Introduction and Background
The care of terminal patients is often difficult and ethically challenging. The standards of competent and compassionate care that characterized a previous generation seem to be wavering, replaced by a post-modern mélange of newer conflicting theories and ethical values.
A shift from deontological principles to utilitarianism has occurred in the past thirty years, corresponding with the rise of the modern bioethics movement (Rae & Cox, 1999). Many members of an increasingly aging population are denied their autonomy on the basis of mental incompetence. The most common cause of the loss of competence is Alzheimer’s disease, which may afflict up to 50% of individuals 85 years and older (Alzheimer’s Disease, 2003).
Decisions to withdraw treatment are often based on a lack of higher mental functioning as evidenced by self-awareness and self-control. On such utilitarian ideas of bioethics, there are degrees of person-hood as though it were a quantity that one individual could have more of than another. To lose these physiologic parameters means to lose something vaguely called the “quality of life.” Such “physiologic person-hood” ignores a patient’s personal history, and the fact that she has existed for more than a moment of time. Dependency and irrationality, with decisions made by others, would often deny such an individual the right to live.
Utilitarian considerations have even led to a “duty to die” in public discourse, a general sentiment that the elderly should “get out of the way” of the young. A report from a recent medical journal is chilling in this regard: An 85 year-old minister with dementia was abusive and irrational, posing a problem for caregivers in a nursing home. The minister’s wife and children agreed that he was “without quality to his life.” Therefore, they and the physicians decided to simply turn off his pacemaker to cause his death. In favoring this practice, the authors of the report made a purely utilitarian argument. Their act was convenient for the family, rather than based on any intrinsic value or person-hood of the patient (Rymes, McCullough, Luchi, Teasdale, & Wilson, 2000).
The Christian thus faces a unique dilemma in today’s health-care environment: How should he commit to compassionate and competent medical care within the current establishment, yet take a stand for the sanctity of life and respect for human dignity? Where is the balance between a commitment to life and a common-sense willingness to “let go” when the time comes?
Mr. M., a 72 year-old retired accountant, presented to the emergency room in severe respiratory distress. He had a history of heavy tobacco use, having smoked two packs per day for 50 years. Though he completely quit smoking two years before this admission, he remained chronically short of breath. Mr. M. had three hospital admissions for respiratory failure in the previous year, two of which required short periods of mechanical ventilation. During the four months prior to this admission he required supplemental home oxygen. Three days before admission, Mr. M. began to notice an increase in his usual shortness of breath, a dry cough, and fever. On the day of admission, these symptoms grew worse and Mr. M. was brought to a nearby emergency room by ambulance.
On physical exam, Mr. M. was a thin, anxious, chronically ill appearing man in respiratory distress. His blood pressure was 140/80, respiratory rate 36/minute, and his heart rate was 124/minute. His temperature was 101.4 degrees Fahrenheit.
Admission laboratory studies revealed normal serum electrolytes, except for a slightly elevated potassium level. His serum bicarbonate was elevated at 36 mEq/l. His blood hemoglobin was normal. The white blood count was elevated at 14, 500 per cu. mm. Arterial blood gases (on supplemental oxygen by nasal cannula) were as follows: pH 7.34, pO2 46 mm Hg, pCO2 66 mm Hg. A chest X-ray showed a flat diaphragm,...
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