Learn to live with what you are – 2

As a follow on from the recent post, let me try to simplify where I’m at, or at least my confusion.

Perhaps using the example of a severely ill infant is too rare and specific a case to be useful in articulating a theology of medicine. My bigger interest lies in how we treat the frail elderly and care for people who may or may not be dying sooner than others.

Death is our enemy and a horrid thing, but it is not medicines job (and definitely not in our capability) to eradicate death. That is guaranteed elsewhere.

Anyhow.

If it is so that the severely ill infant of the last post – who by all appearances seems to be dying – should continue to be resuscitated and treated aggressively because they bear God’s image then it surely follows that we should continue to resuscitate the frail elderly with severe pneumonia (who will almost always have lost capacity to decide for themselves due to their acute illness).

My reaction to the severely ill infant is to aggressively resuscitate but to the elderly patient with severe pneumonia my reaction is to not aggressively resuscitate. I seem to be following a different ethic in each of those situations.

i find these two points that to be in conflict:

1) it is a good thing that you exist. You are in God’s image. Your existence blesses mine

2) it is good that you are not suffering. It is good a thing that you are not in pain

I cannot bring about 1) without going against 2) and I cannot pursue 2) without struggling to maintain 1)

Without bringing in harm/benefit ratios and a generalized utilitarian ethic I find it impossible to resolve them, though I am well aware I may be missing some fundamental point.

And I don’t mean to say that considering harm and benefit in the decision making process is necessarily a bad thing I just feel it dangerous to give them primacy.

There is no doubt a logical fallacy somewhere in there so help me out.

Thoughts people?

 

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2 Responses to “Learn to live with what you are – 2”


  1. 1 Peter December 14, 2010 at 1:07 am

    Ok I haven’t completely thought this through but here goes. You are presenting your two ethics (imago dei vs avoiding suffering) as if they are equal. In my mind, they are not.
    Any ethic using ‘suffering’ ultimately turns into a ‘quality of life’ ethic. I probably did not listen to Ms Boohan (QUB) enough on these things but I struggle with doing this. My problem with even making a quality of life argument is that whatever criteria you use (physical, social, emotional wellbeing or degree of suffering) at some point you may have to admit that there exists a human being with no quality of life. What do you do then? What is your basis for keeping a person with quality of life equal to zero?

    Also, I don’t think it follows that disability (eg impaired motor function) or a life of pain translates automatically into a loss of well-being or life-satisfaction. Assessing suffering or quality of life is not objective and will inevitably be influenced by the assumptions, prejudices and life-experiences of the observer.

    I think this applies to capacity as well. Presence or lack of capacity should never be a determining factor in end (or beginning) of life decisions. Either a life is worth preserving or it is not and I would argue that where possible it IS worth preserving. (Btw how is this position a slippery slope?)

    Having said all that, I live in the real world where these decisions are not black or white. Every week I make difficult decisions with families about when to investigate or when to treat agressively or not. I cannot stop death any more than you can! If someone is dying I have to decide in those circumstances is my treatment is worth giving? NOT is this life worth living? I suppose it is what you call ‘a harm/benefit’ decision but if the two are in direct conflict then preservation of life must be the priority. Then alleviate the suffering. Otherwise the temptation would be to alleviate suffering by deliberatly ending life – and I’m trying not to take this discussion there.

    The more I go on I’m realising that I’m not really answering your questions. I realise I have not been through these questions as personally or as recently as you. I do still believe in a God who has the power to heal even when things look hopeless. And where there is life there is still hope.

    PS. CH is a drumming legend!

    • 2 Andy Neill December 14, 2010 at 8:35 pm

      Good point pete, I have no reason to equate them as equal, wasn’t really my intention. It was more of an illustration that either of the two principles followed absolutely gets us into bother.

      Not sure I learnt anything (about anything) from the man in society stuff so don’t worry!

      The “quality of life” thing is largely observer dependent in the people where this applies and I agree completely that it’s dodgy ground for 3rd parties.

      The idea of the slippery slope is better termed the slippery ramp. This is largely to do with your point about offering treatments that “work” or are “beneficial”. Both of those are fairly slippery terms. What do we mean by a treatment that works? Treatments that “work” either (or both) relieve symptoms or prolong life.

      I agree that preservation of life is a really important principle but we often preserve life without cure (or even reasonable hope of cure). Ultimately none of our therapies cure – everyone dies, medicine puts some stalling measures in between.

      In the ICU setting this can go to fairly dramatic lengths.

      To simplify – if i slavishly follow (not that anyone does) an ethic where preservation of life is paramount then we inevitably end up treating aggressively. Someone with aggressive metastatic carcinoma is not going to get a “cure” but we can probably give 6 months they wouldn’t have otherwise – should we recommend this to those who can choose and should we choose this for those who have no voice?

      Should we do CPR on the 80 year old PEA arrests?, should we now dialyse the 90 year old on the ventilator for pneumonia?

      We have somewhat shifted the goal posts on the phrase “their time has come”

      I should make it clear that I’m not trying to advocate either one of these abstracted ethics, partly because abstracted ethics (from the context) is a dangerous activity and partly because I have sympathies with both positions

      I propose that neither of these “positions” can hold the weight we expect them to on their own.

      I am interested in how we answer the questions where the principle of preservation of life seems to come into difficulty


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