Ethics at the end of life

Ethics and the End of Life

Sometimes, when a human life is coming to an end, the most crucial aspect of providing holistic ethical health care is not maintaining life, but maintaining a semblance of familiarity and routine for the individual in question, and creating an equitable solution that satisfies the broad range of beliefs present amongst the members of all of the dying individual's loved ones. The recent case of Terri Shaivo, one must remember, came to the forefront of the national consciousness not because Terri Shaivo was unique in having her feeding tube removed -- as her husband Michael Shaivo reminded the media and the courts quite frequently, such a medical event transpires every day in hospices and hospitals where critically ill patients are being treated. What was so unusual about the Shaivo case was the level of disagreement amongst the woman's loved ones, about what the woman would have wanted, could she have articulated her full intentions and desires about what was a quality life. The devoutly Roman Catholic parents and Terri Shaivo's husband profoundly disagreed as to the woman's beliefs about when life began and ended.

In the wake of the legal disputes surrounding the Shaivo case, the Montefiore Medical Center in the Bronx has become even more closely watched in terms of its ethical procedures when dealing with end of life care. According to The New York Times reporter John Schwartz, "Montefiore is innovative in giving its bioethicists a central role in mediating end-of-life issues among doctors, nurses, patients and family members." (Schwartz, 2005) Montefiore's program uses the tools of mediation, common in business and divorce but relatively new to medicine, in the way that it facilitates communication amongst competing family interests, emotions and systems of belief that could and should, the article suggests, provide a model for health care institutions dealing with the terminally and chronically ill across the country.

The article affirms the notion that at the end of life, the living relations of the dying have rights, needs, and viewpoints that must be articulated for their own mental health. It is ethically and psychologically necessary to provide them with such a forum. At the bedside, "grown children and their parents can regress to childhood battles," as they rehash old grievances, and "hope" can understandably overcome scientific probability in the hearts of many healthy survivors. Without harshness, in such the director of bioethics at Montefiore and the founder of the program, says "getting to a common place is 95% cutting through conflict and 5% applying the rules of bioethics." (Schwartz, 2005, p.1)

But one could argue that the bioethical issue is not always the patient's immediate or long-term survival, but creating a feasible end of life situation that is amenable to the beliefs and emotional needs all family participants, without unnecessary legal proceedings, as occurred in the Shaivo dispute. (Schwartz, 2005, p.1) In the specific case chronicled in The New York Times article on the program, the individual in question had signed a living will, expressing her wishes for end-of-life care, and appointed her husband to make the decisions if she was unable to make them at the time her life was coming to its end -- still, to provide a venue for expression, the Montefiore procedures required that a hospital team including ethicists and staff members working with the patient work with family members to come to a cohesive solution for Mrs. Haber. Her husband, fearing life without her, was unwilling to 'let her go,' but having counseling made the procedures easier for him to bear.