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The question of life versus death is one of the biggest dilemmas facing families and modern medical professionals in this age of life-sustaining and death-defying technology. There has been a debate for many years about the ethical dilemma to either maintain or to stop maintaining life dependent on its perceived quality.
It has been debated both ways: one side sees death as the ethical choice if quality of life is very low, and the other side sees life as the ethical choice no matter what the quality of that life may be. Life is precious.
In 1973, the American Medical Association (AMA) House of Delegates made a statement regarding active euthanasia: "The intentional termination of the life of one human being by another–mercy killing–is contrary to that for which the medical profession stands and is contrary to the policy of the [AMA]."
They continue by saying the quality of a person's life is not taken into consideration unless the person is about to die, in which case that person may be allowed to die naturally. If the person is not about to die, then quality of life is not calculated into the equation at all.
It is the doctor's job to save life, no matter what the quality of that life may one day be. Doctors are not ethicists. Their job is to save lives, not debate whether the life is worth saving.
The Texas Natural Death Act
There are many laws providing legal answers to this debate. The Texas Natural Death Act (TNDA) is one of these.
Under the TNDA, patients with "incurable or irreversible condition[s] caused by injury, disease or illness that would produce death without the application of life-sustaining procedures, according to reasonable medical judgment, and in which the application of these procedures serves only to postpone the moment of death" are once again given the option of withdrawing "extraordinary means" when these measures only serve to prolong the inevitable.
For those patients with low or no quality of life that are not terminal, however, there is no consideration as to the ethicality of a prolonged torture. This whole debate is viewed in terms of black and white, right and wrong. As we know, life is all different shades of gray.
Hospital Ethics Committees
Any hospital ethics committee is a morass of conflicting ideas on quality of life versus the outright right to life. Some examples of what they face on a daily basis are outlined below.
In the case of Kelsey, the choice became whether or not they should operate again, knowing it was merely prolonging her death. She had been in the hospital for much of her life, and her disease was finally winding down to the end. She was in constant pain, was only kept alive via drugs and machines, and was very tired and wanted it to just end. She'd made her peace with it long ago, and now she was ready. Should the ethics committee allow her to discontinue treatment? She wanted to die.
In the case of José, it was debated whether the quality of his life would be worth living, given he was paralyzed from the neck down. They decided to ask him if he'd like to live paralyzed and be resuscitated if anything happened, or become DNR (do not resuscitate) and die naturally. It turned out that, despite needing his family to care for him for the rest of his life, he was perfectly happy watching his favorite TV shows all day long and being fed by his Italian grandmother. His family was perfectly happy about the idea. He wanted to live.
In the case of John it was debated whether or not his quality of life would be worth living, or if it would be more ethical a decision to spare him the misery of what his life might become, born with severe spinal and brain problems. His parents would have to tend him 24/7 for the rest of his life. Would John's life be worth living, or would it be better for him to die peacefully? Was it worth upsetting the parents' own lives for someone totally unaware and severely handicapped mentally and physically? They wanted him to be put out of his misery.
There is almost never a "real" concensus and never a straightforward "perfect" answer. In the end, right to life almost always wins over quality of life. It's a tough decision to end a life while knowing that it could be saved. It's difficult to know how one person or another will react to living in severe pain, or grossly disfigured. One person may hate every minute, while another may feel they're the luckiest person alive.
- Quality Of Life Wikipedia
- Life: Sanctity Or Quality? Article
- Sanctity Of Life Versus Quality Of Life Article
What Do You Think?
If only there was a way in which we could all come to a definite conclusion as to life's worth. But there's the rub.
Life means one thing to one person, and quite another to someone else. One person may wish to die peacefully when they're on life support, and one person may want to fight death all the way to the grave.
With life-saving drugs and technological miracles, these are questions that won't soon go away: is quality of life more important than a person's right to life? I think the answer is, "It depends who you are, and how much spirit you have."
