End of Life Decisions and the Law
Let's think hypothetically for a moment.
Let's say there's a patient who is conscious and aware of their environment, perhaps on an intermittent basis, but is not able to communicate very well--only inconsistently, or they are hard to understand for some reason. Imagine the person can communicate at some level, but not enough to give a completely dependable answer about whether they want to live, or they are for some reason deemed incapable of making that decision.
This patient doesn't have a living will, and there are witnesses who claim to remember them making statements that would support both sides--some say that they said they'd never want to live if they were unable to care for themselves and others say they were strongly against allowing people to die in very similar situations to what they now find themselves. What do you think should be the standards and procedures used in making a decision about whether to withdraw treatment or not?
Now imagine that this patient has enough limited understanding to form an opinion about whether they wish to continue living in their present situation, and they do not currently wish to die. They have been able to communicate that opinion. But they are incapacitated enough in one way or another that the courts have decided they need a guardian, and the guardian has decided to withdraw treatment because they think it's time for the person to die. What should be done then?
Next let's consider a situation where there's no indication the person is aware, but there is no evidence or conflicting evidence about their wishes.
What if a person has a living will saying they want all life-sustaining procedures except in specific, carefully-outlined exceptions, but when they become incapacitated the family decides to withdraw treatment even though it goes against their living will and their condition doesn't meet either of the two exceptions stated in the living will?
Finally, envision a situation where someone is terminally or seriously ill but fairly high on the awareness scale and able to communicate reliably. They have a living will saying they don't want any extraordinary means used to sustain their life, but when the family and the court decides to remove nutrition and hydration the person starts begging for food and water and saying they want to live. What then?
All these are actual situations that have happened here in the USA that are well-documented. In each of those scenarios there have been cases that resulted both ways--one patient in each of those situations might be allowed to live while another died, when the only significant difference between the two cases is where and by whom the decision is made.
This affects all of us--primarily because it's likely that many of us will find ourselves in a situation where ourselves or our loved ones fit one of the scenarios above. The laws and standards used to make such determinations in our country are something that each one of us can have an impact on, and that we should care about.
That's why I would argue that we need clearer criteria and stricter standards for making these decisions. In my opinion, a good place to start would be by raising the standard required for evidence to prove someone's wishes from "clear and convincing" to "beyond a reasonable doubt." It's a small step, but one I believe would be helpful.
What would you like to see changed, if anything? I'd love to have some dialog on these issues.
Let's say there's a patient who is conscious and aware of their environment, perhaps on an intermittent basis, but is not able to communicate very well--only inconsistently, or they are hard to understand for some reason. Imagine the person can communicate at some level, but not enough to give a completely dependable answer about whether they want to live, or they are for some reason deemed incapable of making that decision.
This patient doesn't have a living will, and there are witnesses who claim to remember them making statements that would support both sides--some say that they said they'd never want to live if they were unable to care for themselves and others say they were strongly against allowing people to die in very similar situations to what they now find themselves. What do you think should be the standards and procedures used in making a decision about whether to withdraw treatment or not?
Now imagine that this patient has enough limited understanding to form an opinion about whether they wish to continue living in their present situation, and they do not currently wish to die. They have been able to communicate that opinion. But they are incapacitated enough in one way or another that the courts have decided they need a guardian, and the guardian has decided to withdraw treatment because they think it's time for the person to die. What should be done then?
Next let's consider a situation where there's no indication the person is aware, but there is no evidence or conflicting evidence about their wishes.
What if a person has a living will saying they want all life-sustaining procedures except in specific, carefully-outlined exceptions, but when they become incapacitated the family decides to withdraw treatment even though it goes against their living will and their condition doesn't meet either of the two exceptions stated in the living will?
Finally, envision a situation where someone is terminally or seriously ill but fairly high on the awareness scale and able to communicate reliably. They have a living will saying they don't want any extraordinary means used to sustain their life, but when the family and the court decides to remove nutrition and hydration the person starts begging for food and water and saying they want to live. What then?
All these are actual situations that have happened here in the USA that are well-documented. In each of those scenarios there have been cases that resulted both ways--one patient in each of those situations might be allowed to live while another died, when the only significant difference between the two cases is where and by whom the decision is made.
This affects all of us--primarily because it's likely that many of us will find ourselves in a situation where ourselves or our loved ones fit one of the scenarios above. The laws and standards used to make such determinations in our country are something that each one of us can have an impact on, and that we should care about.
That's why I would argue that we need clearer criteria and stricter standards for making these decisions. In my opinion, a good place to start would be by raising the standard required for evidence to prove someone's wishes from "clear and convincing" to "beyond a reasonable doubt." It's a small step, but one I believe would be helpful.
What would you like to see changed, if anything? I'd love to have some dialog on these issues.
Copyright 2009. All rights reserved.
Posted by purple_kangaroo at 10:40 PM[Permanent link]
3 Comments:
Let's see now, in the absence of a written declaration, you would require that an incapacited person's oral declaration of medical preference be proven beyond a reasonable doubt? What if a man only tells one person, that he would never want to be kept alive by "tubes"? How in the world could this be proven "beyond" a reasonable doubt"?
Wouldn't that depend on the reliability and detail of the evidence, and how it fit with any other evidence?
Again, by beyond a reasonable doubt, I primarily mean that the evidence is strong for removal of care and that there is not strong evidence that their desire would be the opposite, or that the evidence is very heavily weighted in quanitity and reliability for more than against removal.
Post a Comment
<< Purple Puzzle Place Home