Felicia Cohn,
Ph.D.
Center to Improve Care of the Dying
George Washington University
Director, Program in Biomedical Ethics
Department of Health Care Sciences
George Washington University Medical Center
This scenario
highlights the all too common acceptance of the
"either/or." The care of persons nearing the
end of life is ordinarily considered a choice: either
to treat aggressively, to do "everything," to
restore functional ability, to cure; or to provide
"comfort care" only, to do nothing and await
inevitable death. Human beings, however, are rarely
that neat; we seldom fit well into black or white
alternatives.
Mrs. J. does appear
to be approaching the end of her life. She has
repeatedly affirmed her refusal to use a feeding tube,
but this is not to be confused with a desire to be left
alone to die. Despite her prognostic status and refusal
of a particular life-sustaining treatment, she
continues to have real medical needs. When caring for a
dying patient, it may become easy to forget that the
patient continues to live and that whatever time
remains is of value. Mrs. J. is entitled to live as
meaningfully and comfortably as possible for the rest
of her days. Services that improve a patient's
experience of living while dying, services that will
benefit the patient, should in no way be construed as
wasted, unnecessary, or futile, even given the
patient's shortened life span. If meaningful life
includes eating and drinking, then good medical care
should include efforts to make that possible.
Speech-language pathologists incur this obligation just
as other health care professionals do.
Unfortunately, Mrs.
J. is not alone. We all face a health care system that
is ill prepared to address the myriad of needs we
develop as we age, become ill, and approach death.
Regardless of what insurance companies mandate or
health care professionals prefer, end-of-life care
should be guided by patient and family visions of what
it means to live well until death. The end of life is
no less precious and important than any other period
and its should not be comprised primarily of suffering
and fear. We must work to change our health care
system. To ask the question raised by this case:
"Are speech-language services appropriate for a
terminally ill patient?" should become
inappropriate and denying services to those nearing the
end of life should become unthinkable. Rather, we
should ask: "Will this patient's remaining
life be enhanced by speech-language
services?"
|
Ethics
Roundtable Home
Case Study
Responses
Annotated Bibliography
|