A 68-year-old female with stage IV ovarian cancer, whom I will hide under the name of Amy, requested me for a home visit due to difficulty of breathing. When I arrived, I first noticed her enlarged abdomen, but she was conscious. Four tubes were attached to her body for nutrition, airway support, and for draining excess body fluids. With her was her hired nurse, who was just about to wrap up her 12-hour shift. The patient was clean and the room was comfortable, and there was an indication that all measures were taken to make sure that the environment was acceptable for all family members and visitors.
Amy’s family is well off, and they can afford a hospital bed, airconditioning, and a round-the-clock 24-hour nurse. If ever hospital admission is warranted, Amy looks ready. She is undergoing chemotherapy, no longer to completely remove the tumor, but to control disease progression. She dislikes it and wishes to move on to the next life, but her family members want to do everything possible to keep her alive. This is the reason for Amy being attached to so many tubes. Upon the advise of her physicians, she needed all these contraptions.
In medicine, the goal is always to prolong life. Doctors are trained to do everything possible to keep the heart beating, and with today’s technology, there are so many ways to do this. From medications, to surgical interventions, to radiation treatments, and through the help of highly advanced gadgets and machines, a large hospital can provide the means to extend a person’s stay in this world. This, however, does not mean that the disease is being permanently eradicated all the time. More often than not, the outcome of treatment does little more than delay what is inevitable: the eventual demise of the sick individual. At the expense of maintaining a good quality of life, some medical decisions may force family members to accede to a physician’s advice due to ignorance, lack of a better alternative, or simply because of the promise of having “a little more time here on earth”.
A lot of people do not know that in most training institutions, the death of the resident physician’s patient is a cause of concern for the attending doctor. In audit conferences, medical consultants look at mortality statistics and ask a lot of piercing and not-so-friendly inquiries surrounding a patient’s death. This is a so-called “rite of passage” for the aspiring specialist. Thus, a young doctor learns to cover his or her tracks and does everything possible so that a patient does not die on his or her watch. An audit conference would mean an added workload, a possible tongue-lashing, and probably irreparable damage to self-esteem when mistakes and shortcomings are exposed.
When a trainee becomes a consultant, he carries with him this dictum: the patient must not die. He must do everything possible to keep the patient alive. If the patient’s family disagrees, this results in a very stressful situation for the physician. He suddenly recalls his audit conferences in training, and so he resorts to all arguments possible to convince the family no matter what happens. Medical expenses then skyrocket, and finances are exposed to the limit. When the patient disagrees, or when there is no other aggressive or invasive measure that can be done to prolong life, the family members are asked to sign a so-called “do not resuscitate order“, or are simply asked to go home against medical advice. Yes, it is as if in the medical field, death is unacceptable.
There are a lot of issues surrounding death. However, as we all know, for every man death is inevitable. It is all a matter of accepting it and being able to face its consequences. While both suicide and euthanasia are unacceptable, letting the natural course of illness take over is ethical and acceptable. And in certain instances, the right to withhold treatment may be necessary in order to preserve the dignity of life.
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