Ethics at the Edge of Life

The end of a human life is a complicated time. But when the end is near, healthcare providers often need to make tough decisions relating to how the person should be treated and what the family wants treatment to be.

Treatment

At the end of life, death can be caused by multiple things. Old age and brittleness can lead to one or several diseases proving too much for the body to handle, but commonly, terminal disease without any effective treatment options left can lead to death. While sometimes death is all but guaranteed, for healthcare workers, there is almost always a way to try to save the patient.

For example, let's look at a made-up patient named John. Like many others with terminal lung cancer, John has been a longtime smoker. When he received his diagnosis, he was assured that while the prognosis was poor, there were still treatment options that had worked for many other patients even if his cancer was Stage 4. Stage 4 typically means advanced cancer and one that can metastasize, or spread, throughout the entire body and its organs.

John, under the assurance of his family and doctors, begins chemotherapy and radiation treatment to remove as much of the cancer as possible. As the months go by, the chemotherapy and radiation treatments seem like they are helping John become stronger and healthier. For a few months, John miraculously seems like his old, happy self.

Then, the chemo and radiation stop working. The cancer returns from the brink, now resistant to chemotherapy and radiation. The doctors try to move to a secondary treatment option. John is hesitant, but his family assures him it will help. It doesn't work. Now, John is running out of options. It's clear he doesn't have much time left, and the doctors tell him so. From here, John has two options: start hospice care and spend time with his family in his last days on Earth or fight to the end and participate in unproven treatments or treatments still in their clinical trial phases.

The Decision

At the end of life, what decision is best? We often see the purpose of medicine to heal whatever ailment the patient currently has. But when do we need to abandon this philosophy to make the last few days pleasant? Hospice care focuses on keeping the patient stable without injecting new treatments at home, so they can live a slightly longer life while spending time with family. On the other hand, a patient might die alone in their hospital bed continually being injected with treatments, with no chance of recovery.

These hard decisions at the edge of life are difficult to make. But now, doctors are encouraging hospice as an alternate method to intensive, end-of-life hospital care. It saves money and also brings the patient to their loved ones in their final days. To make life better for people like John, enforcing medicine's limits may be best.