Posted on 05/23/2010 10:11:46 AM PDT by wagglebee
Revisionist history has been released to an impressionable public in the HBO Movie “You Don’t Know Jack.” Contrary to Al Pacino’s portrayal of Jack Kevorkian that makes him the compassionate defender of patients’ rights, physician-assisted suicide enters a world of potential mixed motives and moral chaos.
By any standard, assisted suicide (or active euthanasia) is quite different from simply allowing nature to take its unimpeded course. It is popularly called “mercy killing.” Both morally and practically, this is easily distinguishable from simply permitting the death of a hopelessly ill woman or man (i.e., passive euthanasia). It should be opposed by ethically sensitive people.
Physician-assisted suicide is in direct conflict with our tradition of upholding the sanctity of human life. Whether preserved in the Ten Commandments or the Hippocratic Oath, that tradition says we are to affirm, nurture and give aid to people in pain.
For active euthanasia and assisted suicide will communicate the message that persons who are terminally ill have a duty to get out of the way of the living.
For example, suppose a cancer patient for whom treatment has been ineffective tells his or her family, “I know I’m a terrible burden to you, and I wonder if I shouldn’t just end my own life!”
I can imagine two responses.
“What do you mean!” says one family. “You are central to our lives. We love you, and you could never be a burden to us!” That answer communicates a relationship that inspires a will to live for the patient.
“Perhaps we should think about that,” replies another family member. “You might suffer toward the end, and we’re not really rich enough to hire nurses so you can be cared for while we stay at our jobs.” With such openness to the idea of dying, what feelings are likely to go through the mind of that patient?
Studies show that treatment for depression moves the vast majority of sufferers to think of active euthanasia as unacceptable for themselves. The alternative to making suicide easier and more acceptable is effective palliative care — which includes treatment for depression as well as degenerative disease or injury — and loving concern from family and friends.
In the Netherlands, where active euthanasia by medical personnel has been practiced for some time now, the issue quickly ceased to be assistance to persons requesting it and initiated debates over euthanizing some who had not.
“I don’t care about the law,” Kevorkian once said. “I have never cared about anything but the welfare of the patient in front of me.” What a strange claim from a pathologist who has no experience in the clinical treatment of patients! But most of us do care about the law. We care about law grounded in serious ethical reflection that affirms human worth in ways that affirm people rather than eliminate them when they need us most. Our call is not to become gentle executioners. Instead, it is to provide effective and morally responsible care to the suffering.
Rubel Shelly is president of Rochester College and professor of philosophy and religion at the college.
I haven't muddied the waters at all. This was my argument the whole time, that there comes a time when the battle is lost and it's time to die with dignity.
Yet you seem to lump them together, which tells us everything we need to know.
you seem to think that every situation is the same which tells me all I need to know about you. the injection of religion into this debate tells me more than I need to know about all of you.
What would happen if the patient or patient's family would have to end up paying for or providing this care themselves?
gracie1, in post #23, mentioned:
I also have seen cases of severe anoxic brain injury where the patient is extremely unstable, and also depends on a ventilator and dialysis. The family cannot understand why God let this happen and demand maximum treatment. Months pass and we need to address placement. The only facilities that can take her 200 miles away. The families refuse the placement. Should they pay for the extra days of stay? Is the ethics committee a death panel because they try to show the families the futility of the treatment? What if the nephrologist decides on his own to stop dialysis? The patient is on medi-cal and they will not pay for any of the dialysis alternatives that have been brainstormed. Is that a death panel?
What would have happened had this family had to cough up their money to pay for the treatment? Obviously, if they are on medi-cal, they didn't have adequate funds to pay for the treatment. So the treatment would not have happened on a "pay" basis.
What would the ethical decision-making process have been had a life-or-death decision needed to be made by the family, as opposed to the medi-cal bureaucrats?
If the hospital decided to make this a "charity" case, what would the ethics be for deciding which cases were accepted for charity treatment vice which would be turned away? The hospital obviously couldn't accept every case as a charity case...otherwise, they would have any income to pay for those that would be charity cases.
