The advancements in medical technology has completely impacted the healthcare industry. The structure and organization of the entire medical field has been changed. Medicine is continually moving forward due to technology. The rise of technology has helped with diagnoses, access to care, treatment plans, and much more. Diseases are being cured, and earlier diagnoses’ have created a healthier and more productive lifespan. Nowadays, we have the capability to keep a life going for an extensive amount of time. Most people would agree that living longer would be wonderful, but for patients’ suffering, that may not be ideal. Prolonged life has become a topic of ethical debate, and there are many things to be considered when discussing it.
There are many difficulties when looking at the quantity vs. the quality of a life. Most patients, when asked, would choose quality over length. Someone who is seriously ill, without the ability to take care of themselves, is no longer able to enjoy their quality of life. One of the most widely used medical advancements is the mechanical ventilator, or breathing machine. A ventilator helps the patient breath while allowing the body to rest and heal. The ventilator is capable of totally breathing for the patient. While this can be great in cases for younger bodies who are capable of springing back to life after their illness passes, an elderly patient is much less likely to recover from conditions causing respiratory failure (Zitter 2017). These patients will live the rest of their life connected to a life-prolonging machine that will, most likely, prevent them from ever moving from a hospital bed again. Realistically, an elderly patient placed on a ventilator will unlikely ever to be freed from it. In an article by Jessica Zitter she stated that, “my experience tells me that if patients actually understand what living on these technologies looks like, they will think twice before accepting these treatments” (Zitter 2017). Furthermore, in a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state. To make the decision to be put on Prolonged Mechanical Ventilation, or PMV, one must be informed about the condition of permanent dependence. Often older patients that benefit from these life-extending technologies are not properly informed of the pros, cons, and alternatives (Butler). If a patient knew their life would be drawn out, they would choose to receive less technological intervention.
At times, patients are too ill to discuss or determine their decision and the choice must be determined by the patients loved ones. Most of the time, those loved ones have no clue what the patient might want and out of emotion favor toward a longer life, even if that means being put in an anguish state. Even if the patient is well enough to make that decision, without being well-informed, they might choose to go with the more aggressive treatment unaware of the possible outcomes.
Some may argue that doctors purposely provide a lack of information in order to receive the financial incentives associated with performing the aggressive treatments. It’s quite alarming how seldom doctors talk with their patients about the range of options and the hardship of these famed technologies. A big debate within the medical community is the free-for-service medical care. This is where providers charge fees for specific services. If a provider performs more aggressive treatments and continues to run unnecessary tests, he is going to rack up more money for his bank, which is morally unethical. In a Medicare study, it proved that more than $125 billion, is spent on services for the 5% of beneficiaries in their last year of life. As well, a study from Mount Sinai School of Medicine found that out of pocket expenses for Medicare recipients during the five years before their death average about $39,000 for individuals, $51,000 for couples, and $66,000 for people with long-term illnesses like Alzheimer’s (Wang 2012). A new plan of action needs to be put in place in the medical market systems that lowers the profit margins, so physicians would give their patients the best options available. Making a turn in these incentives, could help to solve the problem of the lack of information provided to patients and their loved ones.
One of the most common overlooked ethical issues with prolonged life treatments, besides the patients themselves, is the life of the caregiver. A caregiver is not always someone that is hired to watch over a person. Generally, caregivers are some part of the family, whether that’s the spouse, child, sister etc. Patients in need of a caregiver are, in most cases, requiring round the clock care. This is time consuming and a caregiver is sacrificing that time out of his or her life. This brings us back to quality vs. quantity of life. In a study of caregivers who deal with patients who have Parkinson’s disease, 77% of people report deterioration in health as a direct result of their caregiving role (Parkinson’s Disease Vol. 12 2012). Many complain of stress, anxiety, depression, and lack of sleep. It creates physical and psychological strain over extended periods of time, and is accompanied by high levels of unpredictability and uncontrollability. This not only creates stress with the loved one they are watching over, but in multiple life domains such as work and family relationships. Lives are essentially lost when they are tied up in the arduous work of taking care of their loved one, all while watching them suffer. In Katy Butler’s article, she discussed the effects caring for her father had on her mother, “…my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to [the doctor], she burst into tears. She was put on sleeping pills and antidepressants” (Butler).
There are caregivers and at home nurses that work for service, while other patients are put in nursing homes to live the rest of their lives. Though this is easier on the family members, the quality of life for that loved one still suffers. The ethical value here is that the family members who play the role of the caregiver, are trading their life and health for the extra time with their loved one. Those caregivers are still in the good years of their lives, and those years are lost in caring for their loved one that has the life-extending technology. This begins a cycle of care from one generation to the next. It would only make sense for us to stop that cycle and focus these medical advancements on younger people, who still have a long life to live. In an article by Thomas Lee he asks, “If you had x amount of dollars, would you spend it on an 80-year-old who has already lived a long life, or a 12-year-old boy dying of cancer?” (Lee 2010). Younger people would be a better investment because they have so much longer that they will be alive to benefit from the technology. We should end this life trade-off cycle, and focus our efforts on the young people that need medical help.
A great deal of patients would prefer to have the ventilator, a life-extending technology, removed from healthcare. However, by doing this, it creates another controversy. Should the caregivers of the patient have a say if the ventilator should be turned off? This question is the biggest issue because if the patient is unresponsive, how is the caregiver going to make this decision. Also, if the caregiver is a loved one of the patient, this decision could be a conflict of interest. Some relatives might turn it off because they do not want to see their family member suffer. On the other hand, the majority will act out of selfishness and want to keep the patient alive on the device since they want them to still be here with them on this earth. Some relatives might act out of greediness which is another problem. They might want to “pull the plug” in order to collect belongings from the family member like life insurance or other collectables that are in the will. There is no way of really knowing of why the caregiver is turning the ventilator off. Herein lies the supposed ethical difficulty. This reality requires that doctors and families make the difficult decision about when to pull the plug, because once a patient is on a ventilator, they have no control over their situation.
Controversy of assisted suicide has been around since the beginning of high-technology and PMV’s. When the caregiver wants to turn the machine off, a lot of them turn to the doctors which can be seen similar to an act of assisted suicide. Doctor’s do not like this because it creates legal issues so, they try to remove themselves from this situation. The State of Oregon stopped using the term “physician-assisted suicide” in 2006. Similarly the American Medical Women’s Association rejects any terms associated with suicide as “inaccurate and inappropriate,” adopting instead “the less emotionally charged, value neutral, and accurate terms ‘aid in dying’ or ‘physician-assisted dying’” (DeathwithDignity 2018). For some, these life-extending devices are not the only means of staying alive. The devices it helps to prevent strokes, breathing issues, and heart attacks. The moral issues in removing or turning off these prolonged-life devices, should not factor into a physician’s decision because there is no intent to kill, but to simply end their suffering. Death comes from the lack of strength for one to sustain life on his or her own.
The ethical issues in these prolonging technologies is abundant. Doctors must inform patients, caregivers, and family members of all options as well as the hardships they may endure from these devises. This will allow patients and caregivers to make an educated decision, rather than live the rest of their lives suffering. Additionally, it will allow the opportunity for a younger individual in the need of these technologies, to take advantage of the many benefits it could potentially have on their life.
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