopulmonary resuscitation, and artificial hydration and nutrition. FROM THIS LINK

Personally, I see a significant distinction between withholding heroic means such as assisted ventilation and dehydrating someone to death, but others do not. What definition would you like to use for discussion, cih92?



rcjames -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 5:19:19 PM)

quote:

ORIGINAL: drmark

quote:

quote:

2) If the proposed treatment carries a net burden than a net benefit,

I do not understand this one, could someone help me out a bit?
Sure, Brother James. This is another way to disguise moral relativism. Just make up your own value system and apply it to "burdens and benefits". The extreme example is that you and I are too old to be of much future economic benefit to society, so if we become comatose from a head injury, the burden in health care costs to society far outweighs the meager benefit we would provide if we are maintained on medical treatment and make an eventual recovery. On the other hand, solo_soprano has her whole life ahead as a promising young physician, so the net benefit to maintaining her treatment is far greater than the probable burden. I think we all can figure out who gets the plug pulled!

Here is an insightful article on A GOOD DEATH from a very helpful website for understanding Christian perspectives in medical and scientific issues. I trust this will assist your search for wisdom, cih92.


Sure 'nuff.

Thanks
RC



3cappuccinosmom -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 5:35:04 PM)

quote:


Please define "medical treatment."


I'm wondering too. Thinking back to Terri Schaivo and nutrition and hydration being considered "heroic measures". [:'(] I believe that no matter how terminal and ugly the disease, basic comfort measures ought to be taken. If someone is *truly* terminal, giving them food and water isn't going to keep them alive, nor is pain relief.



TrustingGod -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 5:44:39 PM)

drmark, I don't think the net burden/net benefit comment is related to financial issues. My dear sister died earlier this year. The doctors could have started another round of chemo - but that would have killed her for sure and maybe just prolong the pain/suffering she was in. Therefore, the burden of continued treatment would not have given her a net benefit of prolonged good health. It would have simply made her days more miserable and painful.

As a side note: Please think your end time over carefully. Get the DNR on file with your doctor (if that is your wish), make the living wills, make a will, make sure your family knows what you want (burial/cremation). Having dealt with the death of my sister - her adult children didn't know what to do and her husband was even more useless. She had no wishes written down (not even a will). Makes it harder on the family. Four months later we went through this with my mom. Fortunately, her husband knew what to do - however, still no will. Thankfully she passed quickly and he made the right decision NOT to put her on a ventilator - keeping her body alive.



cih92 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 5:55:00 PM)

quote:

ORIGINAL: drmark

"Life-sustaining medical treatment" means treatment that sustains or prolongs the operation of vital bodily functions that are incapable of independent operation, such as assisted ventilation, cardiopulmonary resuscitation, and artificial hydration and nutrition. FROM THIS LINK

Personally, I see a significant distinction between withholding heroic means such as assisted ventilation and dehydrating someone to death, but others do not. What definition would you like to use for discussion, cih92?


I would like to use the following definition:
A treatment that sustains or prolongs the operation of vital bodily functions that are incapable of independent operation or any kind of medicine that is used to save a person's life.



solo_soprano22 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 5:57:17 PM)

quote:

ORIGINAL: TrustingGod

drmark, I don't think the net burden/net benefit comment is related to financial issues. My dear sister died earlier this year. The doctors could have started another round of chemo - but that would have killed her for sure and maybe just prolong the pain/suffering she was in. Therefore, the burden of continued treatment would not have given her a net benefit of prolonged good health. It would have simply made her days more miserable and painful.

As a side note: Please think your end time over carefully. Get the DNR on file with your doctor (if that is your wish), make the living wills, make a will, make sure your family knows what you want (burial/cremation). Having dealt with the death of my sister - her adult children didn't know what to do and her husband was even more useless. She had no wishes written down (not even a will). Makes it harder on the family. Four months later we went through this with my mom. Fortunately, her husband knew what to do - however, still no will. Thankfully she passed quickly and he made the right decision NOT to put her on a ventilator - keeping her body alive.


