Definition:
A dilemma occurs when one is faced with a decision based on moral issues that requires one to identify the “right” thing to do- when all/none of the options seems “right”!!!
Example:
Mr. X has metastatic melanoma and respiratory failure. He has an intravenous syringe driver with morphine for pain relief and could live for several weeks if he was placed on a ventilator. But, Mr. X wants to die now. There are 5 options:
1) Sanctity of life view:
- Place Mr. X on a ventilator
- He would almost certainly die in several weeks from progression of his cerebral metastases
- He will be in pain against his wishes
2) Withhold life-prolonging treatment:
- Do not place him on a ventilator
- He would be likely to die within the next few days
- He will be in pain against his wishes
3) Withdraw life-prolonging treatment
- Place him on a ventilator until his condition deteriorates, then stop ventilation
- He would be likely to die within one day of stopping the ventilator
- He would be in pain against his wishes
4) Assisted suicide
- Provide Mr. X with the means to kill himself
- E.g. Tell him how to give himself a lethal dose of morphine
- In accordance with the patients wishes
5) Active euthanasia
- Kill Mr. X with a lethal injection of potassium chloride or sedatives
- In accordance with the patients wishes
- Ethical???
What would YOU do…? What option is “right” ???
20 comments:
Well for me the answer is obvious and it is the first choice.
U may say that it is a ruthless thing to do and that I'm going to prolong his pain since he is going to die anyway so why don't I stop his suffering. Well the thing is that if anyone who is in pain then he should end his life in order to stop his suffering then I would be dead long time ago...:D
Mr.X's life belongs neither to him nor to me, it belongs to God so if God sees that this life is better to end then it will end against our wills and that is that so God may have plans for him that in few days he will stand up and walk away just fine or God may see that in his suffering is a way of atoning for his sins.
Well this is just my opinion and that is what I think the right thing to do...
In Canada where I live we have the legal right to refuse any and all medical care, including that which is life saving. Medically assisted suicide isn't presently legal however.
Factors to be included in this are:
What is Mr. X’s religious beliefs if any
What is Mr. X’s wishes regarding medical intervention.
What is the age of Mr. X. Is he in advanced years in he a child is he middle aged ?
What is the prognosis of recovery and
What is the quality of life expected ?
If you take the people who want to be cryogenically frozen until a cure can be found for their disease you have to understand how disease works in order to understand why this doesn’t work well in theory or (even if it was technically possible). When someone has a disease they suffer damage to certain organs (depending on what disease different organs are damaged). In late stage of any cancer the damage to the organs is acute. For instance in lung cancer the damage to the lungs is such that the lungs themselves shut down. Placing a person in stasis so that a cure can be found later is pointless because even if you cure the cancer the damage to the lungs is already done and the quality of life expected will be nothing. They wont be able to run or work or do what a healthy person can do once the cancer itself is removed from the body.
Next you must answer each of the above questions in turn.
If Mr. X has no religious beliefs what give you the right to impose your religious beliefs on him ? Besides nothing ? If you feel you have the right to impose your religious beliefs on him then I have the right to impose my religious beliefs on you. And today I decided to believe in the Flying Spaghetti Monster (A real religion btw with actual followers). Since the FSM is the true god and everyone else is non believers, my country has the right to invade yours and kill you for not having the proper beliefs in regards to what I believe is the True god. Sounds silly doesn’t it ? But the Crusades in the middle ages was based exactly on that. How many Muslims and Christians died in the middle ages because some religious zealot decided it was his way or death ?
Respect works both ways. If you want your religious beliefs respected, then you must respect mine. Even if I have no beliefs at all.
If Mr. X has indicated he doesn’t want medical intervention of any sort. To then decide for any reason that you are going to pointlessly intervene so that Mr. X can enjoy the benefits of days/weeks/months/years of agony is no different than doing medical experiments on humans without their permission. You wouldn’t dare consider doing frontal lobotomy on a healthy patient just to see what happens for instance.
What is Mr. X age ? Is he in advanced years ? Is he a child ? Is he middle aged ? This one trips people up especially when they get to the child part. I personally believe it comes down to the patients ability to understand AND consent to what is going on and what their decision means. A 2yo child can not make the necessary decisions to chose physician assisted suicide. A 13yo child can. If the patient is 95 and has lived a long and active life what is the point of prolonging that life ? The patient isn't going to miraculously recover to live another 50 years of good quality life.
