Euthanasia Essay, Research Paper

The Idea of euthanasia, or mercy killing, is a concept that is extremly difficult for many to understand. one thing that must be considerd is the particular problems faced by infants whose lives may be prolonged through modern methods of treatment, but for whom there is no prospect of recovery without extrem disability. While recognizing that cultural and national differences exist in the approach to matters relating to critical end of life decisions, the current controversiesa in the United States still must be considered. In all euthanasia cases, there are many important decisions that must be made. First of all, the patient should be considerd. The extent of suffering must be determined, and in most cases the patient is the most reliable source. “The patient should have the right to decide when he or she is ready to die”(kevorkian 149). patients must decide if they are willing to live in pain, or if they would rather end their suffering. Kevorkian says that “when deciding to die, the patient is able to say goodbye to all of his loved ones instead of dying unexpectadly” (149). The families of the patient also have a lot responsibility in makeing decisions for their loved one. Kevorkian thinks that if a person is terminally ill, the family should have the right to decide when it is the proper time to cut of life support (Kevorkian). Decisions about the use of life-sustaining treatment cannot be decided by physicians alone. The physician however, plays a vital role in decision makeing. He will be held responsible for the outcome of the patient. These decisions are always very hard on the people who are forced to make them. Infants obviously lack the ability to request the withholding or withdrawing of life-sustaining treatment. Their present and future wishes simply cannot be known, If decisiond to allow the deaths of such helpless patients are to be ethically justified, three important questions must be answered. First, in what situations are such decisions appropriate? Second, who sould be held resposible for the decision? And third, by what process should they be made so that the interests of the infant are fully protected? “When dilemmas about resuscitation and life-prolonging treatment for infants first came to wide professional and public attention in the early 1970’s, the main focus of concern was on infants born with major congenital abnormalties, particularly of the central nervous system” (Weir 661). Since then, advances in prenatal diagnosis and intensive care have led to an increase in the importance of problems to infants whose future quality of life have been severley compromised by the complications of extremly prmature birth. “Other infants fo whom withdrawal of life-prolonging treatment might be considered ethically justified include those whose brains have been damaged by infection or hemmorage” (Kopelman 679). As the treatments of today become increasingly sophisticated, it may no longer be appropriate to talk simply of brain damage. “It may now be necessary to differentiate between various types of diseases in the neanatal stage” (Weir 7). For all of these infants, the basis for any decision to withhold or withdrawlife-prolonging treatment si compassionate concern about their future should they survivr with devasstating brain abnormality or damage. In rare cases, tragic delimmas arise when the brain remains intact, but irreparable damage has occurred to other organs. To those who are familiar with neonatal intensive care, it is not surprising that concern about qualtiy of life is perhaps the most important element in these decisions. The abnormal development or prolonged intensive care that parents fear most is brain damage, and what it can mean for their child. as a criteria for decisions to proceed with life-sustaining treatment, quality of life has been severly criticized (Weir 661). “Such judgements have been lacled as discriminatory against the handicapped and equivalent to the social judgments have that involve invidious discrimination on the ground of such morally irrelevantcriteria as race and color” (weir 661). It can be argued that quality of life predictions are necessary and inevitable if doctors and parents are to seek, on behalf of the infant, the least detrimental of several burdensome treatment options when it becomes apparent that none will be of real benefit. Also, if we help families cope with the tragedy of having children with severe abormalities or brain damage, the quality of life judgements must precede any decision to withdraw treatment (Duff 890). To leave these judgments out is to first ignore the practical realities of caring for children with abnormalities. It would also undervalue the importance of compassion in patient care. An alternative is to restrict the doctors and nurses to acting purley as technicians and require them to use life-sustaining treatment indisciminatley without regard to the consequences for the child or family (Coulter 840). It is also important to point out what quality of life does not mean. To pediatricians, it does not mean a judgment about the infant’s inherent value or social worth to the community. Nor does it imply that these medical decisions primarily rest upon consideration of the likely financial costs of long term care to the family, hospital or state. To a pediatician, taking account of quality of life means being concerned on behalf of an infant patient about his or her capacity for future health, development and well-being, about the potential ability to reciprocate in human relationships, and about the human costs to the child and family that will accrue with survival (Wier 662). Although economic cost is not a quality of life issue, whether a treatment or its cosequences can be afforded is an important but separate ethical judgment (Duff 893). It would be unrealistic to think that the staff of an intensive care unit could simply ignore the problem of human and financial resourcees and ever increasing demands. “Doctors, nurses, and others, should be prepared to contribute to discussions on financial and other costs as any decisions they make could have adverse consequences for others” (Duff 892). The prolonged care of totally dependent children is very expensive and inevitably uses public as well as private resources. If life is prolonged in infants who will be unable to engage in meaingfull relationships with others, this must cut into the resources available for the care and support of a much greater number of severly disabled children who can form and sustain such a relationship. In most euthanasia cases, most decisions to withold or withdraw treatment are made through individual case by case analysis of the medical facts and sensitive, informed discussions between the responsible doctor and the parents (Weir 663). Parents are likely to make concerned and loving decisions in their child’s interestd if given the facts and treatment options accuratley, sensitively, and objectively. If possible, they should have adquate time for reflection and perhaps for consultation with other family members, their doctor, clergy, and others as they wish.