I think you made some good points. I wouldn't want anyone to end up in a case like Karen Quinlan if they did know they had wishes like that, but if I were braindead I wouldn't want to be fed artificially indefinitely just to keep my body going. Disagreements and not knowing the persons true wishes make it hard I'm sure.



Covaan_Meshuga -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 6:10:30 PM)

quote:

ORIGINAL: drmark
quote:

Sometimes the treatment is more painful than the disease itself.
Is experiencing pain and suffering always a "burden"?

I don't understand. At all. I don't want my loved ones to be in pain, and I don't want extreme pain.



solo_soprano22 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 6:18:55 PM)

quote:

ORIGINAL: Covaan_Meshuga

quote:

ORIGINAL: drmark
quote:

Sometimes the treatment is more painful than the disease itself.
Is experiencing pain and suffering always a "burden"?

I don't understand. At all. I don't want my loved ones to be in pain, and I don't want extreme pain.


I think too, we can't gauge what someone else is going through. There are people that have been in such extreme pain for so long that they kill themelves. I don't think I have a right to say for someone else what kind of pain they should and should not be able to tolerate-- especially since I'm not them and have no clue what they're feeling. We could even have the same problems but different levels of pain.



KuKu -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 6:21:25 PM)

quote:

ORIGINAL: 3cappuccinosmom

quote:


Please define "medical treatment."


I'm wondering too. Thinking back to Terri Schaivo and nutrition and hydration being considered "heroic measures". [:'(] I believe that no matter how terminal and ugly the disease, basic comfort measures ought to be taken. If someone is *truly* terminal, giving them food and water isn't going to keep them alive, nor is pain relief.


In medical occupations, this is commonly known as 'comfort measures only'. It is described as basic needs met, changes of condition noted, but no further/new 'prolonging' measures will be taken. He will be fed, given water, his existing meds (probably on to painkillers soon), etc, but DNR/no heroics is in effect...

This is often where hospice begins care, though that is often considered a doctor's choice... (as well as a financial one, if insurance covers it).

Having had a family member die after an extended illness, I am DNR, as well as comfort measures as soon as the 'heroics' no longer show true progress- that is my personal stance, based on personal experience, take it as you will.



cih92 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 6:28:23 PM)

quote:

ORIGINAL: solo_soprano22

quote:

ORIGINAL: TrustingGod

drmark, I don't think the net burden/net benefit comment is related to financial issues. My dear sister died earlier this year. The doctors could have started another round of chemo - but that would have killed her for sure and maybe just prolong the pain/suffering she was in. Therefore, the burden of continued treatment would not have given her a net benefit of prolonged good health. It would have simply made her days more miserable and painful.

As a side note: Please think your end time over carefully. Get the DNR on file with your doctor (if that is your wish), make the living wills, make a will, make sure your family knows what you want (burial/cremation). Having dealt with the death of my sister - her adult children didn't know what to do and her husband was even more useless. She had no wishes written down (not even a will). Makes it harder on the family. Four months later we went through this with my mom. Fortunately, her husband knew what to do - however, still no will. Thankfully she passed quickly and he made the right decision NOT to put her on a ventilator - keeping her body alive.


I think you made some good points. I wouldn't want anyone to end up in a case like Karen Quinlan if they did know they had wishes like that, but if I were braindead I wouldn't want to be fed artificially indefinitely just to keep my body going. Disagreements and not knowing the persons true wishes make it hard I'm sure.


If a person is brain dead, is he considered to be dead?



Liveloved -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 6:29:35 PM)

I think in regard to suffering we need to determine 'whose suffering'.