RC One brings up an interesting hypothetical:
You have two patients, one of them is a 39 year old man with severe multiple sclerosis, contractures to all extremities, a stage 4 ulcer to the sacrum, diabetes, chronic renal failure with hemodialysis 3 times/week, and respiratory failure secondary to aspiration pneumonia which is a frequent occurrence for this individual due to his inability to safely swallow anything which has necessitated placing a tube in his stomach to deliver liquid nutrition. He needs a ventilator for his respiratory failure or he will die. This individual is, at most, capable of being dragged out of his bed by healthcare personnel and placed in a chair for a couple of hours at a time. Nature would have taken this poor soul years ago had nature been allowed to do so. his healthcare costs are covered by taxpayers.
in the bed next to him is a 39 year old woman who suffered a case of sepsis which ultimately resulted in acute renal failure such that she requires dialysis 3 times/ week. She has contracted pneumonia while in the hospital and is in acute respiratory failure. She too needs a ventilator machine or she will die. She works at a local drug store and her treatment is paid for by her private health insurance.
RC One brings up another interesting case, because there are two basically hopeless cases, one paid for by the government and one paid for by private insurance.
Again, though, what happens if the family had to pay for it and the family was the ones to make the life-or-death call. Which is extraordinary care vice which is ordinary care?
Dr Kopp brings up a third scenario:
I was shocked that he was receiving no water, no food, no IV, only Morphine. His Parkinson's was advancing and the aspiration pneumonia was a crisis, but neither were imminently terminal. We were permitted to wet a sponge to moisten his lips, and he would try to suck all the moisture from the sponge, but we were forbidden to give him a drink of water, ostensibly because of the risk of further aspiration pneumonia. Fr. Ream had shared with me his opposition to euthanasia in the past, and he was trying to talk to me, but he had become so dehydrated that he could not form any words.
The indication here is that he needed ordinary care but was denied that because somebody's criteria was met for a hopeless case.
But I would bet that Dr. Kopp, other friends, and perhaps fellow priests/parishoners would have been happy to provide that ordinary care...had they only been allowed to do so.
I don't pretend to have all of the answers in any of these scenarios. But it seems that our system has been perverted due to the fact that somebody else is paying for the medical care; therefore, somebody else has the decision-making authority.
While I am no fan of death panels, it is a fact of life that either families, governments, or mutual support societies (a/k/a insurers) will have to deal with is that there are limited resources. By that, I mean limited money. And all the choices involve money, folks. And somebody has got to have criteria that must be met or not met, else EVERYODY is going to be hurt.
If a hospital decides to do a charity case, are they wrong for saying that their limited funds could be better spent dealing with a savable patient?
If a family is confronted with a family member who is going to die but can be kept alive longer if everything the family has is depleted and given to the hospital/nursing home? If the family has to sell their house in order to make the payments, is that the right thing to do? Especially if the sick family member is going to die anyway?
I don't know what the answer is. I can easily say "choose life." But if it is a matter of the family member surviving six days versus six months...is it that easy?
The one thing I do know is that if the decision is to be made, it needs to be made at the closest level possible. Because, as with Dr. Kopp's example, the criteria may not be 100% valid in all cases. But bureaucrats, whether they work for a government or an insurer, must, in the name of justice, have criteria to work from.
So the question I would ask is this: if the decision was the decision of the family: possibly lose their house (or go hundreds of thousands of dollars in debt) or lose the family member...when the best case is a few more months of life...what is the right decision? And how would we look at medical ethics if the decision making (and responsibility for the consequences of that decision) was pushed to where in really needs to be (in the name of subsidiarity) -- to the patient or his family?
“As far as removing an IV to dehydrate a person to death, you’re right that’s not assisted suicide, it’s MURDER.”
It’s no different than withholding dialysis or a vent, no different at all. You are clueless, absolutely clueless. what if they have come to the point where giving them IV fluids will just overwhelm their kidneys (or their lungs or their heart) and cause them to need dialysis? What do you do then mr. ethics expert? you couldn’t possible be more clueless.
Do you use asprin, Tylenol, Motrin or things of those sorts?
Will you use an antibiotic if you have an infection?
Do you take vitamins?
Do you or would you take medicine for hypertension?
Would you have bypass surgery?
What about an appendectomy?
You will find that nearly everyone eventually uses medical advances that prolong there lives, advances that DID NOT EXIST a couple hundred years ago.
Who are you to determine Gods [sic] will in this matter anyways?
You don't think God wants us to take care of our bodies? How odd.
If God didn't want us to have antibiotics, etc. we wouldn't.
Nonsense! Your premise from your first post on this thread was that there were two patients who needed ventilators and only one ventilator. You wanted us to decide who got it.
the injection of religion into this debate tells me more than I need to know about all of you.
The culture of death has ALWAYS blamed Christians for interfering.
we’re not talking about tylenol, we’re talking about keeping people alive on immensely expensive machines. Big difference.
