Some of the most difficult decisions we are called upon to make are those we are asked to make for others. This is particularly true of the life and death decisions that we are asked to make for our elders, perhaps parents, grandparents, aunts, uncles, or elderly friends who are no longer fully competent to make their own decisions, and their health decisions fall upon us. The decision of whether to continue a costly treatment that is apparently not effective, the decision as to when to remove a ventilator, the decision of whether to undertake a new and painful course of treatment or not, these are all examples of the sorts of questions that elderly patients face daily and someone must make them if the patient is unable to make them personally.
There are two terms that are critical to this discussion. The first is care. Care simply means providing for the basic human needs of the person: food, water, bedding, warmth, relief from pain so far as that is possible. This is often called palliative care. The second term is treatment. Treatment refers to trying to fight the cause of the person’s deteriorated state, to work toward a cure or at least toward life extension. This includes things like various medications, radiation, chemotherapy, etc. which may be very hard on the patient in their own right.
From an ethical standpoint, Care is always required. There are no exceptions.
In trying to decide whether to pursue treatment or not, there are a sequence of questions to be asked, each with a “yes” or “no” answer although they may not be easy to decide, that guide the decision process to pursue treatment or not.
1. Is the disease fatal? yes go to 2, no go to 4
2.Is the treatment useful? yes go to 3, no treatment is not obligatory.
3.Is the treatment burdensome to the patient? yes then treatment may be refused, no then go to 4.
4. Is the treatment proportionate? yes then get the treatment, no then treatment is not obligatory.
The matter of being “proportionate” is perhaps a little bit vague, and must actually be considered in each case. Consider a patient who has a fatal disease, there is a treatment available that is effective, the treatment is not physically burdensome on the patient. The answers to the first three questions would all indicate that the treatment should be pursued, pending the outcome of question 4. If the treatment will render the patient disfigured, and therefore socially awkward, it may be refused. This is not to say that it must be refused, only that it may be refused. There are no doubt other better examples of the meaning of “proportionate,” but this is what comes to me at this point.
Some of the greatest difficulties with this will be found in making simple “yes” or “no” answers to the questions. A great deal of judgment is required for their application, but at least this is a guide to the right way to think about these matters. We know that death will come for each of us. What we want for those for whom we care is a good death with dignity, peace, faith, and confidence. We most definitely are not to do anything to hasten their deaths, but neither are we called upon for any heroic measures to extend life beyond its normal end. We must let those we love return to God who created them when He calls them.