If a person has a disease where death is a certainty, and where pain involved is a certainty, then I believe you must have respect for the wishes of the patient. If the patients religion prohibits suicide, and they have expressed that they will not accept a lethal dose of morphine then by all means don’t give it. If a person has chosen to believe that they don’t want to have months or weeks of suffering then by all means let them take the dose. Again you cannot impose your religious beliefs upon another. It is up to each person to decide what they believe.
Dying with dignity. My grandfather on my dads side died of a stroke. At the time he died the doctors would do everything they could to make sure he suffered just one day longer. They forcibly intervened against my families wishes and gave him over 30 blood transfusions. The man was in his mid 80’s had lived a long life, and quite frankly wanted to die since his wife died some years earlier from a massive heart attack. Yet these doctors thought it was a good idea to prolong his life even though there was no hopeful prognosis for his recovery. A stroke does massive damage to the body. You have to relearn to walk, talk, eat, everything. Sometimes the damage is so great you never relearn how to do those things. Even if he had lived he would have been a bed ridden vegetable. Something my grandfather would never have wanted for himself. Today we have the right to tell the doctors to back off. No blood transfusions, no massive interventions. Make him as comfortable as you can and let nature take its course.
Kyubai
Atoning for sins ? What if the mans religion doesn’t believe in sin ? When the Jesuits came to Canada and met the Mohawk First Nation they tried to convert the “heathen”. They almost failed in doing this. The reason is the Mohawks not only didn’t have a word for “sin” they didn’t have the concept either. They had a sense of right and wrong but “sin” as a concept simply didn’t exist in their culture. The Jesuits got around the problem for forced conversions. They simply murdered those who wouldn’t agree to agree with the new imposed religion. I personally don’t believe in sin. I think it’s a man made concept to fear people into believing. Sin operates the same way that a pimp forces a girl to prostitute herself. In order to make a girl into a prostitute you must convince her she isn't good for anything else. You do this by destroying her sense of self. Her pride in herself, her dignity etc. The pimp then offers her a way “out”. Be believing that if she loves him he will be the only person on the planet who will care about her. Even though he is the person who put her in that position in the first place. Sin is doing the same to the spirit. It presupposes that a person is evil even if they have never done anything wrong in their life. Explain to me how a new born baby is sinful ? What has that baby done to anyone or anything that makes that baby evil ? Sin tells a person that without spiritual intervention by a priest, Imam, monk or whatever that person is going to spend eternity roasting in hell (but god is the god of love and compassion remember). Even if a new born baby dies they can face this. Does this show a loving god, or a vengeful evil entity that punishes arbitrarily ? In some so called primitive societies there is no words for war. They don’t have murders, they don’t have rapes, they don’t have theft, they don’t have crime. And they don’t have sin. They have had their religion working for them for 10’s of thousands of years. Western theology is a new thing. It has greed, war, rapes, theft and any manner or evil. What system is working and what system isn't ? The one that has existed unchanged for thousands of years or the one that changes with every generation ? What Islam is today isn't what Islam was when it started. What Chrisitianity is today isn't what it was when it started. Sin is nothing more than the carrot and the stick approach to religion. Good cop bad cop. Believe in me I’ll set you free. Don’t believe in me and I’ll punish you forever. I’ll terrify you into belief if I have to. My power demands that you are afraid, and sin is the perfect way to destroy a persons spiritual self. Degrades them spiritually. Like the prostitute it cuts them off from their humanity, their growth as a person, their ability to know god. I find the concept of sin as offensive as I find pimps. It’s the concept of a desperate religion trying to force its ways onto people who don’t need it. There is no sin. There is no heaven, there is no hell except that which we our own selves create for our own selves. Tell me how a baby in Iraq that has suffered and died due to lack of medical care is atoning for their sins ? What exactly has that baby done to deserve it ? And what does that tell you about the nature of god if god does in fact believe that that baby deserves to be treated in such a fashion.
