Biomedical Developments Require Advanced Ethical Reflection
With advances in medical science, the line between when doctors should intervene to save a life and when they should step back to allow nature to take its course has become increasingly blurred. Since life sustaining support systems can be financially burdensome and because the average person emphatically projects themselves into such a situation and find that they are unsettled in the spirit when confronted with these devices, many make statements to their loved ones and even draw up legal documents that specify that they do not wish to receive such treatments to sustain their earthly lives. However, when the individual enunciates these kinds of concerns to their friends and family, they must be explicit as to what they desire or lawyers and related bureaucratic scavengers could very well descend around the withering remains to pick and claw as they play the word games for which their breeds are infamous amidst shades of ambiguity.
As an illustration, consider the following. A young mother with two small children has an accident one morning that does not kill her but leaves her in a coma. She is taken to the trauma center where she is placed on life support. Her husband informs the medical staff that his wife stated that she desired no treatment should she ever find herself in such a condition. Since her temperature is rising significantly, her physician believes she should be treated for an infection. Her husband does not approve.
To decide whose wishes should prevail (either her husband’s or the doctor’s), any bioethics committee called in to make a determination would first have to consider a number of factors. For starters, a bioethics committee would need to distinguish between extraordinary and ordinary means of treatment.
According to Rae, ordinary means are those courses of treatment for a disease that offer a reasonable hope of benefit to the patient without being excessively burdensome; extraordinary means are those that do not offer such hope and place undue burdens on the patient (185). In other words, extraordinary means would include things such as respirators that temporarily extend a life that would come to an end without the intervention of such a device. Ordinary means would consist of those things that ordinarily sustain or improve the normal processes of life such as food and water. Antibiotics could be considered an ordinary means of treatment since these substances are administered to curb an infection threatening life and health rather than prolonging life that is beginning to fade away.
Second, the bioethics committee should look into the quality of the of relationship between husband and wife. While such a suggestion might seem nosy, in light of certain disturbing aspects of the Terri Schiavo case, it would be helpful to know whether the spouse is sincerely seeking to fulfill the wishes of their mate in these grim matters or merely looking for an easy way out to make their way on to their next victim, I mean partner.
This case is not that difficult for objective observers with a traditional Judeo-Christian worldview. Administering antibiotics to fight off the infection in order to bide more time to ascertain more fully God’s future plans for this woman would be a moral obligation.
More extensive life support measures would be a decision best left to the family. The most difficult task might be educating the husband as to the distinctions between ordinary and extraordinary means. Though some might consider it presumptuous to speak on someone else’s behalf, at the time his wife made the statement about not wanting treatment if she ever found herself in such a situation, she was probably not referring to treatments such as food, water, and regular medicines but rather to things more like breathing tubes and respirators. For example, one could argue that, if the “no treatment” criteria was to be upheld as an inviolable absolute, the administration of painkillers would have to be withheld as well since these are also a form of treatment.
Furthermore, the medical professional must make it clear that it is not over until it’s over. The antibiotics do not interfere with the chain of events set into motion by the accident, the outcome of which no mortal can know for certain. Rather, these substances prevent an otherwise preventable or treatable secondary matter from overtaking the body and weakening it further. By administering the antibiotics, the family can better prepare themselves for the ultimate will of God in the life of their loved one, which could consist of any number of possible outcomes such as death, healing, or life-long disability.
Even though a number of these states may be far from what we would consider ideal and we might even question them sometimes as mere human beings, it is not our place to be the direct cause of the conclusion of the process known as life. It is rather the duty of the family and authorized caregivers to make the loved one as comfortable as possible and this is most likely what a person means when they say they do not want to be subject to all kinds of extraordinary treatments.
By Frederick Meekins