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