By “non-diligent”, I mean not pursuing life-saving procedures and throwing in the towel without exhausting all reasonable avenues.
For instance, say you are diagnosed with a brain tumor. The doctors say the tumor is operable, but it’s location puts you at a very high risk of becoming severely disabled (blind and paralyzed) if you have it removed. But if you want to live, the tumor must go.
You have health insurance but no long-term insurance. There would no one in your life who could care for you or afford to pay for care for you if you were to become so disabled. And even if there were, you would not want to burden anyone with your problems. Independence has always been your credo.
You decide that rather than becoming a ward of the state–which you most likely would become if things turn out the doctors say it would–you’d rather the tumor do what God “intends” it to do. If that means dying, then so be it.
My question, especially to those who are anti-welfare state AND moralistic, do you view this as essentially killing yourself? If not, why? And if so, do you think this type of inaction is more noble than fighting to live, even if it means using societal services? What other variables make it more or less noble?
Catholic here. If it’s high risk, then in my view, it’s not suicide. I believe the Catholic Church allows for making the choice to discontinue treatment in circumstances where the risk is high or the end is inevitable short-term. But I believe the Church also would take a dim view of anyone but the patient making that decision because then it would come down to society making a decision to throw away a disabled person.
2278. Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.
The key principle in this statement is that one does not will to cause death. When a person has an underlying terminal disease, or their heart, or some other organ, cannot work without mechanical assistance, or a therapy being proposed is dangerous, or has little chance of success, then not using that machine or that therapy results in the person dying from the disease or organ failure they already have. The omission allows nature to takes its course. It does not directly kill the person, even though it may contribute to the person dying earlier than if aggressive treatment had been done.
If I had a cancer that could only be fought by heavy doses of radiation or chemotherapy, I might very well choose not to bother. I do not believe I have the stamina, the mental toughness, the courage, or the innate stubbornness to bear up under the side-effects.
A co-worker of mine went through all of that – twice! And he won. He lived a while longer. He got better, recovered his strength, and, each time, lived a year or two. That’s a very great reward. But I watched his suffering, and I saw how much of a fight he had to put up. I know I do not have that kind of guts. He was a hero, a scrapper, and he wrestled with death and won. But some of us just don’t have what it takes to do that.
In another case, a great-Aunt of mine (back in the 1960’s) chose not to fight her cancer, in order to save money, so that her sons could go to college. It was, I suppose, a form of suicide, but it was also selfless and, in its way, noble. The rest of the family strongly disagreed with her decision, but I could, while disagreeing, respect it.
In this scenario, it comes down to how much you are willing to endure and how much extra time it gives you. If the side effects are horrendous but it gives you only a few more months, many people would choose not to have the treatment. But others would choose it for whatever reason, like wanting to stay alive long enough for the birth of a child. Either choice is not immoral or wrong, nor is either choice imo a sign of cowardice. To me, where it gets murky is if the person chooses not to try a treatment that will allow their life to go on for a long while (and the side effects aren’t so bad) or where a person is disabled but not dying but wants to end their life because they don’t want to continue to live like that.
Then there’s the issue where society is making the decision on whether a person should no longer be treated or shouldn’t be kept alive because of limited resources. That I think is where the question of ethics really comes in and produces a lot of argument about what kind of control society should have over the sick and disabled.
B. F. Skinner and ABC. A nice long stay in the hospital, a big bill for my copay, a learning period dealing with my new condition, and loss of things important to me immediatley. Maybe cancer later. No guarantee I won’t die of something else first. Duh?
In the 1950s, when dialysis machines were rare, there were committees that decided life-and-death for patients. They would make a utilitarian assessment of the value of a human life. A young married man with children and a job would be more likely to be granted access to dialysis than an older, unemployed bachelor.
It makes a horrid kind of sense – one is reminded of the science fiction story “The Cold Equations.” Utilitarian morals are always scary, even when, sometimes, they are the only rational basis for a decision.
The alternative of putting human life up for auction – the richest live and the poorer all die – is morally troubling to many of us. Even a totally random lottery is preferable.
I don’t know what to say except that I’m so sorry you’re in this situation.
The reason why I asked the question was because the thought crossed my mind as I contemplate my own health. I know something unusual is happening to my brain. I don’t feel any pain (thank goodness), but it is affecting my ability to move normally and to have an optimistic future. I’m going to a new doctor in a few weeks and it got me thinking. What if they discover I have a brain tumor?
Like Trinopus, I don’t think I have the stamina to do all it takes to live. Cancer survivors usually have some motivation–like kids or grandkids–to push them into the future. And some people are just so full of life that they can’t imagine dying. I don’t consider myself a morbid or cynical person, but I can easily see myself accepting a death sentence. Not because I want to die, but because I don’t see myself having the motivation to fight hard enough.
I also don’t have that much money. Like in the hypothetical, I have health insurance. But if I could no longer work following my operation, I do not have the financial capability to stay independent. I have a year’s worth of savings, which would evaporate very very quickly. Without welfare programs I would not have any means of survival. So even if I wanted to live in a severely disabled body, I would have very sparse means to do so and I would have to rely on the “system”, subjecting myself to the judgment of others.