I have watched as my family members have made decisions for my elderly aunt who still (at 93) has more brain power than many of us. Their concern re: suffering has been their own suffering. In other words, they placed her in an assisted living facility after she had TIA's and fell several times. She was totally opposed, wore a lifeline, and wanted to remain in her own apartment. She knew she could fall again. She knew that she might die on the floor of her apartment. That was OK with her. But NOT with them. Their concern was about them. I voiced my opinion to let my aunt choose how she wanted to live (or die). They could not abide her choice.

Due to the pressure they put on her, she moved and gave them POA. She has been miserable in her living environment ever since.

It is the same with medical treatment such as chemo. There can be real confusion between whose suffering we are dealing with---the living or the dying. I think the dying, if able, should make the choice as we should support them.



solo_soprano22 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 6:47:45 PM)

quote:

ORIGINAL: cih92

quote:

ORIGINAL: solo_soprano22

quote:

ORIGINAL: TrustingGod

drmark, I don't think the net burden/net benefit comment is related to financial issues. My dear sister died earlier this year. The doctors could have started another round of chemo - but that would have killed her for sure and maybe just prolong the pain/suffering she was in. Therefore, the burden of continued treatment would not have given her a net benefit of prolonged good health. It would have simply made her days more miserable and painful.

As a side note: Please think your end time over carefully. Get the DNR on file with your doctor (if that is your wish), make the living wills, make a will, make sure your family knows what you want (burial/cremation). Having dealt with the death of my sister - her adult children didn't know what to do and her husband was even more useless. She had no wishes written down (not even a will). Makes it harder on the family. Four months later we went through this with my mom. Fortunately, her husband knew what to do - however, still no will. Thankfully she passed quickly and he made the right decision NOT to put her on a ventilator - keeping her body alive.


I think you made some good points. I wouldn't want anyone to end up in a case like Karen Quinlan if they did know they had wishes like that, but if I were braindead I wouldn't want to be fed artificially indefinitely just to keep my body going. Disagreements and not knowing the persons true wishes make it hard I'm sure.


If a person is brain dead, is he considered to be dead?


To me, that person is gone on to the other side (body is here; soul is not). At that point, if we take more action (ventilator because they can't breath, artificial feeding/hydration, etc) we're keeping a biological body alive, but the person has gone on already. I'm sure some people think being braindead still means one is "here," but for me (and many others), that's it.

If someone is truly alive as long as something is breathing and feeding their bodies, we could probably live on indefinitely. But are we really alive as people... or are we living bodies if we do that?

(Well, not indefinitely live on, but "live" long after we're not there.)



cih92 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 7:48:57 PM)

Once the soul leaves the body, I don't think that the person's body should be artificially feed and hydrated.



solo_soprano22 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 7:54:12 PM)

Yes, but the problem is that.... at some point you run into "when is the soul gone."



Covaan_Meshuga -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 8:07:44 PM)

Well, I am a master of the half-thought.
quote:

ORIGINAL by Abiyah:
I have an illness which has a life-expectancy of . . . 10 years from the onset of symptoms. My illness was discovered in about 1994-1995, so I have lived past the life expectancy for me. . . . I am likely still alive because I have refused to take the prescribed medicines.

So if I die from this illness, the first of the final symptoms are fatigue, nausea, loss of appetite and some others. As it progresses, the symptoms become more serious, requiring urgent care. They include a swollen abdomen, bleeding easily, confusion, sleepiness, and eventually coma.

The reason I wrote that, which I removed from my post above, is because I don't want any heroic measures taken to prolong that kind of junk. That is the process of my death, my own, and it is personal. I will neither take my own life nor prolong it to make some doctor feel like a hero. I don't want any doctor making any decision for me where s/he has no business in my life.



cih92 -> RE: Withdrawing medical treatment from a terminally ill person who is about to die (8/24/2008 11:49:22 PM)

quote:

ORIGINAL: solo_soprano22

Yes, but the problem is that.... at some point you run into "when is the soul gone."


Is the soul gone, when there is brain death?

If the soul is gone and the biological body is "alive", does the person really have life?



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