Medical Care at the End of Life

Medical Care at the End of Life: A Catholic Perspective

DAVID F. KELLY
Copyright Date: 2006
Pages: 192
https://www.jstor.org/stable/j.ctt2tt5gn
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    Medical Care at the End of Life
    Book Description:

    For over thirty years, David F. Kelly has worked with medical practitioners, students, families, and the sick and dying to confront the difficult and often painful issues that concern medical treatment at the end of life. In this short and practical book, Kelly shares his vast experience, providing a rich resource for thinking about life's most painful decisions. Kelly outlines eight major issues regarding end-of-life care as seen through the lens of the Catholic medical ethics tradition. He looks at the distinction between ordinary and extraordinary means; the difference between killing and allowing to die; criteria of patient competence; what to do in the case of incompetent patients; the meaning and use of advance directives; the morality of hydration and nutrition; physician-assisted suicide and euthanasia; and medical futility. Kelly's analysis is sprinkled with significant legal decisions and, throughout, elaborations on how the Catholic medical ethics tradition-as well as teachings of bishops and popes-understands each issue. He provides a helpful glossary to supplement his introduction to the terminology used by philosophical health care ethics. Included in Kelly's discussion is his lucid description of why the Catholic tradition supports the discontinuation of medical care in the Terry Schiavo case. He also explores John Paul II's controversial papal allocution concerning hydration and nutrition for unconscious patients, arguing that the Catholic tradition does not require feeding the permanently unconscious. Medical Care at the End of Life addresses the major issues that inform this last stage of caregiving. It offers a critical guide to understanding the medical ethics and relevant legal cases needed for clear thinking when individuals are faced with those crucial decisions.

    eISBN: 978-1-58901-367-4
    Subjects: Health Sciences, Religion

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. ACKNOWLEDGMENTS
    (pp. vii-viii)
  4. INTRODUCTION
    (pp. ix-x)

    FOR the past thirty years I have written about medical ethics and taught the subject to physicians, nurses, social workers, hospital chaplains, undergraduates, and graduate students. During this time I have been active in American hospitals and nursing homes, helping patients and their families deal with the difficult and often painful issues regarding medical treatment at the end of life. As I have worked on hospital ethics committees, designed hospital and nursing home policy, and taken part in ethics consultations, I have also helped my own friends, colleagues, and family members work their way through these issues. In this book...

  5. ABBREVIATIONS
    (pp. xi-xii)
  6. Chapter 1 Ordinary and Extraordinary Means
    (pp. 1-11)

    From the 1960s to the 1980s, Americans were unable to reach a consensus on the morality of forgoing medical treatment. Scholars disagreed about many of the issues—this continues today, as we will see—the basic stance of U.S. law had not been determined, the medical profession was largely unsure of what to do, and hospital policies varied widely. To the degree that there was a general approach, it was usually that the physician decided what to do in each individual case, and often that decision was to insist on ongoing aggressive treatment even when there was little human benefit....

  7. Chapter 2 Killing and Allowing to Die
    (pp. 12-20)

    The second pillar of the American consensus is based on the distinction between killing and allowing to die, a distinction that Catholic tradition, in its analysis using the principle of double effect (PDE), has provided. According to this distinction, the direct killing of an innocent person is never morally right, but allowing a person to die is sometimes morally right. Some would now question the absoluteness of this distinction; that is, some now argue that direct killing (active euthanasia or assisted suicide) may be morally right in some cases. And some wish to legalize the practice. I will turn to...

  8. Chapter 3 Decisions by Competent Patients
    (pp. 21-36)

    In chapters 1 and 2 I discussed the first two pillars that support the present American consensus on forgoing treatment, the two that are based in Catholic medical ethics. The third pillar has its basis in law and derives from the legal concept of the right to privacy, autonomy, and liberty. This has been interpreted to mean that patients capable of making decisions of this type may refuse treatment even against the advice of their physicians. The patient has the right of autonomy to choose and of privacy to be left alone. The Supreme Court’s June 1990 Cruzan decision, which...

  9. Chapter 4 Decisions for Incompetent Patients
    (pp. 37-65)

    Thus far in my discussion of the third pillar of the American consensus, I have focused on the decisions of competent patients, cases in which the problems are not as difficult as those concerning incompetent patients. As we have seen, the “gold standard” or the “ace of trump” in these matters is the decision of a competent patient. But when a patient is not able to make decisions, this ace of trump is not possible. In such cases, U.S. law, with its emphasis on individual autonomy, tries to get as close as it can to the gold standard.

    The question...

  10. Chapter 5 Advance Directives
    (pp. 66-86)

    An advance directive is an instruction made in advance by a competent person specifying what that person wants if and when he or she should become ill and unable to make treatment decisions. There are two kinds of advance directives: proxy directives and treatment directives. Proxy directives appoint someone to make decisions if a person no longer can do so. Treatment directives (often called “living wills”) are instructions, usually in writing, about what kind of care a person would want. Because I think proxy directives are often more helpful than treatment directives, I will begin with them.

    A proxy directive,...

  11. Chapter 6 Hydration and Nutrition
    (pp. 87-117)

    The ethical issue of withholding and withdrawing nutrition and hydration involves a specific application of the general principles developed in the previous chapters. There has been considerable controversy over whether or not nourishment and hydration can ever be omitted or discontinued for a dying or comatose patient, or for one who is in a persistent vegetative state.

    The consensus in the United States is that nutrition and hydration may properly be forgone in some cases. The Cruzan decision of the Supreme Court upheld this general agreement (Cruzan v. Director, 1990),

    Director, 1990), but there was considerable controversy along the way,...

  12. Chapter 7 Physician-Assisted Suicide and Euthanasia
    (pp. 118-132)

    We have seen that the American consensus on forgoing treatment has as one of its ethical bases the claim that there is a difference between killing terminally ill patients and allowing them to die of their underlying condition. The general agreement has been that while it is often right to withhold or withdraw medical treatment that would prolong the lives of dying people, it is not right to kill them or to help them to kill themselves.

    There have always been, of course, those who disagree with this position. But only recently have we seen major turmoil in the United...

  13. Chapter 8 Medical Futility
    (pp. 133-154)

    When I began working at St. Francis Medical Center in Pittsburgh in 1989, during a sabbatical year, I began with a number of preconceived notions about what I would find, some explicit and many implicit. One of these was that most instances of conflict about forgoing treatment between health care providers and patients or patient surrogates would be cases in which the providers would insist on initiating or continuing aggressive therapy while patients or, more often, patients’ families would ask to have humanly useless or burdensome treatment withheld or withdrawn. The medical ethical literature I had read suggested that the...

  14. GLOSSARY
    (pp. 155-158)
  15. CASES CITED
    (pp. 159-160)
  16. REFERENCES
    (pp. 161-172)
  17. INDEX
    (pp. 173-180)