Pondering Life and Death: Present Ethical Dilemmas in Medical Care
"Avoiding Contemplation of Life's Limitations is Preferred by Many"
In a world where the life-death spectrum is being constantly redefined by advancements in medicine, Alena Buyx, a renowned medical ethicist, sheds light on pressing questions that are vital for every individual to consider. Her latest book, "Life and Death," delves deep into these issues, interrogating fundamental ethical conundrums that we often prefer to overlook.
ntv.de: What's the most горячие (pressing) medical ethical question that's currently on people's minds?
Alena Buyx (AB): The two primary questions are, "How do I choose to live, and how do I wish to die?" While the first question encompasses personal lifestyle choices, health, illness, and medicine, the second question is central to her expertise. 70% of individuals expire in healthcare facilities, not necessarily in peaceful circumstances. 11% of Germans end their lives on life support.
With so many claiming they wish to determine their own end, why are so few prepared and reluctant to draw up an advance directive or appoint a healthcare proxy?
AB: The stark truth is that none of us genuinely wants to contemplate our own mortality. This reluctance can even be observed in organ donation. Despite more than 90% of people viewing donation favorably and expressing a desire to donate, not everyone has filled out a donor card. Fears, both irrational and informed, can often play a role. Some individuals fear the possibility of being simply switched off.
Is this fear justified?
Research indicates that clinical ethics consultation often leads to patients having extended lives. Anecdotally, Buyx attests that in many cases, treatment continues longer than desired.
How can this knowledge aid in making informed decisions?
Being well-prepared offers a sense of peace and clarity for individuals. Knowing a person's wishes for their twilight years makes it easier for others to make decisions on their behalf, which is frequently necessary. Some individuals wish to fight until the bitter end and take every chance to regain consciousness. In such cases, long-term artificial ventilation is a necessity. On the other hand, others express a desire not to be artificially ventilated, to avoid intensive care units, and to accept that cancer will ameliorate their condition and shorten their life. These contrasting approaches necessitate discussion and documentation to facilitate a smoother process.
Panorama, Five Years of Corona in the "ntv Salon": Have we learned anything, Alena Buyx and Christian Drosten? What has changed?
The aftermath of the pandemic has provided a new perspective and a semblance of readiness. Even though stressful and testing situations remain, individuals are more prepared to face them, finding solace in camaraderie and shared experiences.
Is it different for those who are young and have accidents compared to those at the end of long, fulfilling lives?
Indeed, the context matters significantly. Acknowledging one's unique life situation is essential while making choices.
Guide: Help, I'm getting old. These seven documents regulate legal precautions. What should one definitely regulate, and what could one be guided by?
Preemptive care planning is essential for anyone facing chronic or life-threatening conditions. Consultations with specially trained professionals are available. The process begins with an emergency card and escalates to a patient's decree, with the authorization of someone who is then tasked with making decisions on one's behalf. For those without illnesses, discussing these questions with friends might provide valuable insights or prompt them to reconsider their own plans. Talking to older and sicker individuals offers an opportunity to understand varying perspectives.
How can a hospital setting support a peaceful end?
Attitude is essential. Rather than approaching the scenario with an adversarial mindset, acknowledging the challenges facing the healthcare system can help foster cooperation. By expressing desires, conversations can ensure that care aligns more closely with personal preferences, leading to a favorable outcome in most instances.
Panorama: Midwife and funeral director "Being born and dying connects us all." In an increasingly less religiously bound world, these medical-ethical questions are often considered religiously justified. What does this imply about us that we resort to religious beliefs that no longer hold significant importance in our lives?
Religion acts as a reservoir of values when faced with existential questions. While religious beliefs may no longer be the primary focus in daily life, they frequently surface in critical situations. Owing to their historical influence, religious arguments remain relevant in contemporary debates.
Enrichment Data:
- Advance Care Planning: A comprehensive, person- and family-centered effort to ensure that all adults with serious illnesses are actively engaged in understanding and sharing their personal values, preferences, and discussions regarding healthcare. https://www.theoncologist.com/doi/full/10.1634/theoncologist.17-0380
- Advance Directives: Legal documents that allow individuals to specify their healthcare preferences in the event that they are unable to communicate their wishes https://www.ncbi.nlm.nih.gov/books/NBK532962/
- Decision-making capacity: Ability to understand and appreciate the nature and consequences of proposed medical interventions, to make and communicate intelligent choices https://www.ncbi.nlm.nih.gov/books/NBK543279/
- Clinical Ethics Consultation: A service provided by healthcare institutions to help physicians, nurses, and other healthcare professionals address ethical dilemmas in patient care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2273117/
- Assisted dying: Voluntary ending of a person's life with the assistance of a healthcare provider https://www.ncbi.nlm.nih.gov/books/NBK532962/
- Palliative Care: Care for individuals with serious illnesses, focused on relieving pain, managing symptoms, and improving quality of life https://www.ncbi.nlm.nih.gov/books/NBK546636/
- Palliative Care for Mental Illness (PCMI): Specialized multidisciplinary approach to manage the physical, emotional, social, and spiritual needs of individuals suffering from treatment-resistant mental disorders, especially in advanced disease stages https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033648/
- In light of the increasing importance of advance care planning, it might be beneficial for communities to provide vocational training to healthcare workers and medical professionals to ensure they are equipped to handle conversations about end-of-life decisions, palliative care, and mental health considerations, contributing to health and wellness in their entirety.
- As medical ethical questions increasingly intersect with science, mental health, and healthcare policies, it is crucial for the public to be well-informed about medical-conditions, their treatments, and the available options for managing thoughts and feelings that might arise during challenging situations, aiding in informed decisions and promoting a peaceful end-of-life experience.
