An article published in The Economist newspaper on August 26, 2021, states that “the technological advance in the ICU (intensive care unit) that allows keeping patients alive, almost indefinitely, is a problem for hospitals.”

End of life confrontationsDr. Robert Truog, a pediatric intensive care physician at Boston Children’s Hospital and director of the Center for Bioethics at Harvard Medical School, notes that advances in medical technology mean that “it is very difficult to die in a modern ICU these days “This can make it difficult for families to accept that there is no chance for a seriously ill patient to recover.” This situation is further exacerbated by the availability of experimental treatments online.

In the USA, which has the well-known Federal Right to Try law, Dr. Truog recalls that “a decade ago, in my own Intensive Care Unit, there used to be one or two patients a year who were kept alive and now there are two or three at any time” statement that makes Dr. Troug about his own experience. The circumstances that have been enumerated mean that even the movements that defend life, very numerous and active in the United States, do not have a single criterion. There are those who want to prolong life as long as possible, waiting for a new treatment to emerge, and those who are opposed to therapeutic obstinacy.

Large numbers of patients diagnosed with brain death remain hospitalized

The article goes on to provide the opinion of Thaddeus Pope, bioethicist and professor at Mitchell Hamline School of Law in Minnesota, who says that “the influence of vitalism, which holds that life must be preserved at all costs, has meant that a growing number of brain dead patients are hospitalized. We add a key factor that can relativize the already stated diagnosis; There is no single criterion for the diagnosis of brain death that can significantly facilitate the patient and her family members to cope with the situation (see HERE).

End of life confrontations

In any health system, end-of-life confrontations between doctors and patients’ families are inevitable. Our Observatory has insisted on the need to increase the number of doctors specialized in palliative care in all hospitals (read HERE) that would facilitate better and personalized care for critically ill patients and their families, something crucial at the time of taking decisions regarding death.

The author emphasizes the need to develop policies that reduce confrontations between the medical staff and patients and families and states that it can be more difficult in a decentralized health system. He highlights the case of Texas, which is one of three states, along with California and Virginia, that have legislation that gives physicians more power to withdraw patient care without consent. Other states are more restrictive.

For adults, advance directives can help. Patients tend to be less in agreement with life support interventions than families or guardians. “People don’t want to take the blame for the decision to withdraw their family member’s treatment,” Pope says.

Bioethical assessment

From the perspective of Personalistic Bioethics, which defends the dignity of the patient in all circumstances, therapeutic obstinacy should be condemned as an attempt to artificially prolong the life of the dying patient when this does not entail any benefit but, rather, increases their suffering.

On the other hand, what is called the “adequacy of the therapeutic effort” should be respected in any case, rationalizing the level of intervention on the patient based on its usefulness and the potential benefits that it can bring.

This adaptation can only be carried out adequately when it is accompanied by quality palliative care (read “Adequate palliative care from the diagnosis to palliative care units with a specialized and trained multidisciplinary team of medical professionals” HERE). On the other hand, unifying the criteria for death, making them more rigorous, would avoid the conflicts that are generated when doubting whether a patient has died or not. Global brain death, which establishes the cessation of all brain function, seems the most objective criterion for this diagnosis (read more HERE).

Related article Brain death: experts divided on how death is defined and The Charlie Gard case. An ultimate dispassionate ethical reflection

 

 

 

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