George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.

Point and Counterpoint: Abortion and Alternatives - Article 9, for Sunday, June 4, 2006

End of Life Issues….So, What Do We Do?

In our previous articles on this subject, posted for May 7 and for May 21, we delved into issues of “death and dying”.  The reader has probably correctly concluded that end of life decisions can be more complex than issues relating to the beginning of human life.  The emotional components are also much more complicated.  Today, we try to divide the issues into component parts, excluding emotion.  From that effort, we will offer recommendations for each of us to consider doing…before the time comes.  The issues can be divided into Medical/Ethical, Legal, Moral/Religious, and Personal.

  1. Medical/Ethical.  A physician has a continuing obligation to preserve life and never to take life: “Primum Non Nocere”.  However, a physician has no professional obligation to offer treatment that he or she considers “futile”, a determination that involves disease processes and not “quality of life” issues.     Artificial hydration and nutrition are ordinarily not considered “futile”, depending, however, on the mode of administration and on the specifics of the case.
  2. Legal.  There is a legal right of a patient to refuse medical interventions, under the doctrine of self-determination.  All interventions, including nutrition and hydration, can be legally and ethically removed.  There is no difference between withholding and withdrawing medical interventions.  The views of a competent adult prevail, if expressed.  In the absence of that expression, a designated surrogate can make the decisions.
  3. Moral/Religious.  Papal encyclicals have addressed many of these subjects.   These formulations, however, sometimes fail to provide sufficient guidance in concrete cases.  But one must consider the guidelines in forming a right conscience in such decisions.  Unfortunately, some commentaries regarding such guidance have been unhelpful.  Examples of this may be found in some of the comments of Wesley Smith in his book entitled: “Culture of Death: The Assault On Medical Ethics In America” (Encounter Books, San Francisco, 2000).
  4. Personal.  In addition to the constitutionally protected right of self-determination, the Compendium of the Social Doctrine of the Church is clear on the unity of man in body and soul, and on God’s gift of free will to all of us in conducting our lives, as informed by our experiences, by our Faith and by the Church.  We have choices, and we must live and die by those choices.
Therefore, our recommendation is that, after careful thought and reflection, each of us should complete an Advanced Directive (“Living Will”) and a Power of Attorney for Health Care Decisions.  Such action will inform our physician and our family of our wishes and decisions in this matter.  The alternative to this can be chaos, for us and for our families.

Peter Moore, PhD    George A. Sprecace, M.D., J.D.

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