26 July
2013
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The Drawn-Out Indignities of The American Way of Death
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A
disturbing and surprising read for me. Under Australian law, people have to
right to decline treatments offered, but they do not have the right to demand
treatments that are not appropriate. Conversely, doctors are not obliged to
offer treatments that are considered futile. Regarding limitations of
treatment, it is the responsibility of doctors to first decide what
interventions will be offered in the event of deterioration. People can then
decide that they want less than what is offered, but they do not have to right
to demand beyond what is appropriate.
Despite
the finite resources of the health system, the main role of treatment
limitations is not to save money, but to not harm the patient; primum non
nocere. Although death has become a more taboo topic since the days of Queen
Victoria and Emily Dickinson, it remains an inevitable reality. When it is
time, people should die peacefully, with dignity, and without
unnecessary and prolonged suffering. Inappropriate resuscitation attempts
are not only futile, but rob people and their loved ones of this "quality
of death."
Therefore,
if resuscitation is not medically appropriate, I do not ask people if they
would want it, but tell them that it will not be attempted and why this is in
their best interests. In this situation, the choice is not theirs, for
while they have the right to decline what is offered, they do not have the
medical training and experience (other than starkly unrealistic television
portrayals of resuscitation effectiveness) to decide what treatments are
appropriate to offer. It is unfair to burden people with decisions that should
not be theirs and subject them to the risk of misplaced guilt, needlessly
wandering in silence for decades after whether they "gave up on their
loved one by pulling out too early."
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