virtual class room excercise

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Chapter 11

Death, Medicine, and Moral Significance of Family Decision

Making

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We Die Differently Now…

• Contemporary medicine has made the dying process very complex.

• This causes patients and families to make many difficult choices.

• Families often play important role in end-of- life decisions.

• Therefore, families need to be considered in end-of-life decisions.

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Romanizing Death and Demonizing Families

• The consensus is that end-of-life decisions should respect patient autonomy and the right to balance benefit with burden.

• This consensus sometimes conflicts with the autonomy of the professional.

• The main issue is the ability of the patient to make this decision.

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Romanizing Death and Demonizing Families

• There is a need for others to convey the patient’s preferences when he/she cannot do so.

• The family is assumed to be in the best position for this decision.

• However, they may not be disinterested parties.

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Romanizing Death and Demonizing Families

• We need to guard our judgments concerning starting or stopping life-sustaining therapy when the patient is not able to authorize this action.

• There may not be a match between what the patient wants and how the family member’s understanding matches this want.

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Romanizing Death and Demonizing Families

• Society has generated laws to empower patients to make their own decisions about death and dying.

• These laws attempt to protect their ability to die in agreement with their beliefs and who they are as people.

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Dying in Intimacy

• Previous claims about the role of families in the dying process have been overstated.

• Few people have taken advantage of advanced directives.

• The medical practice may be confused about the patient’s definition of a good death.

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Dying in Intimacy

• Many people think of their families as advanced directives.

• However, many people are not able to express their preferences for action in a future crisis.

• Advanced directives do not consider the nuances of a romantic death.

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Dying in Intimacy

• The ill are not excused from their obligation to family because of their illness.

• Selfishness is not the only approach to illness. • Policies should be made to recognize the role

of the family in making proxy decisions.

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Dying in Intimacy

• Hospitals have their own agenda when it comes to the dying patient.

• Patients need to be empowered in a setting which has the power to control their autonomy.

• Patients must be able to have contact with their sources of protection and personal affirmation.

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Solutions

• When people trust their families, they should be allowed to have them make proxy decisions.

• When they do not, non-family proxies could be appointed.

• Specific treatment directives could also be available.

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Solutions

• Most people will die without advanced directives in place.

• There could be a system of proxies in descending order beginning with the spouse.

• While not perfect, this system could make a good start toward addressing the problem.

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In Summary…

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