I mentioned in comments on the thread about Terri Schiavo a research project at QUT’s Law Faculty called Rethinking Life-Sustaining Measures. The project leaders, Associate Professor Lindy Willmott and Dr Ben White, have now released an Issues Paper which canvasses some of the legal and ethical issues arising in situations where questions such as these arise:
When should a person who has a heart attack not be resuscitated? When should a patient no longer be kept alive on a ventilator, or be provided with artificial hydration and nutrition through a tube? When should a person not be given a blood transfusion they need to stay alive?
A decision to withhold or withdraw medical treatment that will inevitably result in an adult’s death can be extremely difficult. In addition to making the appropriate medical and ethical judgments, there are also legal considerations to take into account, the most important of which is ensuring that the death is lawful.
Obviously, it’s my view that these questions – which are serious ones – were obscured in the hyperbolic politicisation of the tragic situation of Terri Schiavo and her family. But I think they are ones we need to come to grips with in a serious and measured fashion. The intent of the issues paper is to promote discussion. I’d be very interested in what LP readers have to say in response to the questions raised in the paper.
My understanding of the ethics re the questions raised in the issue papers is based on the idea of what constitutes extraordinary treatment.
In my mother’s case, she has a tumour in her gullet which is inoperable due to her advanced age. A recent trip to a larger and more competent medical facility resulted in a decision not to put in a stent (tube) to keep open the passage. Now the tumour has practically closed off the gullet leaving the 1 litre of saliva every day to be vomited out or go into the lungs causing pnuemonia. Now on a drip only and awaiting decision whether to again go back to the larger medical facility, with declining strength (since a feeding tube can not be inserted down the gullet for fear it will perforate the wall at the tumour); by the time ‘they’ decide (probably) not to waste resources it will be ostensibly be because she’s too weak to make the journey etc etc. Then it will be pull out the drip, put in a subcutaneous (I think) morphine device and wait 3 or so days for her to die from dehydration.
I do accept and understand that a blocked gullet makes life fairly intolerable and that treatment now (the stent) would probably not be applicable. I accept that the morphine palliative care seems to be appropriate way given that even a feed tube (extraordinary treatment?) directly into the stomach does not rectify the blocked gullet/saliva problem ie sleep is somewhat difficult when one is drowning in one’s saliva. With a mid range aspect of dementia thrown in you can get some idea of the overall situation.
Where my argument lies is in the prior management which precluded a treatment which with the benefit of hindsight admittedly, might have prolonged life for months even years longer. I wonder however, that the decision made not to fit the stent, was a simple cop-out with full knowledge that the leeway in future to perform this proceedure would be minimal given a much weakened state. This ‘mismanagement’ now makes my acceptance of the palliative/death routine more difficult as I feel so bloody resentful but unable to express my resentment to the doctors who are 400 km away–it is necessary to attend to more pressing matters day by day.
My understanding of the ethics re the questions raised in the issue papers is based on the idea of what constitutes extraordinary treatment.
In my mother’s case, she has a tumour in her gullet which is inoperable due to her advanced age. A recent trip to a larger and more competent medical facility resulted in a decision not to put in a stent (tube) to keep open the passage. Now the tumour has practically closed off the gullet leaving the 1 litre of saliva every day to be vomited out or go into the lungs causing pnuemonia. Now on a drip only and awaiting decision whether to again go back to the larger medical facility, with declining strength (since a feeding tube can not be inserted down the gullet for fear it will perforate the wall at the tumour); by the time ‘they’ decide (probably) not to waste resources it will be ostensibly be because she’s too weak to make the journey etc etc. Then it will be pull out the drip, put in a subcutaneous (I think) morphine device and wait 3 or so days for her to die from dehydration.
I do accept and understand that a blocked gullet makes life fairly intolerable and that treatment now (the stent) would probably not be applicable. I accept that the morphine palliative care seems to be appropriate way given that even a feed tube (extraordinary treatment?) directly into the stomach does not rectify the blocked gullet/saliva problem ie sleep is somewhat difficult when one is drowning in one’s saliva. With a mid range aspect of dementia thrown in you can get some idea of the overall situation.
Where my argument lies is in the prior management which precluded a treatment which with the benefit of hindsight admittedly, might have prolonged life for months even years longer. I wonder however, that the decision made not to fit the stent, was a simple cop-out with full knowledge that the leeway in future to perform this proceedure would be minimal given a much weakened state. This ‘mismanagement’ now makes my acceptance of the palliative/death routine more difficult as I feel so bloody resentful but unable to express my resentment to the doctors who are 400 km away–it is necessary to attend to more pressing matters day by day.
My question really is how does one tell one’s mother, a fighter, that when they pull the drip out, it is time to just give up and die?
My question really is how does one tell one’s mother, a fighter, that when they pull the drip out, it is time to just give up and die?
Peter, I’m very sorry to hear about your mother’s illness. I think what you’ve very movingly wrote illustrates the complexities and tragedies involved in a lot of these circumstances, and why the issues need to be discussed in a measured and calm fashion.
Peter, I’m very sorry to hear about your mother’s illness. I think what you’ve very movingly wrote illustrates the complexities and tragedies involved in a lot of these circumstances, and why the issues need to be discussed in a measured and calm fashion.
Thanks Mark, but I needed to get that off my chest and a reminder to all that these issues can strike very close to home, necessitating constant vigilance and questioning of the authority of non-family, non-Court agents that pull the plug in the name of resource allocation.
Thanks Mark, but I needed to get that off my chest and a reminder to all that these issues can strike very close to home, necessitating constant vigilance and questioning of the authority of non-family, non-Court agents that pull the plug in the name of resource allocation.
The issues paper seems to be a 99pp pdf file. It seems that access is denied to me because it requires version 7.0 of Acrobat Reader, which requires Windows 2000. My Windows 98 is simply too old.
Yet when my young son’s motherboard fried the other day after about 3 years of use, the computer tech just said, that’s what you’d expect. They don’t make them like they used to!
Damn!
The issues paper seems to be a 99pp pdf file. It seems that access is denied to me because it requires version 7.0 of Acrobat Reader, which requires Windows 2000. My Windows 98 is simply too old.
Yet when my young son’s motherboard fried the other day after about 3 years of use, the computer tech just said, that’s what you’d expect. They don’t make them like they used to!
Damn!
Brian, you might try emailing the authors and pointing this out. Clearly if there intention is to stimulate wide discussion, this will be a problem.
Brian, you might try emailing the authors and pointing this out. Clearly if there intention is to stimulate wide discussion, this will be a problem.