The ethics of death and dying

by Sarah Vogel Oct 03, 2012 in Law

and Ethics

When I was studying at university,

one of my lecturers asked the
question, Has it become illegal to
die? We were studying end of life
issues and discussing how all too
often, doctors will do anything to
prolong the life of a patient,
whether this appeared to be in the
patients best interests or not. A
confronting question then, it is still
a pertinent topic as Professor
Bill Silvester has cause to know.
As Director of the Respecting
Patient Choices program based in
Victoria, he is responsible for the
discourse being undertaken in
hospitals, nursing homes and teaching facilities on questions such as When do you stop life
prolonging medical treatment and move to palliative care? A seemingly macabre topic, in reality it
empowers patients through providing an opportunity for their choices to be respected.
Advance care planning (ACP)
Creating an advance care plan, in which a patient specifies how they would like to be cared for in a
situation where they are no longer able to speak for themselves may be initially confronting, yet it is
both sensible and life affirming. Patients are able to plan things such as whether they would like lifeprolonging treatments should they enter a situation where this would be necessary, or whether they
would prefer the focus to be on comfort and pain management. It is sensible for patients to discuss
their plan with their doctors and most importantly with their families, as it can be an emotionally
charged topic. Also of importance is the fact than an ACP is legally binding and lawfully a Doctor must
act in the best interests of the patient (following what they have written in their ACP). The following
scenarios demonstrate how an ACP can be a positive, effective tool.

Scenario one
Edmond had end stage cancer and had succumbed to pneumonia. He was in ICU, where his
body fought to live, but his mind had already closed off, totally unaware of his surroundings. As
the doctor came through and prescribed another antibiotic, the family denied that this is what
Edmond would want. He would have hated to be here like this, he would have preferred to die.
Please dont give him those drugs, just let him go... Now the burden of decision making rested
on the doctors shoulders: would he be helping euthanise the patient if he didnt prescribe drugs
or should he do what he thought was best to prolong the patients life?

HLTHIR506C Handout

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Scenario two
Sasha also had cancer and the doctors estimated she had five months to live. At the suggestion
of her oncologist she sat down to write an end of life care plan. She asked for the focus to be on
pain management, not on prolonging her life if she was no longer able to interact meaningfully
with others. Sasha then called her family together and discussed her plan with them. They felt a
greater sense of peace and confidence in their decisions when it came time for Sashas plan to
be activated.

End of life planning

As part of his program, Dr Silvester has educated staff in nursing homes across Victoria about end of
life planning. As a result of this the number of patients transferred to hospital to die there has reduced
from 46 per cent down to 18 per cent. The Respecting Patient Choices program is continuing to
spread to other states, with both SA and NSW coming on board, although as yet the other states have
not recognised its importance. Although the program could save up to a third of a billion dollars simply
by running in aged care homes across Australia, the focus remains on improving the quality of patient
cares, not on financial savings. Not only do ACPs result in better end of life care, they also increase
the levels of satisfaction that patients and family feel about hospital care. Also of importance is the
fact that family members who could follow an ACP had a reduction in anxiety and depression six
months after the death of their loved one, and felt less burdened at the time of death.
Given the choice of going quickly, or long prolonged suffering, what would you choose?
References

Newton, J, R Clark, and P Ahlquist. 2009. Evaluation of the Introduction of an Advanced Care
Plan into Multiple Palliative Care Settings. International Journal of Palliative Care Nursing 15
(11): 554561.
Anon. 2012. The Ethics of Care: Death on Your Own Terms? Life Matters. ABC Radio
National. http://www.abc.net.au/radionational/programs/lifematters/the-ethics-of-caresegment/4125310.

HLTHIR506C Handout

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