Withholding Life-Sustaining Treatment: Ethics and Disability

Introduction

This paper reviews the case study conducted by Werth (2005) exploring the ethics and morality of withholding life-sustaining treatment from a select population — in this case, individuals with disabilities. Werth (2005) concerns himself with a review of the ethical and moral dangers associated with withholding life-sustaining nutrition and hydration among patients with disabilities, examining a specific case of an individual who died as a result of such actions.

This issue, like any matter of life and death, is charged with considerable emotional intensity, as noted in the review of the subject and in other studies exploring similar case histories. Historically, the United States has devoted significant attention to this subject. The SUPPORT Study (1995) offered arguments for withholding treatment while also suggesting that too many people — including those with disabilities — are left to die under poor conditions (Freeborne, Lynn & Desbiens, 2000; Werth, 2005). Werth appears to argue in favor of offering patients the choice, under certain conditions, to withhold treatment. The position taken in this paper is that such a choice may only be made if an individual — disabled or not — provides those responsible for his or her care with an appropriate power of attorney or an advance directive that clearly explains his or her preferences.

It is critical that the individuals involved do not introduce bias that may influence the ill or injured patient's or family member's views on such decisions — a concern affirmed by Werth (2005) in his observations of the SUPPORT Study and in his own work with disabled populations. Werth raises the concern that while considerable support has been given to the right to assisted suicide, little attention has been paid to the possibility that individuals with disabilities may experience bias and be influenced by the negative opinions of others when deciding "crucial aspects of the dying process" (Werth, 2005, p. 31).

Discussion: Patient Autonomy and Sound Judgment

Legally, morally, and ethically, the decision to end one's life should depend on multiple factors, including the patient's capacity to be of sound and rational mind — which may be the case for many patients with disabilities. As acknowledged by Freeborne, Lynn, and Desbiens (2000), in certain cases the decision to withhold support may come from outside sources, particularly when the individual involved lacks the capacity to make a choice and has not provided a will or advance statement outlining their preferences in the event they cannot sustain life without nutrition and hydration.

While most patients who face the possibility of critical illness are given documentation they can sign to record their preferences, this is not always the case — nor may it be appropriate for individuals who are not of sound mind, such as those with severe injuries or certain disabilities, as discussed extensively by Werth (2005). Even patients without disabilities may be influenced by negative thinking or external pressures, as Werth (2005) suggests when addressing the right-to-die process.

If a patient is of sound mind, he or she should be presented with both sides of the issue and given appropriate time and psychological support before any agreement is reached regarding the withdrawal of life-sustaining treatment. This view is echoed by Freeborne, Lynn, and Desbiens (2000), who argue that patients — including disabled patients — have rights, and that special and careful consideration must be given in these cases to ensure that the patient, not the physician, is making the final decision, provided the patient is in a sound psychological state.