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Advanced Medical Technologies and Terminal Illnesses

AdvancedMedical Technologies and Terminal Illnesses

AdvancedMedical Technologies and Terminal Illnesses

Theburden of disease has become a major problem in most nations today.Precisely, the prevalence of terminal illnesses has increased tosignificant levels in today`s world, and this has compelledclinicians to look for different ways of improving the quality oflife for persons suffering from these illnesses. Among theinterventions that are gradually gaining popularity in medicalpractice is the use of life-sustaining technologies, which are slowlyreplacing the concept of euthanasia (Ezra, 2006). Life-sustainingtechnologies are deemed helpful in averting the pain and complexitythat is associated with death. Even so, complex ethical and policyissues have been raised concerning the utilization of suchtechnologies. Like most other medical technologies, life-prolongingtreatments are viewed with great skepticism by religiousorganizations (Patel &amp Rushefsky, 2014). In addition, attentionneeds to be paid to the fact that the nursing practice is executedwithin an ethical platform (Zerwekh, 2006). What this means is thatevery single decision and action made by a nurse can generate ethicalconflicts. The situation becomes more complicated when it isconsidered that the central objective of medical care is to prolongor sustain patients’ lives (Thompson, Hickey &amp Thompson, 2016).Going by this latter statement, it appears perfectly acceptable forclinicians to use any technologies that will prolong a patient`slife. Clearly, the utilization of life-prolonging treatments andtechnologies is a controversial issue, more so from an ethical pointof view. This paper explores the ethical issues related to the use ofsuch technologies on terminal patients, including those who are in avegetative state.

Background

Inmedical care, a vegetative state is a terminology used in referenceto a situation whereby a patient appears to be in a coma, but he orshe seems to be wakeful as the eyes are open. The situation canbecome persistent, where the affected person lacks awareness togetherwith wakefulness. Additionally, patients in such a state have nocognitive function (The Medical Dictionary). The difference betweenvegetative state and a coma is that unlike the vegetative state wherethe person may occasionally make body movements, people in coma donot exhibit any motion, even when exposed to pain. Additionally,people in coma stay with their eyes closed, whereas in a vegetativestate, a person`s eyes are open and he or she may yawn or cough(Fabiny, Sabatino &amp Coltrera, 2009). On the other hand,life-prolonging or life-sustaining treatments refer to any kind ofmedical procedure or technology, as well as drugs, which are given topatients with the aim of forestalling the time of death. As thedefinition implies, life-prolonging treatments include proceduressuch as mechanical ventilation, cardiopulmonary resuscitation,chemotherapy, artificial nutrition, and haemodialysis.

Regardlessof the disease from which a person is suffering, use oflife-prolonging technologies has received strong opposition fromreligious as well as cultural viewpoints. For example, it is commonlyargued that it is wrong to attempt to prolong a person’s life, asthis goes against the natural order as well as the divine lawsestablished regarding death (Lucke et al., 2010). Similarly, it isargued any attempts to extend human life are unethical because theyresult in an unnecessary waste of scarce resources to the benefit ofonly a few individuals. Elaborating on this school of thought, Luckeet al. (2010) cite the concern that the development oflife-prolonging technologies consumes a lot of resources, yet theyonly benefit the very wealthy people. The argument is thatlife-prolonging technologies widen the socio-economic gaps betweenthe affluent and the less-privileged and that due to resourceinequalities, a majority of patients die prematurely. Besidesviolating the principle of justice, certain medical technologies arealso thought to compromise the patient’s dignity, which is veryimportant in healthcare delivery. According to Patel and Rushefsky(2014), some innovative technologies clash with the norms, values,and traditions to which the patient adheres.

