Context Is Key When Considering End-of-Life Treatment Options

Abstract

I feel compelled to respond to Lisa Day’s recent article titled “Questions Concerning the Goodness of Hastening Death” (May 2006: 312-314). Day expresses concern about a growing trend to accept hastening death as an option for care. She proposes that we should not use logical or analytical methods to make ethical decisions for seriously ill and/or dying patients. She suggests, instead, that we should create a belief from the uncertainty of death and base our actions on that belief. Without logical analysis, however, we are left with illogical, random methods for decision making. Belief, by definition, asks us to accept as true something for which there is no evidence. But when it comes to my patients—and to me, for that matter—I believe that healthcare decisions must be based on a logical analysis of what is actually known. After disparaging logic, Day applies Pascal’s logic to the question, “What if something important happens during the process of dying?” If this is true, then hastening death could harm the person in ways we cannot imagine. However, in the same manner, preventing or prolonging death also could cause harm. If a man develops cancer, should we not refrain from interrupting his dying process? If we have saved a woman’s life, but she exists only in a vegetative state, should she then be killed? These types of questions have plagued the healthcare community for years, and they can be easily solved. Healthcare professionals and their patients have merely mistaken the question. It is not a question of life and death; it is a question of the life and death of a particular person. Decisions about what type of care a person receives should be based on the context of the situation; they involve a unique individual who has a particular healthcare problem. That individual’s needs, desires, values, and resources must be examined along with his or her ability and willingness to participate in treatment. 1 Add to this the context of knowledge: what is known about the problem within the healthcare arena. This includes knowledge about the particular problem and evidence-based studies about which treatments are shown to be effective and which are futile within that context of care. Examining healthcare decisions in this manner avoids the dilemma. Instead, it offers a clear path to the best treatment for a unique patient in a particular situation. The values of the patient are clearly directing the type of care received. We in healthcare should be about promoting and enhancing human life, not hastening death.