While doctors and parents can be seen as partners in decision-makeing for infants, it must be noted that any decision to withhold or withdraw life-sustaining treatmet is primarily a medical decision for which the doctor has the ultimate resposibility. However, good practice imposes an important duty on doctors to take careful note, not only of teh wishes of the family, but the views of the members of the intensive care team (Weir 662). Like the doctors, nurses are accountable for their own actions in the care of patients. By the nature of their work and their frequent and prolonged contacts with parents at the bedside, nurses may be in better position to understyand the true feeling and wishes of grieving parents that may not have found expression during more formal discussions with the medical staff. “When it is clear that there will be no further benefit from intensivetreatment, and where it seems beyand reasonable doubt that, with survival, the infant will be seriously impaired, there will usaully be agreement to withold or withdraw a life-sustaining procedure such as assisted ventilation” (Rhoden 40). Sometimes parents may disagree with the staff and request withdrawal of treatment earlier than indicated. On the other hand, parents occasionally may insist that treatment be continued long after the doctors and nurses believe it to be hopeful. Parental wishes should be respected as far as possible, but there will be circumstances when they cannot be justified medically, ethically, or legally. Even loving parents can make choices, perhaps based on stronr religioys belifes , that conflict with their child interest. The doctor may have to intervene and act as an advocate for the infant. (Stanley 20). for doctors, nurses, and parents, the emotionally charged atmosphere that surrounds abnormal birth or illness canlead to snap judgments that, in hindsight, are seen to be hast and ill-advised. Parents often view the future overly pessimistic oe overly optimistic. It may be difficult for them to understand how complex the condition is, or their treatment choices, especially when time ia limited by the circumstances (stanley 14). Conflicts often arise among the various people involved. Most of these can be resolved by discussion or through “the help of some arbitrating procedure sudh as referral to an Institutional Ethics Commitee (IEC) but occasionally it will become necessary to seel court opinion” (Coulter 841) “Doctors have a particular responsibility to take all of the necessary steps to establish a diagnosis and prignosis as accuratley as possible and to consider the various treatment options available, their likely outcomes and hoe these might affect the future life and health of their patient” (Rhoden 39). They also have a responibility to ensure that good communication exists between themselves and the parents, and between themselves and other members of the intensive care team. This is so that the clinical decisions and other important information affecting the care of the child are properly shared (Rhoden 39). The doctor in charge must exercise good leadership by not only beong prepared to make difficult decisions, but also by ensuring that they are soundly based. He or she should provide all of the staff involved with opportunities to reflect on the issues and express their views (Rhoden 39). This is very important when individuals disagree or are uncomfortable about the ethics or legality of the decisions made. “It has to be acknowledged that what makes a life worth living, and what counts as a benifit or burden, and the relative ratio between the two, will vary with the circumstances and in the perceptions of different individuals” (Rhoden 35). In this kind of medical decision-making, some further dicretion is necessary. “Underlying the regulations in the United States was the view that making quality of life judgments for others is morally unacceptable, and that the traditional dicretion awarded to parents and pediatricians in deciding the treatment of disabled infants was inappropraite and should be curtailed” (Kopelman 10). Relativley recent court decisions give some idea of how the law currently views the resposibilies of doctors for making decisions about life-prolonging and life-savine treatment for children (Rhoden 35). They are consistent with the view expressed earlier, that quality of life judgments are proper components of the decision-making process. For exa,mple, in the cases heard by the Court of Appeal in 1981 surgery was authorized to correct congenital intestinal obstruction in an infant with Down’s Syndrome disregarding parental objection because in the judges’ opinion , the infant’s life was not so “demonstably awful” that the infant should be allowed to die(Campbell 15). Also, in 1989, a High Court judge agreed that a very seriously handicapped infant should be permitted to die, and that no further attempts should be made to prolong her life. She was four months old, hydrocephalic, blind, and with severe cerebral palsy. This decision was appealed because some people were unhappy with the judge’s use of the phrase “treat to die” which might be interpreted as giving authority for taking active steps to end the child’s life. In their judgment, the Appeals Court agreed that “the doctor had failed to express himself with his usual felicity, and that the original decision had been too restrictive on the exercise of his normal clinical direction” (Stanley 16). It appears that with the more open and ongoing discussion of the ethical issues relating to prolonging life, there has been a swing towards a more deliberated approach to decision-making in intensive care units. Consideration of the relative benefits and burdens in each individual case influences the judgement made. In addition, an increasing tendency to resuscitate smaller and more immature infants has made it necessary for doctors to consider withdrawal of treatment when there are clear indications of severly opposing outcomes. Doctorws may decide to withhold or withdraw treatment. By doing so, they legitimately allow or assist death when it is agreed between thew informed parents and themembers of the intensive care team, that continued treatment will lead to unacceptable burdens without compensating benefits for the ionfant (Duff 891), The resposibility for such a decision ultimately rests with the doctor in charge, but he or she has a duty to share the decision-making process with those closely involved in the care of the patient. in assessing the benifits and durdens, quality of life judgements are unavoidable if the decision-makers are to act in the best interests of the child (Rhoden 35). If the decision-making is informed, thorough, and properly shared, and if recording is accurate and careful, then the process itself will help to mitigate the long term consequences for the staff and the parents.