Advanced medical technologies are reshaping the circumstances around natural death, by sustaining human lives beyond when death might naturally have occurred. When advanced technology sustains life, but offers no promise for meaningful recovery, and requires secondary support (like feeding tubes, ventilators, etc.), patients and families face the important task of choosing their treatment preference during end-of-life
care.
“Decision-making”
for end-of-life care has capability to prolong human life with the support of
medical technologies or can let the natural death process continue by foregoing
the treatment option. This raises various ethical issues. Every citizen of the
United States has a right to autonomously voice their end-of-life treatment
preferences and those preferences have to be respected ethically
considering the use of advance treatments and their prognosis. However, the
right of autonomy, as it is called, has some limitations because
physicians also have a professional oath to carry out their duties to benefit
the patient without doing harm.
Therefore,
physicians strive to perform their duty to rightfully provide patients detailed
information about the benefits, limitations and drawbacks of treatment options.
In general physicians seek to apply what is known as “deontological theory” and
perform the treatment that will gain greatest good for the patient and act for
patients benefit. They will explain the implications of a proposed treatment
and emphasize its risks and consequences. They are obliged by law to respect
the beliefs and values of the patient, but they additionally have a duty to
preserve patient’s life. This duty does not oblige them to perform
treatments that would inflict more harm than good to the patient or to continue
medically futile treatments.
When
this is the case, physicians strive to reach a mutual agreement with the
patient about withholding a futile treatment or withdrawing a treatment that
has been begun, but now is deemed to be causing more harm than good. They
explain the drawbacks of unrealistic expectations from the treatment.
Good communication between patient and families is a necessary component of the
“goals of care” family meeting with the physician to discuss treatment and
care. The chaplain can help to bridge a gap between the patient, their
families and the physician.
In
case of incapacitated individuals, families play a central role as primary care
givers and have a responsibility of putting forth the end-of-life care
preference of the patient. Family members may not be very good in guessing the
patient’s preference for end-of-life decision making when explicit declaration
of patient’s preferences is not clear. Families are emotionally attached to the
incapacitated patient and hence their moral interest may raise spiritual
questions that can best be addressed by a chaplain.
The
ethical value of patient autonomy and surrogate autonomy should be respected
but weighed against the use of expensive treatment in futile case circumstances
with current increase in healthcare costs. Healthcare rationing of end-of-life
care in futile situations can be considered as greatest good for society but
has to be weighed against the patient autonomy. These questions may raise
moral dilemmas for medical healthcare workers and hospital administration as
well as for patients and families and chaplains are trained to provide support
for staff as well as patients and families in arriving at a morally acceptable
choice that honors autonomy and beneficence of the common ethical standards for
patient care.
Compassionate
care is another option sought by the patients while considering end-of-life
care which can be at times is a good preference when medicine is unable to
restore patient’s health. Chaplains and health care professionals work together
to assist the patient and families to make thoughtful end-of-life care
decisions and document their preferences. If there is a disagreement between
the healthcare provider and the patient or surrogate end-of-life care choices,
then they can take appropriate steps by consulting with an ethics committee to
address this ethical or legal issue and document its proceedings.
Much
progress has been made in addressing the ethical issues surrounding end-of-life
care
situation in the light of ongoing advancements in medical science, but further
research into this topic is still needed. As life expectancy continues to rise
so too the number of people living with chronic illness and pain
increases. Chaplains are involved in researching the most humane and
compassionate ways to relieve stress faced by people during critical times and
optimize quality whole person care to improve and ease end-of-life journey.
