Advancements in the modern medicine have seen a tremendous increase in the number of the elderly people in the society. Equally, with life support technologies, separating between a living person and a dead one is increasingly becoming tough as organs like the lungs and the heart are being supported. Today, treatments like cardiopulmonary resuscitation enable doctors to have a way of re-starting and maintaining the functioning of both the heart and lungs. Today, patients’ lungs and heart may function even after the total brain failure. This has generated much debate and concern over the ethical issues relating to end-of-life care.
Ethical Issues Relating to Death and Dying
With the advancement in technology, there has been tremendous increase in medical knowledge, thus, in the number of options for healthcare providers in relation to death and dying. Whenever a decision is to be made with regards to a dying patients’ treatment, there have always been real ethical dilemmas. Doctors have to make tough decisions regarding the kind of treatment that can best ease the final suffering of a dying patient. Such decisions are critical because it depends on them whether a patient’s life should be allowed to end. A situation reaches the peak when doctors are torn between terminating treatment and continuing “in futility”. Patients and relatives are not left behind because they also have to make decisions regarding healthcare of their affected relatives. The big questions are, therefore, whether physicians should be allowed to help their patients to end their lives; how to handle the case of terminally ill but suffering children, and in general, the extent to which individual patients should have their autonomy respected.
First, it is rather hard to even define death. Doctors are faced with an ethical dilemma concerning when an individual can be declared to have died legally and physically. Scholars have tried to come up with a policy that gives a uniform definition of death to assist in cases of confusing scenarios. The agreement would be vital in cases of donation of organs as well as the removal of life supporting machines. Though most practitioners have come to an agreement that death should be referred to as a state when an individual’s brain stops working without the possibility to resume working again in the future, it has attracted criticisms. The brain is dead if it is no longer active electrically, when the blood flow test in the brain is negative, and when clinical functioning of the brain is no longer possible. This is a definition by the Uniform Determination of Death Act (UDDA) that has widely been adopted in the United States (Center for Bioethics, University of Minnesota, 2005).
The definition of death has raised serious dilemma issues splitting stakeholders into two camps. Those for the definition argue that it gives stakeholders a uniform way of determining who is dead and who is alive across various states. This way, doctors are able to act with speed to retrieve the organs that had been donated to the patient. The common definition of death also allows for accuracy in as far as declaring death is concerned. Finally, the definition allows doctors to have their focus on the whole human organism, and the brain as a part of the complete organism.
On the other hand, those who oppose the common UDDA’s definition have raised a number of issues that have resulted in an ethical dilemma. The first criticism is that the definition causes the increase in the number of organs that can be transplanted. It is also argued that it can lead to brain death’s misdiagnosis. Another concern raised by this group is whether brain death should be given priority to lung and heart functioning cessation. Finally, the other issue that has raised a big dilemma is the determination of irreversibility of the death of brain or heart and lungs. Those against the common definition argue that it is dependent on the possibility of an individual being revived. The whole thing is thus determined by the kind of technologies as well as CPR treatments available in the stated location and the decisions reached regarding their usage. The dilemma has been on whether brain stem’s loss should also be considered among the test for brain loss since it is the cerebellum and the cerebrum whose stoppage in functioning leads to an individual’s death (Center for Bioethics, University of Minnesota, 2005).
Another source of dilemma relating to death and dying is organ donation. The dilemma is triggered by the fact that the patients who look forward to receiving these organs always outnumber the donated organs. This has led to cases where some hospitals allow donation from those whose hearts do not beat, since the procedure to be followed also has its own controversies. A good example is an individual from whom the organ is being removed for transplantation having unrecoverable damage in the brain though the brain is not necessarily dead. This raises the question regarding the number of minutes that hospital staffs need to wait after the heart stops beating before trying to retrieve any organ from him/her. The exact duration of time has been debatable, with some case studies showing the possibility of cardiac arrest patients to be resuscitated with success past five minutes. The question is whether to move with speed to retrieve organs before they become useless when there is no good flow or blood or let the patient end his/her life with dignity. It means the sacredness of the donor can usually be compromised in a hurry to ensure that the organ is not wasted and that another patient is saved.
Another source of ethical dilemma emanates from the concept of a good death, which is determined by the kind of support and compassion, as well as other people’s presence while one is dying. Without these, deaths are characterized by isolation, fear, anxiety as well as loneliness. Those advocating for good death have raised the need for stakeholders to know the kind of elements that their patients believe are necessary if they were to die a honorary death. Some of the issues that have been raised are; the need for adequately managing symptoms and pain, avoidance of a long process of dying and good communication of any decision made between the patient, physician and the patient’s family. There is also the need to prepare the patient for death as well assupport their families. Equally, the dying patient needs not to be condemned but given affirmation of his/her uniqueness and worth. A person should not feel lonely at the moment of death. Instead, people should show a dying individual much love (Center for Bioethics, University of Minnesota, 2005).
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Another ethical issue surrounding death is the availability of hospice care and life-supporting machines. The access to and equality of these services have raised real concern in the US. The access to these services is never just in the healthcare sector. There are cases of people dying in rural areas knowing that those who took care of them had no sufficient knowledge to manage their pain and diseases. It is mostly the case with people who believe that their lives are being cut short because their rural environment/hospitals lack these life supporting machines and adequately trained personnel that can use them. It is unethical to have just a few certified nurses for such vital services as palliative care and hospice. In most case, those who take care of patients find it hard to believe that there is no way to save their patient’s life. The dilemma has raised the issue of having a policy to determine the futility of treatment but this has brought up more disagreements (Cable News Network, 2009).
Finally, there has been a dilemma over the point at which one can be allowed to take his/her life. It could be either in the form of a doctor’s assisted suicide or self-infliction. The dilemma is whether people should be allowed to take their own life to relieve themselves of situations they consider intolerable. Those who oppose the idea that maintain that the best the doctors and other stakeholders can do in such situations is to help come up with more effective ways of helping their patients control pain. Equally, the counselors and spiritual leaders can step in to help those who want to take their own lives, see the meaning of life. Doctors have also faced the dilemma of patients refusing to get any kind of treatment, meant to prolong their lives like ventilators, while the relatives think otherwise (Price & Gwin, 2007).
The very initial case relating to an individual’s right to die was that of Karen Quinlan. The case was brought before the Supreme Court in New Jersey in the year 1976. It happened when the patient’s breathing system stopped working after her attending a party. This had lasted for a quarter of an hour leaving her at coma. After being rushed to the hospital, she was sustained by the respirator. Though her physician said that the treatment was futile, he disagreed with her father, who wanted the life supporting machine to be disconnected. The father then proceeded to court. The case raised the issue questioning when one should be considered dead and the respect for sanctity of death (“End of life issues”, n.d.).
Another case was that of Cruzan who had an automobile accident causing severe brain damage. It was clear to the doctors that her chances for recovery were very slim. Like in the first case, her life was ‘prolonged’ with life supporting machines but her parents opposed it. The Court did not consider the prayers of the parents but what the patients would have wanted in that situation (“End of life issues”, n.d.).
Long are the days when patients only knew natural death and could do little to prevent it. Today courts, doctors and ethics guiding various healthcare institutions decide when to let patients end their lives. With the active research in the sphere of brain, it is expected that decisions relating to death and dying will be harder to make. Medicine and life saving technologies will continue to change people’s perception of death and dying. The question of when medical practitioners should be allowed to stop giving care if attempts are futile will continue to provoke controversial debates.