That’s why I targeted the question to anti-welfare and moralistic people. If you deny people of inexpensive/free health care and a means of support when they cannot take care of themselves, you will see more people being non-diligent when it comes to medical crisis. Seems to me, though, if a person is going to say that life is sacred and that suicide is wrong, they would find this to be untenable. Thus, it is impossible to be truly anti-welfare AND moralistic (in the standard Judeo-Christian use of the word). You can be one of them, but not both.
thelabdude and monstro: I’m very sorry that these matters are, or may be, for you, serious and real. I only posted out of a sort of abstract “fantasy philosophy” sense, without pausing to think that the people who read this may be involved in such moral questions in real life. Please do not take my ideas as advice!
Stephen Jay Gould wrote an essay where he notes that cancer survivorship seems to be correlated with the mental toughness, the firmness, the raw determination to fight to survive. But he concludes by emphasizing that this must not be turned into a “blame the victim” mind-set. We must not discount the right to life of those who, by the nature of their character, aren’t powerfully equipped to fight for it.
Among the advances in medical science which we may hope to see in the future are means of providing mental and moral support for those who, at no fault whatever of their own, simply lack the “fire in the belly” to fight like wolverines for every last second of life.
Some brain tumors can be zapped and you go home the same day. Some kill people. I don’t know the difference. If you have a brain tumor, bring up the subject of the Gamma Knife. It is a very powerful tool. The more I deal with doctors, the more I am afraid your treatment depends on tools your doctor is familiar with, not what might be best for you. My doctor referred me to one of the top surgeons in the field. He hasn’t even discussed the possibility of chemo and radiation, not that I have found much there very encouraging.
Getting back to the question. Today a lady was telling me about her first husband and how well he got along for the 4 years after his surgery. 4 YEARS? I could live that long without it. With it, I would hope to have many more years of life such as it would be. How much are we required to endure to cling to life? Or even improve the odds?
Most Wednesdays I attend a senior citizens lunch because it is convenient and cheap. Usually they play bingo after lunch. Recently they were treated to my presentation on guide dogs. It is a highpoint of the week for many. I usually slip out and get back to my volunteer work. Fridays I pick up some church bulletins and take my retired guide dog to a nursing home to give the bulletins to our church members. My dog’s visit is a big deal to many of the residents including the Alzheimer’s unit. If that is the way I will be living, no thanks.
I have called the guide dog school and told them I am not going to be hospitalized and I can take a puppy to foster as soon as they have one available. I need to get going on scheduling guide dog presentations and vision screening pre school kids. There is work to be done as long as I am able to do it. I really need to be tidying up some of my projects around home too.
Catholic here, and from a country with single-payer healthcare.
To me the key point is the difference between “living” and “lasting”. Too often, doctors mistake both; I believe the patient (or if he’s incapable, his closest relatives) should be able to trump any doctors’ wishes to keep someone lasting for as long as possible, way beyond the date when they stopped living.
What I will want most when/if I am in any kind of similar situation (as I imagine is likely to happen eventually as I get older) is:
(1) Access to the most aggressive palliative treatment available, up to and possibly including palliative sedation, possibly even terminal sedation, and,
(2) I want to have the choice of when to go there! Not some medical ethicists in some office somewhere philosophising about dual effects and my ideations or whatever, or some buttinsky politicians trying to score political points, or pontifications from Rome, all of which happened with Terry Schiavo.
I have an AHCD, but I don’t think it even remotely covers all of that. I wish I knew how to write one that does.
If I ever come to where I am sick or injured to the point of being in severe pain, or severe discomfort, or profoundly debilitated, with little hope of any significant recovery, I want to have the option of deciding to “pull the plug” by which I mean, terminating all life-maintaining therapy (even including feeding and hydration), and having palliative care as thoroughly as possible.
Labdude and monstro, you talk about the idea of quitting treatment and letting nature take its course. Do you think much about the palliative care you might want or need? Will you want that? Will you be able to get it?
Do you have AHCD’s? If so, do you have much confidence that your AHCD will be honored when the time comes?
Yes, as I walk through the nursing home with the dog, I see the same people asleep in their bed every week. They don’t have feeding tubes, so the staff must be able to wake them up to eat. My wife’s one grandmother spent about 10 years comatose before dieing.
Treating those corpses is quite expensive.
Note, I dug out advance directives forms a month ago, but haven’t got them filled out and witnessed. For now, and maybe for a few years, I am fine and plan to go on with life. But surgery or not, the end could be ugly. Even without documentation, if people have heard you talking about it, they can pull the plug.
Let’s turn the coin over and look at the other side. Is it moral to squander resources on the non living? I haven’t been given the cost of surgery, but I am sure it will be high. So far my copays have been about $1500. How much is it worth to keep me able to to hang out at the senior center and play bingo?
As I struggle with this, I do so from a Christian perspective. Suicide is the ultimate denial of faith and trust in God. It is also a selfish act of hatred for those around us. God has given us life. I also believe medical science is a gift of God*. God has made available one of the top surgeons in the country. How can I reject the life saving treatment? Maybe I am rationalizing, but God has given me some other gifts too. Ones I will no longer be able to use following surgery. At the end of my church’s governing board meeting last night, I shared some of this thinking. The others backed my decision to reject surgery.
*I am not one to say God will heal me without the doctors. I am not depending on the elders to lay their hand on me and anoint me with oil. I just don’t feel the proposed procedure is right for me.