Have you ever had to make a tough decision for a loved one? Does quality of life matter, or is all life so sacred that even the hardest amongst us should be spared? Is there ever a point where medical professionals should step in and play God?
What do you think?
© 2011 Kate P
Ian D Hetri from Papua New Guinea on January 25, 2012:
Love the way you presented the information. Superb. voted up and useful. Following you to read more of your hubs.
Kate P (author) from The North Woods, USA on January 07, 2012:
Cost definitely does become a factor, and quickly. That's a very good point, and is high on the priority list in hospital Ethics Committees.
I see how having a choice is good; at the same time, many people who have tried to commit suicide, and survived, have been VERY grateful that their attempt failed. Food for thought!
roshall from Ohio on January 06, 2012:
hi I admire people you overcome diversity in their life. I believe that its should be your choice to end your life when you want for whatever reason you feel fits.Great story!! Have a great day.
Sherry Hewins from Sierra Foothills, CA on December 23, 2011:
I recently heard on the radio, a case about a severely disable, ventilator dependent child who was turning 18. He had been on a government program for disabled children that was ending because he was no longer a child. His very dedicated family had been caring for him at home with some homecare support. As an adult his expenses would only be covered if he were in a Nursing facility, which he and his family felt, based on previous experience, was would be a death sentence. So, there's another aspect to the question, who should pay and how much is a life worth?
Larry Fields from Northern California on December 18, 2011:
Here's a link to an article about the medical rights of women vs dogma in Catholic pseudo-hospitals, by Molly M. Ginty.
The Church also has 'teachings' about end-of-life care. My understanding is that if you land in a Catholic pseudo-hospital, allow yourself to be intubated, or to be connected to artificial life-support of any other kind, and then become comatose, the moral mediocrities in charge will never voluntarily pull the plug, regardless of what your written medical directives say.
In that case, the only realistic option for your designated advocate is to have you put into an ambulance, and then transported to a REAL hospital, which will respect your final wishes.
I'm not an expert on this subject. Someone please correct me if I'm mistaken about any of these details.
C E Clark from North Texas on December 18, 2011:
State laws do very, sometimes quite a bit, other times not so much. I'll check with my former husband (attorney) on what the law is in regard to living wills, etc., here where I live.
Larry Fields from Northern California on December 17, 2011:
Au fait, sorry about that. Fundies are Fundamentalists--Christian in this context.
About the trumping. That applies in California. I'm assuming that it applies everywhere in the U.S. However I'm not a lawyer, and can't be 100% certain about that.
C E Clark from North Texas on December 17, 2011:
Interesting article and interesting comment from Larry Fields about DPOA and living wills. What are Fundies?
Voted you UP and interesting because I think you have provided some good food for thought.
Kate P (author) from The North Woods, USA on December 17, 2011:
Thanks Kaitlincolee and Larry for your positive feedback and commentary.
I was not aware that the DPOA trumped a Living Will; that's sure food for thought. I definitely should add a section here about living wills and DPOA. Thanks!
Larry Fields from Northern California on December 17, 2011:
Also voted up. On a related note, I'd like to mention Living Wills and Durable Power of Attorney. Getting both can DECREASE your chances of having your final wishes respected. It's not like wearing suspenders and a belt.
Why? Because DPOA trumps a Living Will. If the person holding DPOA is not absolutely trustworthy, you're more likely to suffer needlessly in your final days. On the other hand, with a Living Will, it's more likely for your hospital physicians to honor your wishes. (However that's not true if you have the misfortune to land in a Catholic hospital, or in a hospital run by bloody Fundies.)
I know, because someone in my extended family had his final wishes disrespected by the DPOA-holder, another family member. In this situation, the Living Will was absolutely useless.
kaitlincolee on December 16, 2011:
I never had to make the tough decision for a loved one, and if that day ever comes, I think I'll choose to let them fight till the end. A thought-provoking article, voted up!