By
Julie Grimstad
Patient
Advocate and President, Healthcare Advocacy and Leadership Organization
1. No matter what
life-sustaining procedure/medical treatment is in question, when in doubt, err on the side of life. A medical
intervention can be tried with the option of stopping it if it proves
ineffective or excessively burdensome for
the patient.
2. It is the physician’s
obligation to truthfully and fully, in layperson’s terms, discuss with the
patient/agent/family/guardian the benefits, risks, cost, etc. of available
medical means that may improve the patient’s condition/prolong life. The focus
should be on what the person making medical decisions needs to know in order to
give truly informed consent.
3. The patient/agent
makes the decision whether or not a treatment is too burdensome. (Note: The
patient’s life must never be ended because it is considered a burden to the
patient or others.) If a patient wishes to fight for every last moment of life,
this is a legitimate interest to be respected.
4. It is impossible to
make morally sound, sensible, informed health care
decisions based on guesswork about some future illness or injury and possible treatment
options. Health care decisions must be based on current information.
5. Two extremes are to
be avoided:
- Insistence on physiologically
useless or excessively burdensome treatment even when a patient may
legitimately wish to forgo it.
- Withdrawal or
withholding of treatment with the intention to hasten/cause death.
6. The object and motive
for administering pain medication
must be to relieve pain. Death must not be sought or intended.
7. Nutrition and
hydration, whether a person is fed with a spoon or through a tube, is basic
care, not medical treatment. Insertion or surgical implantation of a feeding
tube takes medical expertise, but it is an ordinary life-preserving
procedure for a person who has a working digestive system but is unable to
eat by mouth.
·
Acceptable - During the natural dying process, when a person’s organs are
shutting down so that the body is no longer able to assimilate food and water
or when their administration causes serious complications, stopping
tube-feeding or spoon-feeding is both medically and morally appropriate. In
these circumstances, the cause of death is the person’s disease or injury, not
deliberate dehydration and starvation.
- Unacceptable - When a person
is not dying—or not dying quickly enough to suit someone—food and fluids
are often withheld with the intent to cause death because the person is
viewed as having an unacceptably low quality of life and/or as imposing
burdens on others. The direct cause of death is then dehydration and
starvation.