If you want to believe such things by all means go ahead. Do not attempt to impose them on others or you are nothing more than a spiritual pimp. Otherwise my armies will come and you will find yourself forced to believe in the FSM ;-)
i'd get the patient to sign a DNR (Do Not Resuscitate) paper if he/she so wishes, and wait for him to croak on his/her own.
meanwhile i'll keep pumping him/her full of meds/life support
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if his family want to sign the DNR paper for him, if the patient can't do it, no prob.
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this is not about religion, i think this is about Hippocratess Oath:
"Do No Harm"
heyyy i keep hearing the FSM references all over the place these days, what's up with that? anyone spreading the FSM gospel? :))
Anarki-13
I believe the FSM was started by the atheists. Don’t quote me on that though I might be wrong. It was started as a deliberate piss take on religion. Here and in the US you can start a religion over anything. All you need is one person willing to play priest and less than 24 followers and you can be registered as a real religion and in fact be able to legally marry people. So if you wanted to worship fire hydrants and had some followers you could legally marry people in your religion.
As for hearing about the same subject all the time its weird how that happens. A few years ago it was golf balls for me. I was finding them everywhere. And I don’t mean by hanging out on golf courses. I mean in the middle of no where in the bush. And I don’t meant one of two, I mean hundreds of them. Hundreds. In places golf balls had no biz being. I have no idea why. Did a plane explode that was carrying golf balls ? Don’t think so never heard of one going down here. But they were All Over The Place…. When I die I wanna know what was up with the golf balls. Maybe it was the coming of the FSM that did it ??? :-P
In the UK, option 1 is very uncommon, 2 and 3 are common practice, and 4 and 5 are illegal.
Religion would support option 1...do everything to prolong his life. But, is it really fair if the person doent want u to keep him alive (just like Malamute said)???
But then again, should u really help someone commit suicide?? Or even worse, kill them and end their suffering urself?
Personally i think that option 3 is the most reasonable...keep them as comfortable as possible until the condition deteriorates beyond the chance of recovery, and then stop life support and let nature take its course.
But then I think, who decides when recovery is not possible? Do we even have the right to decide such a thing? Isn’t it all in the Almighty’s hands? Miracles do happen...
i dont think age matters...a life is a life...regardless of age. Just because its an elderly person, i dont think that ending their life would be considered less of an immoral act.
We did not have the choice of being alive...so can we make the choice of ending that life? Shouldnt our soul be retracted by its creator at the time that He chooses?
So maybe option 1 is the 'right' choice...
But like Malamute said, what if that person doesnt have these beliefs?
"What is the prognosis of recovery and What is the quality of life expected"
Malamute, the answers to these questions would be based on assumptions and an educated guess...what if its wrong?? Who knows??
No1 can answer these questions but He...
WHAT IN THE WORLD SHOULD I DO???
You are Muslim. In your religion its up to god to decide when a person dies and assisted suicide is immoral. If you were say a doctor of a patient who isn't Muslim or any other religion that forbids suicide should you be compelled to assist, even though that person has been your patient for the last 20 years.
No. You shouldn’t. It is a very hard choice to make. One that should NEVER be taken quickly or lightly. Case in point.