“Your premise from your first post on this thread was that there were two patients who needed ventilators and only one ventilator. You wanted us to decide who got it.”
My premise is that there are limited resources and, as such, difficult choices have to be made. You are the one muddying these waters. You muddy it even more by injecting religion into it.
Are you saying he’s clueless?
Let's see:
First you claimed that there was a shortage of ventilators, but you were unable to cite a single instance of this being true.
Then you said it was about the terminally ill and letting them die. What does money have to do with that?
Later you opined about debating with Stephen Hawking and he actually does use some very expensive medical equipment.
Then you tried to blame it all on Christians.
The bottom line is you are defending EVERY SINGLE TALKING POINT that Zero and his ilk are using to push death panels on us.
Well said.
Unfortunately, the shortages are real in Canada and the UK. They are intermittently real here in the US. Neither would get the ventilator in the UK, and probably not in Canada. In the US, we still have these decisions made by the attending’s medical judgment to some extent. Here, the decision would be according to triage - who could best survive?
I like to point out to the Public Health people that the courts could be described as limited community resources with and inefficient, jumbled mix of private and public payers, too. But no one considers triage on justice in a court of law or contemplates going to a completely government-paid legal system.
The Public health ethicists and theorists like Ezekial Emanuel (Rahm’s brother and President Obama’s go to guy) should concern the rest of us. Emanuel believes knee replacement is not a medically necessary procedure and points out that all of them, along with most hip replacements, are elective. Never mind that the money has been stolen from the patient via Medicare and income tax going to Medicaid - money that could have been better used to buy long term care and true insurance.
I understand that this is your premise, it is the same premise that has always been used to promote death panels. But the reality is that you have yet to demonstrate that it is valid.
You are the one muddying these waters.
By asking for proof? Who would you rather be when you grow up: Pelosi, Hillary or Obama?
You muddy it even more by injecting religion into it.
Actually, YOU brought it up in post #81 when you wrote:
"the injection of religion into this debate tells me more than I need to know about all of you."
All Brian had done was talk about a Catholic priest who was dehydrated to death, NOTHING would have changed if he had been an atheist.
The only time I mentioned religion was when you asked what I thought God's will was and I later remarked that the culture of death always blames Christians for getting in their way.
it's pretty obvious that you are purposely missing the point.
Later you opined about debating with Stephen Hawking and he actually does use some very expensive medical equipment.
and I'm sure he's paying plenty out of his own pocket for all of that. I guarantee that.
Then you tried to blame it all on Christians.
No, I didn't blame anything on anyone, I just suggested that injecting religion into this debate takes waters that were already pretty murkey and makes them even more so. God isn't paying the medical bills btw.
The bottom line is you are defending EVERY SINGLE TALKING POINT that Zero and his ilk are using to push death panels on us.
the bottom line is that you can't accept death and dieing and your misguided sense of ethics and morality are the reason why we have a government take over of healthcare. answer me this, should we the tax payers be paying for all of these lifesaving services for people who can't afford them, people like... illegal aliens for example?
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I wonder how long before you receive a response to that one, wagglebee. Choosing between the three may be difficult for our RN friend.
I don’t believe that RC one was saying that either patient should be intentionally killed. The scenario looked like stories I’ve heard from missionaries to the third world, heard from friends with parents in England, and read about in Canadian news reports. (Worse, one friend’s father was denied a central IV - they “hydrated” this 80-something man with a kidney infection with fluids under his skin because they couldn’t get a good IV in the arms or legs and it would have necessitated a surgery consult to place the central line.)
We know that self-defense and even capital punishment is not murder. Neither are medical triage that knowingly and intentionally allows some to live and some to die or the instances where comfort care is given to those for whom interventions are just as likely to cause death or injury and /or burdensome or overly invasive.
the bottom line is that you can’t accept death and dieing and your misguided sense of ethics and morality are the reason why we have a government take over of healthcare. answer me this, should we the tax payers be paying for all of these lifesaving services for people who can’t afford them, people like... illegal aliens for example?
The issue isn’t illegal aliens, no matter how much changing the subject may appeal to you.
maybe you didn’t hear me so I’ll ask again, should the tax payers be paying for the HC services of uninsured illegal aliens? I mean, we wouldn’t want to just let them die, that would be a culture of death, right?
If you want to discuss illegal aliens, start a thread.
Oh but it is because it’s about putting a price on human life. so answer the freaking question should tax payers be paying for all of those super expensive medical treatments for uninsured people and illegal aliens? Does God not care about the unisured? Are they included in your “culture of death”?
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