4th Global Conference
Wednesday 12th July - Friday 14th July 2006
Mansfield College, Oxford
Session 7B: Moments of Death and Interventions
at the End of Life
Chair: Bodil Ellefsen
The Moral Problems of some Forms of Medical Intervention in Elderly
Demented Patients
Harald
G. Kratochvila
Department of Philosophy, University of Vienna, Vienna, Austria
Withholding
and withdrawing life saving medical treatment (LSMT) are common
medical practice in European Hospitals. Recent data from the Netherlands
and Belgium suggests that nearly 40 % of all deaths are due to Medical
Decisions Concerning the End of Life (MDELs), including physician-assisted
death (euthanasia and physician-assisted suicide), alleviation of symptoms
with possible life-shortening effect, and non-treatment decisions. For
example, although in 2001 less than 3% of all deaths in the Netherlands
are
the result of euthanasia and physician-assisted suicide academic and
public
discourse focus on the moral permissibility of both of them, neglecting
the
problem of withholding and withdrawing treatment. In comparison with
practices of physician-assisted death, non-treatment decisions are less
often regulated, overtly discussed or subject matter of academic and
public
discussion. The frequency of non-treatment decisions change due to old
age
- the elder the patient the more often such decisions are made. These
descriptive results are to be in need of serious consideration especially
against the background of increasing withholding and withdrawing nutrition
and fluid in elderly demented patients.
The practice of medicine is object
of various normative regulations - law,
professional ethos (ethics) and ethics (medical ethics). From an ethical
point of view some non-treatment decisions are morally justified and
others
are not. Which are the moral relevant facts determining the respective
moral judgments? Substantial moral concepts like the doctrine of the
double
effect (DDE), the sanctity of life (SL) or the act-omission distinction
come to one's mind. But what about the aims and goals of medicine? What
about medical futility and the significance of physician-patient
relationship? One has to deal with all the mentioned components to be
able
to offer a reasonably justified moral judgment about non-treatment
decisions with fatal outcome.
Death and the Maiden: End-of-life Policy
in the USA: The Interplay of Technology and the Iconography of the
Female Body
Regis
A. De Silva
Cardiovascular Division,
BI-Deaconess Medical Center, and Harvard
Medical
School, Boston, Massachusetts, USA
Medical technology enables the extension
of the dying process in coma and persistent vegetative states, where
patients are kept alive by drugs and mechanical devices. These technological
possibilities have provoked debate over a legal definition of death,
the circumstances in which treatment should be withdrawn and the grounds
on which such decisions might be justified. These controversies have
usually been analysed in terms of doctors’ fears of liability,
concerns over the sanctity of life and the need for viable organs for
transplantation.
Our argument in this paper is that end-of-life policies
in the USA, on a deeper level, have been driven by the fact that all
of case law in this area has concerned a succession of three young white
women in their twenties, Karen Quinlan [unconscious 1975-1985], Nancy
Curzan [unconscious 1983-1990] and Terri Schiavo [unconscious 1990-2005].
Decisions over whether to maintain them in an unconscious state or to
withdraw life-preserving treatment have proven to be controversial. Legal
and political involvement of activists, politicians and the law escalated
with each case, culminating in interventions at the highest levels of
government, as end-of-life and beginning-of-life issues became conflated.
The
iconography of the female body in popular myth and culture positions
these women as “sleeping beauties” awaiting the kiss of life.
Yet, simultaneously, they suggest a powerful denial of death and evoke
our fascination with the “undead”.
We explore the nexus between
unrealistic expectations about the power of medical technology, salient
case law, and representations of the female body, juxtaposed with concepts
of fertility and death in popular culture.
Contemporary Constructions of the
'Moment of Death'
Christine Valentine
and Glennys Howarth
Centre for Death and Society, University
of Bath, Bath, UK
The ‘moment of death’, once a dominant concept
in relation to preparing for a ‘good death’, has been eclipsed
by a focus on the wider concept of the ‘dying trajectory’.
An individual’s
dying moments have become merely the end point of a complex and uncertain
process that has been constructed as either the ‘medical bad death’ or
what ought to be our ‘final stage of growth’ (Kubler-Ross,
1979). This reflects changing belief systems and practices, in which
a secular, medicalised management of dying has replaced the traditional
deathbed preparations or ars moriendi designed to ensure the soul’s
safe passage to the afterlife. In a medicalised, institutionalised system
of dying the family’s presence at the deathbed may not always be
practical or possible. Dying trajectories are uncertain, hospital schedules
must be negotiated and people may live at a distance.
However, findings
from interviews with twenty-five bereaved individuals suggest that an
individual’s final moments may still be experienced
as highly significant in their own right. In some accounts the
dying individual’s final moments did not feature or made little
impression, either because the survivor was not present, or there was
no obviously definable moment, or because other, usually medical factors,
such as whether to resuscitate the person, took precedence. However,
for a small number of individuals, the moment of death was constructed
as a profound, special and memorable event. These constructions are also
important in relation to what they reveal about current values, fears
and hopes about death. The discourses that inform them are explored in
relation to the role they played in making sense of the dying experience
and the achievement of a good death. Consideration is given to the relationship
of the moment of death to the dying trajectory as a whole and to its
impact on the bereavement experience.
© Inter-Disciplinary.Net 2006