Useof life-prolonging technologies on patients in vegetative state

Fromthe foregoing discussion, it is evident that the use oflife-sustaining technologies generates ethical controversies.However, it is important to evaluate the acceptability of thepractice in the context of terminally ill patients. A review ofexisting literature reveals mixed opinions regarding theacceptability of the practice. On the one hand, there are those whoargue that life-prolonging treatments should be withheld when dealingwith persons who are in a vegetative state. For instance, Price andMcNeilly (2009) have outlined five situations in whichlife-sustaining treatment may be considered unethical. These includea situation where a patient’s vegetative state is permanent,meaning that he or she is severely traumatized and totally dependenton others. For such a person, it is somehow hopeless to be put onlife-prolonging treatment due to the notion that he or she no longerhas a purpose in life.

Incontrast, there are those who strongly feel that persons inpersistent vegetative states or irreversible coma requirelife-sustaining treatment. Having mentioned that life-sustainingtreatment comprises a variety of procedures and technologies, one ofthem being artificial nutrition, the recommendation that personssuffering from irreversible coma should be tube-fed counters theclaim that such patients in a vegetative state do not requirelife-supporting treatments. In fact, research shows that patients whofind themselves in a state that is persistently noncognitive- alsocalled irreversible coma- can only survive through tube feeding(“Life-sustaining Technologies, n.d). If the question of ethics isapplied to this finding, it emerges that withholding this much-neededsupport to patients is unethical because it deprives them of thefundamental right to survival.

Alsoin support of the idea that terminally ill patients should be put onlife-prolonging treatment is the realization that even though mostterminal conditions affect the functionality of the brain, leading toa condition known as brainstem death, it is not always guaranteedthat the affected person will not regain his or her cognitiveability. According to Leach (2014), there are some instances whereterminal illnesses impair cortical functions of the brain, but leavethe brainstem intact. The author states that in such scenarios, it isnot easy to make the decision of withdrawing treatment. The reasonfor this is that there is a possibility of the person regaining hisor her cognitive function. Consequently, life-sustaining treatmentscan only be ruled out where it is evident that the person will neverregain his or her cognitive behavior. In any case, it should beremembered that being in a coma or vegetative state does not meanthat a person’s bodily functions have stopped by virtue of theirbrain stem being intact, such persons are still breathing unaided(Gigli &amp Zasler, 2004). For these reasons, it is only ethical forclinicians to put such persons on any life-supporting treatment thatis necessary to help them recover their bodily functions.

Still,on the issue of vegetative state and advanced medical technologies,Gigli and Zasler (2004) not only support the idea of putting patientsof artificial nutrition they also recommend the administration ofmechanical ventilator support for a minimum of one year. According tothese authors, the possibility of misdiagnosis in medical practice isnot unheard of there could be instances where doctors wronglydiagnosed a patient as suffering from irreversible coma. In light ofthis reality, any rash decisions to withdraw treatment might causeearly death to patients, which is highly unethical because itcontravenes the principle of no harm.

Ina summative statement that answers the question of whether or not isethical to use life-prolonging technologies on persons in a coma orvegetative state, Gigli and Zasler (2004) assert that cliniciansshould be very reluctant in showing despair on such persons, and thatevery relevant life-sustaining intervention should be employed up tothe point where it is decided that the patient`s health cannot berestored.

Thetopic of the ethics of life-prolonging technologies has also beenapproached from the dimension of its impact on quality of life. Keown(2012) has written a very interesting book in which he argues that inas much as every life is worth living, not every treatment is worthgiving. The author backs his statement using the observation thatsome treatments are too extraordinary, yet they do not add value topatients’ lives. To be precise, the author states that somecircumstances are too burdensome and futile for extraordinarytreatments to be administered. This assertion has a lot of relevanceespecially in the context of terminal illnesses, which refer to allthose conditions for which accurate medical diagnoses have been made,and about which death is certain. This is to say that terminalillnesses are beyond cure together with palliation (Keown, 2012).

Inaccordance with the definition of terminal illnesses, the perceptionis that the primary duty of clinicians is to employ every suitablemedical skill and knowledge to ensure that the patient spends theremaining days of his life in the highest level of comfort possible.In other words, doctors should focus more on managing the patient’ssymptoms as opposed to prolonging his or her life (Keown, 2012). Infact, any form of treatment whose objective is not to managepatient’s symptoms is regarded unethical and inappropriate. Again,this gives the impression that life-sustaining technologies areunethical for use on patients with terminal illnesses.

