DEATH AND DIGNITY

Death and dignity

Death and dignity

Question 1

Patient consent is the principle that anyone over the age of 18 has the right to accept or decline all physical interventions, from operations and injections, to help with getting dressed. Providing that a person is competent (that they understand what is going on and the consequences of their actions) and that they are acting voluntarily, the decisions of adults about physical intervention cannot be overridden or ignored. Patients should not be under pressure, from the medical practitioner, or anyone in authority over them, such as a prison officer. Nurses and doctors can suggest treatment, but should answer the patient's questions and provide a balanced, full picture of the options and their consequences( Jones Mcculloug Fiduciary 2007 258-860).

A most contentious subject relates to the decision of patients to refuse life-prolonging treatment. The law generally gives adults the right to refuse treatment. However, one must often decide whether a dying adult is competent to decide or even communicate his or her decision. Legally speaking, adults are presumed to be competent to make decisions unless there are reasons to suppose otherwise. The right to refuse treatment is firmly established in British medical practice standards (2); the right to refuse treatment was upheld even in a patient diagnosed as psychotic who refused amputation of his gangrenous foot (3). In the United States, the Supreme Court in the Cruzan case is one of many which asserted the principle that individuals have the constitutional right to refuse treatment even if this may result in the person's death (4). This right has been reiterated in several other judgments even where patients did not have life-threatening illnesses.

Question 2

In this case the patients needs palliative care. Supportive, or palliative, care is aimed at comfort versus cure. The decision to accept such care versus aggressive treatment is often difficult for family members. It means accepting a poor prognosis, but it also means providing a very special kind of care to a loved one. It means a new goal of providing a peaceful, pain-free death in the presence of loved ones. Palliative care can be provided in the hospital, at home, or in a setting specializing in such care. The duration may be long-term over several years, or short-term, lasting days or weeks. Palliative care may include chemotherapy or radiation for pain control. ( Earle Neville Landrum Ayanian Block Weeks 2004 315-32) It is important to discuss that the goal of such therapy is not for treatment or cure, but to relieve pain and discomfort. Relief from pain and suffering is an important issue at the end of life. Drugs may help but only to a limited degree. Unfortunately, most drugs required for this purpose are not necessarily safe. These drugs may produce 'unintended harm' to the patient invoking anger or even legal liabilities against the doctors. For example, sedatives, administered to produce some sleep or give relief from restlessness, breathlessness and extreme anxiety, may depress one's respiration and other brain ...