I had a dog Kela. She was my alpha female. A malamute. Sweet dog, gentle loving. To me there is no difference in love. Yes there is romantic love and there is love for a child or parent, but to me love is love. I make no difference between species. If I love a dog its with all my heart. Kela got Cushings. It’s a tumor and there is a chance of curing it. However Kela was also 15 years old. Do I put her through the equivalent of doggy chemotherapy ? Or do I say, no this is what will kill her. First thing I did was learn all I could about Cushings in dogs. So I know what I'm dealing with. Things like what is the symptomology of the disease. Will she be in pain ? What sorts of physical deterioration will she have. I spent a month learning all I could about it. I also learned what to expect from the treatment. How its going to affect a dog that is 15. Then I decided to let her go. I wasn’t going to try to save her so she could have a couple of more years. So that something worse could get her, or the Cushings could come back… NOT an easy choice for me to make. I wavered back and forth for a couple of months. Dealing with it wasn’t easy. Part of the disease is the loses control of her bladder. I was up once an hour to let her out to go pee for 7 months. Seriously. Every hour including the middle of the night. I watched her get slower and slower. I watched it sucking her energy away. It truly broke my heart. I was playing god and hated every second on it. I'm not so wise to decide for another when they should die. Then in the spring I took everyone to the beach to play in the water and snarff the stinky things on the beach that dogs love so much. Kela loved the beach. Where I parked my car to the water line was only 100m. Kela couldn’t make it. She had to stop for a rest part way along. I walked with her cos I wanted her to know she wasn’t alone. My rules are we stay as a pack. If one cant go we all cant go. I wont leave someone behind. So we had a play at the beach, Kela stood beside me for the most part. She didn’t swim that time she was too tired. I sat with her and we watched all the other dogs play. Then we went to go home and again Kela couldn’t walk the 100m to the car. She needed a 20 min rest half way there. That’s the day I knew it was time. The balance is, are you keeping them alive for you ? Or are they staying alive for them ? Does it hurt so much they cant do what makes life worth living ? Or do they have more good days than bad ? That’s the day I knew I was keeping her alive for me. She just wanted to sleep. It was time. She had a long life, and she was much loved by us. I don’t take these choices lightly. I cried all the way home. I'm crying now in fact just thinking about her. After all this time I still miss her like crazy. She was my friend. To lose those we love HURTS. It’s the worst pain in the world make no mistake. But I didn’t want my friend to suffer. I made an appointment with the vet. My vet will come out to the car and give her the shot so her last moments aren't ones of fear in a vets office she doesn’t know. I had taken her out for a drive before hand. I held her as the shot went in. Told her that when she “woke up” again she would have a new life free of pain. Told her that Bobbers and Colour, and Tahshcah and all the others would be wating for her on the otherside. So she wouldnt be alone. I told her I loved her so very much. And she was gone…. After she was gone I felt like shit. I felt like I had murdered my friend. I don’t take this lightly, its not a mental exercise for me. ALL life is sacred to me. I once stopped my car on the highway to remove a small spider from my windshield. Place it in the long grass beside the road where it cant be hurt. Even though I'm terrified of spiders. ALL life is sacred. I would never presume to choose for you. I will argue you blue in the face if I disagree, I will tell you why I am doing what I believe is right for me. But I wont impose my beliefs on you. Only you can choose for you.
If we can do that for our pets why cant we do that for us ? Not everyone will want to go this way. Be it fear of death or for religious reasons, not everyone will want to have physician assisted suicide. Not every health care worker will want to be a part of it either. And they shouldn’t have to be a part of it if they have objections. But for those of us that don’t want to needlessly suffer there needs to be an option where we don’t have to. If I am very very lucky I’ll end my days in a green meadow. Going to sleep in a place where I'm not afraid (I have a phobia of hospitals since my grandfather died). Where I can pass beyond the veil with dignity and as pain free as possible. And I wont be dying alone. Animals have souls. There are a fair few now on the other side who are waiting to play with me again. I look forward to seeing them once this life is done. I wont be afraid. Life has a beginning and middle and an end. All points are natural ones. Death is only hard for those left behind.
I know this poem kinda negates my disbelief in heaven but I like it all the same…
Just this side of heaven is a place called Rainbow Bridge.
When an animal dies that has been especially close to someone here, that pet goes to Rainbow Bridge. There are meadows and hills for all of our special friends so they can run and play together. There is plenty of food, water and sunshine, and our friends are warm and comfortable.
All the animals who had been ill and old are restored to health and vigor. Those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by. The animals are happy and content, except for one small thing; they each miss someone very special to them, who had to be left behind.
They all run and play together, but the day comes when one suddenly stops and looks into the distance. His bright eyes are intent. His eager body quivers. Suddenly he begins to run from the group, flying over the green grass, his legs carrying him faster and faster.
You have been spotted, and when you and your special friend finally meet, you cling together in joyous reunion, never to be parted again. The happy kisses rain upon your face; your hands again caress the beloved head, and you look once more into the trusting eyes of your pet, so long gone from your life but never absent from your heart.
Then you cross Rainbow Bridge together....
Author unknown...
Well the thing is it doesn't matter what we humans think about whether Mr.X should be assisted to commit suicide to end his suffering or not cause his life belongs to God (whatever his religion is since there is but one God). But let's say that we don't want to get religion involved in this matter (which is fairly impossible) but let's just assume that then we will have to assist all the people who is thinking of committing suicide when in distress since emotional damage is more devastating than any physical damage so if Mr.X was in a severe state of depression that is very difficult to cure then we should assist him to commit suicide too, so can we do that?