Ithas been mentioned earlier that even though persons in the vegetativestate lack cognitive ability, it is very important for them to be puton artificial nutrition. In response to this claim, critics assertthat artificial nutrition is inconsequential in improving the qualityof life for terminally ill persons. One of the arguments that havebeen raised in opposed to the practice is that even though artificialnutrition is helpful because it provides nourishment to the patient,it is of no use in alleviating pain or suffering (Fine, 2005).Clinical ethicists argue that nourishment adds very little value toterminally ill patients, essentially because it has no role in thealleviation of suffering (Fine, 2005). On the same note, concerningthe fact that the biggest medical need of terminally ill patients isthe alleviation of suffering, then it would be pointless andunethical to try administering life-prolonging treatments. Going backto the issue of scarce resources and justice, the use oflife-prolonging treatments on terminally ill patients could be saidto be unethical because it allows wastage of resources.

Expandingon the concept of suffering, it may rightly be argued that theadministration of life-supporting treatments on persons in avegetative state is by itself unethical because it subjects them tounnecessary burdens from which there is no hope of recovering.According to Fine (2005), artificial nutrition is a futileundertaking because it does not put the patient in a position topursue higher-order goals in his life. In other words, no matter theamount of artificial feeding that the patient gets, the chances ofhim or her recovering from his situation and resuming personalactivities are minimal. In addition to this, artificial nutritiononly contributes in keeping patients in a state of persistentvegetativeness, meaning that the patient will never be able tofunction independently. When approached from this dimension, thepractice of artificial hydration should be abandoned because it putspatients in a state of permanent dependence, and this is a violationof personal dignity.

Regardlessof the validity of the statement that persons in vegetative statesare still living beings largely because they can still breathe, it isimportant to keep in mind that death is an inevitable phenomenon. Asmuch as it is biologically justified to use life-support technologyin an attempt to prolong a person’s life, the inevitability ofdeath is reflected in the report that a significant number of deathsthat have been recorded in the United States take place within theintensive care unit, wherein the use of life-support technology iscommon (Li, 2013). Moreover, the harsh reality is that a vegetativestate is, in most cases, a hopeless situation to be in. This is inlight of the fact that there is no welfare, therapeutic, or medicalbenefits reaped from continued treatment (Tingle &amp Cribb, 2014).In view of these facts, two ethical considerations appear to be inconflict: life’s sanctity and minimization of suffering. Of thetwo, the idea that patients should be subjected to the minimum amountof suffering possible appears to have more weight.

Conclusion

Takingcare of dying patients is a very complicated task, primarily due toconflicting viewpoints regarding the end of life. With reference toterminally ill patients, whose chances of recovery are zero, thequestion of whether or not life-support technologies should beutilized has generated a heated debate. The research conducted inthis paper reveals that supporters of the use of such technologiesquote the idea of life being sacred, as well as the duty ofclinicians to help sustain patients` lives. More importantly, and inreference to persons in a vegetative state, the use of life-supporttechnologies is accepted because it acknowledges the fact that suchindividuals are still living. Despite the credibility of theseclaims, arguments in opposition to life-sustaining technologies havebeen found to be weightier and more convincing. From an ethical pointof view, it has been established that artificial nutrition, which iscommonly administered to persons in the vegetative state, isinconsequential and unethical because it prolongs patients’ liveswithout causing any improvements in the quality of life itself.Precisely, life-supporting treatments are usually administered withthe purpose of alleviating suffering, given that persons in avegetative state do not experience any pain, it is irrelevant toadminister such treatments. Another ethical issue that has beenraised in opposition to life-support technologies is that itencourages wastage of scarce resources, besides benefitting a richfew at the expense of many poor persons.

References

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