by John D. Lantos, MD
Pullman and Hodgkinson present a case that, it seems, should have been an easy one. A competent adult makes a simple request to discontinue a medical therapy. Further, it was a therapy that he’d already tried so personal experience informed his preference to discontinue therapy. His request was repeated over time. He was determined to have adequate decisional capacity. So why did both the physicians and the bioethicists consider this to be a difficult case?
There are certain cases that lead to such dilemmas. They are cases in which emotions tug us in one direction and reason tugs in another. The best example of this type of situation is the difference between withholding a treatment and withdrawing the same treatment. Bioethical principles suggest that these two actions are ethically equivalent. Legal precedent shows that the law treats them as comparable actions. Yet both health professionals and families say that the two actions feel very different. Another example is the difference between withdrawing life-support in a patient who is awake and alert compared to withdrawing life-support in a patient who is unconscious. If the diagnosis and prognosis are the same, then the fact of consciousness does not change the legality or morality of the action. But they feel very different.
Many studies show that it feels different to turn off an implanted mechanical device than an external device. Huddle and Amos Bailey report that “[s]ome cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient’s ‘self.’” This is true even in situations that should be easier than the one described by Pullman and Hodgkinson, that is, in situations where the patient is terminally ill and has refused other life-prolonging treatments.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.