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Using one of the readings for this week (Rachels, Callahan, or Brock on Euthanasia; the reading on futility; the Oregon Physician-Assisted Suicide reading), comment on the main ideas of Dr. Atul Gawande's Being Mortal book and video. Here's a video interview with him about his book and those ideas.
My comments for this topic include the article by James Rachels and Dr. Atul Gawande's ideas mentioned in his book and his video. First, I'll mention that Rachels argues the morality of active euthanasia. His belief is one that states that active euthanasia should be as accepted as well as passive euthanasia since they both come to the same end; that one is no different than another. He tends to argue that the acceptance of euthanasia in any form is an acceptable way to end pain and suffering if all is in agreement. In my opinion this removes the sacredness of life. Although, I do understand that a value placed on what quality of life is, is subjective. Dr Gawande makes a point about this. Each person has different goals and priorities that define what their quality of life is to them. He points out that the medical profession has not effectively served people's needs as they faced the end of life. This is an excellent and valid point to consider. A person facing end of life with an advanced disease sees his options as; aggressive treatment, or none. They may view this only in a medical way. This leads to despair, giving them the feeling of 'giving up'. Their choice to end it all quickly can rob them of possibly having some valuable, quality of life. Dr. Gawande brings up another option; palliative care. Palliative care starts by conversation with the patient. Asking them what are their priorities. What does quality of life look like to them. This type of care should be more widespread in the medical world. According to Gawande, studies show that the result has shown longer life, less harsh treatment, such as chemo, and more family time, lives ending at home with loved ones instead of in a hospital.
ReplyDeleteI agree Gloria, Dr. Gawande has so many valid points. Very good read! As medical professionals, I feel like we sometimes fail to recognize each individual patient's needs and wants in all aspects of care not just end of life. I know my mentality is to always want to "fix" them and their problems, when in reality this is not always possible nor do I really know if they want "fixed".
DeleteAfter reading all of the articles that pertain to suicide, Physician-assisted suicide, and active euthanasia I feel that Dan Brock’s article on voluntary active euthanasia had the most impact on me. Brock argues that there are two fundamental ethical values to support the ethical permissibility of voluntary euthanasia: individual self-determination (autonomy) and individual well-being. Patient’s should have a right to decide about life sustaining treatments or the withdrawal of those. A person should feel free to decide based on their own values, priorities, and concepts of what quality of life they would like to have left. If life is no longer considered a benefit by the patient, but now is a burden then they have the right to competently request euthanasia.
ReplyDeleteA person also must value self-determination and be allowed to live in accordance to their own conception of a good life, taking responsibility for their own life and the kind of person they have become. Brock points out that although we don’t always have a say in when our death will take place we should be able to have a say in maintaining the quality of ones’ own life, avoiding great suffering, maintaining one’s dignity, and ensuring that others remember us as we wish them to. So if a person is competent and able to exhibit self-determination then they should be able to control the manner, circumstances, and timing of their dying and death (Brock, 403).
In Dr. Atul Gawande’s book Being Moral, he discusses some of the same ideals. He points out that in the case of patients that have been diagnosed with stage 4 cancer, only one third of patients have had the discussion with their doctor about what their major goals are with care once their condition worsens. Patients that have had that discussion are noted to experience less suffering, improved quality with the time they have left. Gawande states that having autonomy is important. Historically patients explicitly trusted in whatever course of treatment was prescribed by the physician. They rebelled in the 70s to have more of a choice, greater autonomy and self-determination. Gawande also states that we should be “councilors” to our patients and discuss where their priorities are what outcomes are unacceptable and to respect them in the end.
I hope that if I ever get tho the point that I know that I am terminally ill that I would not only have the discussion with my physician about my values and wishes are, but that I will have the same discussion with my family so that everyone understands the decisions that I'm making.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
Gawande, Atul. (2014).Being Moral. New York, NY. Metropolitan Books.
After reading all the weekly cases/ articles, I leave these comments knowing there is never going to be a right or consensus on this topic. It’s easy for us to judge and to apply our beliefs to every case and disregard others’ experiences, what they live daily when we go home to our healthy families at night. That is something Atul Gawande has done well with the cases he sites in his book. He has listened to the patients, to their families. He has tried to put himself into their life situations and really address not only the physical and the disease process, he also has nurtured and treated their psychosocial needs.
ReplyDeleteHe made it clear how we went into this study of his stage 4 cancer patients with his surgeon mentality “I want to fix this”. He used the example of the heartbreaking story of Sarah, expectant mother to be, beloved wife. She very much wanted to live, to watch her baby grow, to enjoy her family. They jumped into treatment very much with a “let’s fix this mentality”, although he knew that was not possible, he hoped. In the end, after the aggressive treatment, her miracle cure did not happen and she was left too weak to hold her baby, too sick to enjoy and quality with her husband and child, She and her husband were left looking at each other, wishing they had instead taken the time they had, and lived it enjoying that quality time, taking the memories of that with them instead of the horrible final two weeks they had. This scenario has nothing to do with giving a patient a lethal injection, or withholding life sustaining care like food or hydration. It’s about assessing what their true attainable goal is, and making that work for them in the moments they face certain death. It was startling to me that less than 1/3 of the patients and families had actually discussed with their physicians their goals and priorities.