In the end I may say that this is my opinion and I might be wrong in the eyes of other people...
awww malamute...thats a really sad story...sorry for ur loss
"Maybe it was the coming of the FSM that did it ???"
maybe indeed :)
sorry about your dog. truly sorry.
"That’s the day I knew it was time"
had one of those situations myself a few moons ago. found her hiding under a mattress, having crawled away to die. i carried her in my arms, she fought blindly, when i put her down on the ground, she just fell there,unable to lift her head even.
i just miss her so much.
Kitten:
why all the "life and death" stories/questions?
and just how come someone has to die in your stories? :) true its a very dramatic thing, perhaps THE most dramatic thing in someone's life, but still.. :) have you ever read Catch-22? if there's one story that ever changed my perspective on anything, its Catch-22 :)
anarki,
No i havent read it...but i think iv heard of it. Is it about someone who suffers from a severe fear of death, and is part of the air force of world war 2??
"why all the "life and death" stories/questions? and just how come someone has to die in your stories?"
Im not sure really. In fact, i hadn't even noticed until u just pointed it out!!!
The only possible explanation that i can give u, is that iv lost someone really dear recently...so maybe its a subconscious thing...i donno...
I promise i'll try to avoid the topic of death in my next entry :)
Choice number four. He wants to go, so respect his wishes.
Kitten:
"s it about someone who suffers from a severe fear of death, and is part of the air force of world war 2?"
yes indeed, and much much more!
read it read it read it read it!
even if just the first chapter! read it read it!
about death, Kittie don't avoid it, don't be afraid, its besides, if you force yourself to omit something out of your natural storyline, it won't be good, for you and for the story, yes?
take care Kitten :) how are your exams?
you've got a point anarki :)
my exams were fine thank u...and the book, i'll try to find it and read it...it better be good :D
FSM was started by some kid who was angry over Kansas Education's adoption of 'intelligent design' theory side by side with evolution, ID is really just religion posing as science, some say. Wiki it for more. Catch-22 is good but I think it is not for the faint of heart, there are more accessible mind-bending ridiculous books out there for grabs. As for this medical ethics thing, I suppose the best answer would be none, becuase i Will never be a doctor.
By the way, that malamute guy is a real boring nerd, he spends hours talking as if his life is depending on it and as if we're all as lifeless as he is to bother sifting through all those stupid wisdom pearls.
Catch-22 and finite state machines....er flying spaghetti monsters... don't mind me I'm just stupid.
And I would leave the decision to Mr X as long as it's not an illegal decision (ie. 4 and 5), if he was not capable (mentally or physically) of making that decision, then the nearest family member should do it, and so forth.
The doctor should be absolutely neutral about the situation, telling facts only and nothing more than facts.
This is the only way I would get out of a similar situation and be sure I did not make a wrong decision... and I think this is what is actually followed by proper medical ethical practices.
Frankly, I had a general idea about the comments as they need more than an hour to read, they all are obviously great, but what I simply think is : Medical care is optional and no one can say no to that, you have a flu?!, you can go to the hospital or just lay down, also, you can quit the hospital anytime you want, the patient could just say : I'm feeling OK and I will sue the hospital If I'm not let out, If he can't speak due to his illness then naturally what he said before he reached that state is what's counted on, morover, I won't kill him because we can't kill anyone who's suffering and about to die, may be he won't die! miracles happen, plus, a few weeks of suffering pass by like a thunder just like many years of suffering like many people lived and went.
Greetings.
the first mind-bending book i read was Arthur Clarke's 2061: Odyssey Three. i read it first at age 14, then another time age 18.. i still try to find time to read it again, but.. :)
i'd rather re-read Catch-22 or the Hitchhiker's Guide to the Galaxy.. or maybe the Dune series. hmm.
oh, seriously: i dont think you've tried Robert Howard's Conan stories? beautiful style. bucketloads of it everywhere.
if u'd like, i can find u DL links or send them by email..
actually i meant
Mind-expanding, rather than Mind-Bending.
bending a mind doesn't take too much effort from a book, expanding it takes a special kind of genius!
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