Can The Person Find Meaning In Life?

What are our moral obligations and duties? But for many decades, and frankly as long as transplantation has existed, there’s been a growing need for donated organs and tissue. We’ve reached a point where we need to consider what we can and can’t achieve for your mother. There are days when we think she’s getting better and recognizes us and other days when she doesn’t react at all. If she could talk, we think she’d say, Please let me go or Just end it, please. Should we really stop all treatment? That seems like killing her. She may look bad to you, but she’s fooled us in the past. Family members often will ask us what they should do, saying This can’t go on, expressing feelings of hopelessness. This isn’t surprising, given how stressful, complicated and uniquely disruptive it can be for family to care for a loved one who’s comatose. It’s common for some ethical dilemmas to arise. Most humans have a desire and a need to do good, and they can recognize what’s intuitively wrong. Along with the irrevocable loss of someone they love, family members have an obligation to honor their loved one’s wishes. Making decisions based on gut reactions should be avoided because the choices often can be irrational.

Will Anything Happen?

Achieving moral compromises during family conferences is an important goal when caring for a comatose patient. This often takes commitment and time. As physicians, we constantly must ask ourselves if we’re doing good rather than harm and if we’re working from a highly balanced assessment of the situation. I’ll focus on the personal side and not just philosophical theory. I don’t pretend to offer solutions or extraordinary advice, but I will examine issues that worry physicians when we make ethical decisions. Because the issues involved are becoming ever more complex, it’s easy to drift from reality into abstraction when discussing them. What is neuroethics? This burden, ultimately, involves everyone striving to do their best. Doctors need to be careful not to be lackadaisical or to take an extreme position if it’s not warranted. Coma, and certainly one that’s prolonged, immediately invites questions about the goals of care. The topic of futility may arise, but it’s hard to define and grasp, and some ways of defining it are questionable. Futility may mean continuation of care despite a hopeless situation, not letting nature take its course. It may be viewed as treatment that won’t accomplish a set goal, or when the burdens, suffering and costs of treatment far exceed any benefit.

A Matter Of Trust

A person’s outcome is never a simple statistic. Although the determination of futility is imprecise, pragmatic judgments are necessary in daily medical practice. Without them, the patient, physician and family remain at a standstill. Medicine would become a corporate discipline if medically unnecessary treatments were given without serious critical reflection. Futility is when we determine that there’s no possible way to reverse an individual’s downward course and achieve a good outcome. Once that’s established, we can adapt and provide a different type of care, such as palliative care. Remember that care of a patient never stops until there’s finality and eternal rest. Any possible course of action in medicine can lead to ethical questions. Whenever we take a position, some people will agree with it, and others will not. No matter which side you’re on, ethics can’t be viewed in terms of black or white, good or evil, or right or wrong. We always must balance morals and values and recognize each other’s good intentions. Relief is achieved through pharmacological means or by ending all useless interventions.

Race Against Time

Strongly conservative religious beliefs deserve respect, but they shouldn’t become the dominant ethical stance. Older traditions may give way to newer traditions or beliefs. While still healthy, many patients inform family members that they don’t want to be a burden to others if they became ill or are injured. Of course, we can’t confirm what was said, and seldom can we ask the individual because few patients in intensive care are able to make such decisions. Maximal therapeutic effort but only for a specific period of time with reassessment of whether adjustment is needed. No cardiopulmonary resuscitation. Attention given to comfort, including oxygen therapy for shortness of breath and analgesics for relief of pain. If the patient improves, reclassification may occur. All therapy stopped and nursing continues. This is often where differences between physicians and family members originate. When it comes to issues regarding care, health care staff know they may be on the receiving end of criticism. Questions such as, Why are you doing that? Why aren’t you doing more? Why are you hurting my mother? Why isn’t anybody taking care of her? are common. We understand that families of comatose patients are emotionally stretched to the breaking point despite our best efforts to support them as we care for their loved ones. Physicians want to provide maximal care, but as compassionate human beings, we can’t disregard a patient’s or family’s wishes that we stand down and let nature take its course, particularly if the request is legitimate. Ethics are tools to help interpret quality of life, a term that’s not easy to define. There are just as many definitions of quality of life as there are people trying to define it. Yet no matter how good we think we are at describing quality of life, it’s still a judgment call. It also may be quite relative and different for a person in a coma after a major brain injury than for someone born with a major brain dysfunction or with a slowly progressive neurologic disorder. The questions we ask about quality of life in a comatose individual are different. How much can he or she adjust? Can the person find meaning in life? Will the loss of many pleasurable and meaningful activities result in a joyless existence? I think we’d all agree that a life consigned to passive compliance, and in which one may be pitied and possibly ostracized, isn’t dignified.