It seems pretty straightforward for some folks, when a person is in more pain than pleasure — when they can’t really have good interpersonal relationships because of that pain — then, it’s ok to end the life — BUT, it’s often more complicated than that.
The problem is often that we don’t want to talk about the end of life.. it makes us sad, it brings home the idea that we are finite beings whose minds and bodies will fail.
Several years ago I was part of the decision to end life support for my grandfather. I’ve written about it here — the interesting part about the whole decision was that the family was in agreement, it was time for Grandpa to be let go.
One woman on the healthcare team disagreed — and since my mom was the one doing most of the visiting of Grandpa in the ICU, mom ended up taking the brunt of her unprofessional behavior.. the first time.
The second time I stepped in. At the time I was teaching biomedical ethics. We’d just discussed the idea that healthcare providers and patients/families may have different values, and that an important virtue of a healthcare provider is to let the values of the family take precedence. That wasn’t the case with this particular physician.
The scene was a crowded ICU waiting room (first violation.. really, those folks don’t need to know my Grandfather’s kidney function numbers.. ). She sat down and pretty forcefully told my mom that she was killing my grandfather — not exactly in those words, but the message was clear. I was observing — probably wearing the same jeans and t-shirt I packed for a 2 day visit that had been suddenly extended — and I’m sure I didn’t look like a bioethicist (whatever they look like).
When I spoke up, she looked stunned. Clearly I wasn’t the chunky, not-well-dressed relative there to hold Mom’s hand. I then told her that I didn’t like the way she was talking to my Mom — that mom had been a nurse for 40ish years and that she had plenty of professional experience. I then told her that she was out-of-bounds, that I was a bioethicist and that I thought she was imposing her beliefs on my family.
She asked what I meant — and I told her… then I started to ask questions… is what she’s proposing to do to my Grandfather invasive? Could it cause him pain? (I knew the answers, she wanted yet another line put in him so she could do dialysis on a 90-year-old man whose other functions were clearly failing and he wasn’t even awake to decline treatment we all knew he’d decline).
I asked her if she ever met my Grandfather prior to his being admitted to the ICU? Did she know that he was an extremely active person, even for 90? Did she know that just prior to his collapse, he’d ridden his bike a few miles and was coming home for a nap? Did she know that he was never happy in an office job, and made his career active and out doing environmental clean-up to reclaim coal mine sites in Iowa? Did she know that, even at 90, he was playing golf most days and generally was unhappy being incapacitated — and that if he ever did wake-up from the surgery to repair his aortic aneurism that he’d have to be inactive for a long time?
Of course she didn’t know any of that — she was making decisions based on one test result.. a test result that had a very small improvement, but that was no evidence that my Grandfather was struggling to live (as she claimed). She didn’t even know, as my mom did, that when mom changed his hearing-aid battery he winced when the inevitable screech happened..
That’s why my partner and I are very clear with one another.. in fact, the point at which I consider our long-term commitment to each other was when he asked if I’d put him out of his misery if he was incapacitated…
So, we go into this whole marriage thing with that resolved…. no question that when he gets to be in his 90s, can’t function etc.. I’m going to put on some Grateful Dead and sneak up behind him with the bolt cutters — (currently the heaviest tool in our house..).