By Charalampos Karouzos,
While we have just started navigating the highway of the 21st century, crossing the first quarter in a few months, the developments in the field of healthcare have led us in an important ethical crossroad. As medical advancements enable us to prolong life, providing not only more years quantitatively, but there has been a significant prolongation of the quality-of-life years, the issue of care at the end of life has risen at the surface. People are living significantly more and better than ever before, with previous dreams of eternal living coming closer to realization. However, a novel field regarding the ethical considerations surrounding the decisions made at the end of life has made the realms of healthcare even more complex. Balancing patient autonomy, the duty of healthcare providers, and societal perspectives on life and death is a delicate dance that requires careful navigation in the novel ethical dilemma that we must cross.
In the recent decades, end-of-life care has transformed significantly compared to the past when discussions regarding euthanasia and maintenance of one’s dignity were brought to an equal footing to assisted suicide not to mention death row. However, although advances in medical technology and interventions have empowered healthcare professionals to sustain life in ways that were previously solely part of one’s imagination, they generate novel moral debates regarding the value of prolonging life and the role of euthanasia as part of end-of life care. Indeed, pivotal questions have been raised that some decades ago were unseen, as “do you really want to live forever?”
One of the central tenets of medical ethics is the principle of patient autonomy. Individuals’ have, and must always preserve, the right to their bodily autonomy, including the medical treatment they must adhere to, extending to choices regarding the end-of-life care. Advance directives, living wills, and the right to refuse treatment are crucial components of respecting patient autonomy, that have been brought to the surface in the contemporary healthcare realm.
However, there is an increasing need to emphasize the importance of successfully striking the balance in the delicate equilibrium between preserving autonomy and safeguarding vulnerable individuals is addressed. Truly informed decisions can only be made by patients with preserved consciousness, so individuals which are not solely awake and responsive, but people that are able to process and hold significance about internal and external stimuli. Cognitive impairments, mental health issues, or coercion, all on the rise in recent years, directly compromise a patient’s ability to make truly informed decisions. This raises questions about how to navigate situations where a patient’s wishes may conflict with what healthcare professionals believe is in their best interest.
Furthermore, on contentious aspect of end-of-life care ethics is the debate surrounding physician-assisted suicide and euthanasia. Advocates argue that individuals facing unbearable suffering or terminal illness should have the right to choose a dignified death with medical assistance, rather than going through an unavoidable painful road where the sense of peace and respect to one’s final moments cannot be maintained. Opponents, on the other hand, express concerns opening this pandora box, with the potential for abuse, and the ethical implications of actively hastening death. In addition, the dilemma revolves around preserving life and respecting one’s autonomy and thus a nuanced understanding of the cultural, religious, and societal perspectives that shape these values must be reached. To prevent abrupt decisions on such a delicate matter, legal frameworks, as seen in jurisdictions where assisted dying is permitted, attempt to provide guidelines for responsible and ethical implementation.
End-of-life decisions seldom occur in isolation. In most cases, family members play a crucial role in the decision-making process, and their perspectives may vary; further complicating the issue. Disagreements among family members, differing cultural beliefs, and emotional distress complicate decision-making and add layers of ethical complexity, perpetually deteriorating the patient’s condition. Open and empathetic communication becomes paramount in fostering a collaborative approach between families, their autonomy, and the healthcare provider’s medical opinion.
Another wove in the complex tapestry of euthanasia is made by cultural and religious beliefs towards death and dying. Ethical considerations in end-of-life care must take into account the diverse perspectives within society, with different demographics prioritizing familial decision-making, while others may place a strong emphasis on individual autonomy. As a natural consequence, understanding and respecting these cultural and religious nuances by the healthcare team becomes crucial in providing compassionate and ethical end-of-life management, ensuring that the values and beliefs of patient’s are integrated into the decision-making process.
End-of-life ethical considerations in the 21st century, are the result of the technological advancement and enrichment of the understanding of health and disease, which combine prolonging living yet unable to prevent death. Nevertheless, consciously choosing to cut the wire is a decision that must be held in sturdy foundation of both logical and feelings. Making a holistic and compassionate approach essential, recognizing that end-of-life care is a deeply personal and complex journey with various ethical principles as of autonomy, beneficence, non-maleficence, and justice guiding these decisions.
References
- Providing Care and Comfort at the End of Life. National Institute of Aging. Available here
- Late Stage and End-of-Life Care. HelpGuide.org. Available here
- End of life and palliative care explained. Better Health Channel. Available here
- What is end of life care? Marie Curie. Available here
- An Ethical Review of Euthanasia and Physician-assisted Suicide. National Library of Medicine. Available here
- The ethics of euthanasia. Australian Medical Student Journal. Available here