The cases he sites are not the extreme unrealistic cases mentioned in many of the other articles we have read. His cases are real, they apply ethics and morality on a case by case condition. It’s very personal and not about making examples of anyone, it’s about looking at what’s realistic, looking at patient priorities and making every last moment count to those patients and families, We do not see those “physician assisted suicide cases” where patients are being injected with a drug that will make the take their last breath; we do not experience the cases where we withhold surgery that could save their lives or the lack of could kill them. The cases we see are cases where every possibility has been exhausted and that patient is critical and facing certain death. Then, it’s not that care is just withheld then, it’s that the extraordinary, aggressive, unnatural treatments that are grasping at straws and are not normal functions the patient could do without advanced, invasive medical care are no longer forced upon the patients. The most realistic scenario in Gawande’s book to me is the one the 60-something year old woman who had a ruptured bowel obstruction, followed by an MI, septic shock and renal failure; she had her colon surgery, colostomy, coronary stents; she was on dialysis, intubated on the ventilator, receiving TPN; she developed gangrene of her foot, needed an amputation, had an open abdominal wound with leaking bowel contents; she was non-responsive… Those are the comfort care patients we see.
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DeleteIn contrast, Rachels uses extreme situations, most often hypothetical, trying to prove there’s no difference in passive euthanasia, letting someone die, and active euthanasia, the act of performing actions certain to kill the patient. His examples do not focus on case by case situations, never uses the idea of comfort care or palliative measures. His scenarios focus very specifically on technicalities, legalities and words. Gawande’s examples, which are his real-life experiences as a physician, focus on the patients and their families.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
Gawande, Atul. (2014).Being Moral. New York, NY. Metropolitan Books.
I chose to use James Rachels article as well. While I found that the two were very different, I felt as if they both seem to truly be concerned about the individuals wants and desires regarding end of life care. I enjoyed Gawande's book and video the most however. There are so many powerful quotes and stories that have really stuck with me. The quote Gawande makes about how end of life decisions need to be made prior to the final days of life really hit home for me. Then followed by the conversation in the video between the Grandfather and Grandson about how he was not afraid to die and reassuring his grandson by answering his questions was absolutely amazing! Brought me to tears!
DeleteI agree. I just felt like his holistic, proactive approach made such terrible events and circumstances more a positive for each of the families. I can definitely see myself reading it again and referring to it in the future.
DeleteCan I just start out by saying that video should have come with a warning label! I was a blubbering mess. My son asked me what was wrong… oh nothing, just doing homework. But getting on to the assignment, the book and video clip from Being Mortal definitely had the most impact on me. Gawande seems like a genuine, caring, and compassionate doctor/human being. I wish there were more like him. One of his main ideas is to focus less on prolonging life and more on making it meaningful to the patient. In the video clip we saw a husband who loses his young wife and mother of his newborn baby to stage four lung cancer. She underwent the treatments only to become sicker and weaker in her final days. The husband states, “I wish we would have started our quality time sooner.” I could not agree with that statement more.
ReplyDeleteIt seems in today’s society medicine and technologies have taken over, we have become more concerned with living longer, healthier lives. While that is the perfect goal, it is often unachievable and can greatly interfere with the quality of life in the end. In the article written by James Rachels, Active and Passive Euthanasia, he argues that if passive euthanasia (such as refusing treatment to prolong life) is morally permissible then why isn’t active euthanasia (such as a lethal injection to end suffering). He makes an extremely valid point of active euthanasia is typically more humane than passive, however, society and the law views it as killing versus letting die.
While Rachels’ article does not specifically mention “quality of life” it does seem as if the main focus on both of these author’s writings is that they are concerned with what is truly best for the individual. If the individual views quality of life as being pain free and no longer suffering then euthanasia may be the answer of what’s best for that patient. Whereas if the individual believes spending as much time with loved ones regardless of a specified timeline of death, then that is what is best for that particular patient.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 395-399. New York, NY. MCGraw Hill.
Gawande, Atul. (2014).Being Moral. New York, NY. Metropolitan Books.
I did enjoy our reading assignment and especially the Frontline video. The question about the morality of euthanasia and PAS is a difficult one on many levels. I understand both sides of the coin with regard to the patient's autonomy and dignity. A terminally ill patient, who can still make rational decisions, has the right to decided how he wants to live out his last days. With active euthanasia being against the law, the patient's only option in our society, other than in Oregon, is to invoke palliative care. On one hand, I wonder if palliative care isn't a possible form of passive euthanasia. All non-essential treatments and medications are stopped and only comfort medications and treatments are continued. It's the patient's rational choice to pursue palliative care. However, is some instances of extreme pain and suffering, wouldn't it be the patient's right to choose PAS or active euthanasia? In chapter 6 in our book, there is much discussion of how euthanasia and PAS will cause the deterioration of the value of life and be a detriment to society. It also states that euthanasia and PAS goes against the professional oaths taken by the physician. It further states there is a significant difference between killing and allowing to die. (Degrazia, et al.pp. 378-384). In my mind, it comes down again to the patient's choose. They have the right to autonomy and respect of their wishes. Do I think euthanasia should be legalized? I'm not sure how it would work as a law nationwide. Do I think physicians are missing the mark in some instances? YES! Physicians need to be more interested in end of life care for the terminally ill and dying no matter what their age is. Dr. Atul Gawande did his research and by life experience, learned how to say the difficult words to the terminally ill patient. He learned when to say treatments are futile, lets start looking at making the lasts days some of the best days.
ReplyDeleteAs a hospice nurse, we often get patients on the unit directly from the hospital setting. Their doctors haven't had those crucial end of life conversations with them. The patient doesn't understand what palliative care means. But I also understand, the patient may not be listening because they have been given the grave news that they only have a short time to live. I often hear from patients "give me a shot to end this suffering". Sometimes I feel the patient has been misled to believe that, in someway, hospice will perform euthanasia, which is not the case. Comfort care and the patient's right to autonomy is most important.