Ethical Issues at the End of Life

If you are a regular reader of my blog, then you likely know that I have a passion for ethical dilemmas. Perhaps you even participated in a debate on one of my Your Truth posts.

I was recently asked to give a lecture on Ethics at the End of Life. Although I am passionate about ethics, I'd never given a lecture on the subject before. Having recently graduated from my Master's program, I dutifully prepared Power Point slides on concepts such as autonomy and choice, advanced health care directives, medical futility, quality of life, double effect, the spectrum of hastening death, moral distress of nurses, and the four-box method.

I *love* to teach. And no matter what the subject is, I always maximize interactivity between myself and my audience. Personally, I learn best when I am awake and I have a suspicion this is true for others. ;-) Fortunately, ethics is a subject that easily lends itself towards a lively discussion.

I have been wading through my email inbox, now that I'm done with school. I apologize to those of you whose emails have been sitting unanswered. I'm doing my best to get through them now. During this sorting of emails, I came across a link to an on-line excerpt from William Colby's book, Unplugged, where he writes:

"When surveyed, the majority of us say that when our dying comes, we hope to be at home, free from pain, surrounded by loved ones, and not hooked up to machines. In the abstract, that's likely true. We also very much want to be hooked up to those machines right up to the very moment when the doctor is sure that those miraculous tools can't fix us. Trying to find that exact line is no easy business."

This thought seemed particularly relevant to my last blog post, as well as to the discussion / lecture I gave this past week.

In the 1970's, it was accepted practice that any and all interventions should and would be taken to prevent death no matter how extreme the intervention (Drought & Koenig, 2002 - no, I'm not old enough to be speaking from personal experience, so yes, I used a reference for this). But as technology has advanced, we have vast and ever-growing means of keeping people alive, even while their bodies are otherwise failing them. As a result, ethical considerations in making decisions about treatment have become increasingly complex. This was a point I stressed in my talk; William Colby speaks to this in his book as well. Although technology has advanced dramatically, we are still no better at predicting when death will come. In my post asking how you'd like to die, not one of you said that you wanted to die hooked up to machines in the ICU. Why or why not?

If given the choice - to be kept alive as long as possible, but then to die in the ICU connected to machines or to possibly die prematurely but die peacefully at home, which would you prefer?