End-of-Life Care: : Ethics and Law

Module 6: The Ethics of Life-Prolonging Treatments (LPTs)

265 Module 6 The Ethics of Life Prolonging Treatments (LPTs) Module 6 The Ethics of LifeProlonging Treatments (LPTs) iMODULE SIX 266 Module 6 The Ethics of Life-Prolonging Treatments (LPTs) Module 6 Contents Page 1. Module 6 Key Points 270 1.1 Advance Care Planning (ACP) 1.2 Withholding and Withdrawing LPTs 1.3 Withholding a Particular Treatment 1.4 Withdrawing Treatment Already Begun 1.5 A Common Misconception on the Topic 1.6 Judgements of ‘Futility’ 2. Module 6 Definitions 272 2.1 Advance Care Planning (ACP) 2.2 Artificial Nutrition and Hydration (ANH) 2.3 Cardiopulmonary Resuscitation (CPR) 2.4 Do Not Resuscitate (DNR) 2.5 Euthanasia 2.6 Life-Prolonging Treatment (LPT) 2.7 Physician-Assisted Suicide (PAS) 2.8 Principle of Double Effect (PDE) 2.9 Principle of Proportionality 3. Module 6 Background 274 3.1 Autonomy and its Limits 3.2 Advance Care Planning (ACP) 3.3 Goals of Care 267 Module 6 The Ethics of Life-Prolonging Treatments (LPTs) 4. Central Issues and Concepts in Decisions about LPTs 277 4.1 Starting and Stopping LPTs 4.2 Ordinary and Extraordinary Treatment 4.2.1 Ordinary Means 4.2.2 Extraordinary Means 4.2.3 Clinically Difficult Judgements 4.3 Principle of Proportionality 4.3.1 Benefits and Burdens 4.3.2 Competence and Incompetence 4.4 Killing and Letting Die 4.4.1 Conditions of Judgement 4.5. Quality of Life Judgements 4.6 Sanctity of Life 4.6.1 Challenges to the Sanctity of Life Position 4.6.2 Inalienable Human Rights 4.6.3 Compatibility of Quality of Life and Sanctity of Life 5. Futility 287 5.1 Debates on the Meaning of ‘Futility’ 5.2 Evolution of the Concept of Futility 5.3 Divergent Views about Futility Judgements 6. Cases: Decision Making Involving the Use of LPTs 292 6.1 Case 1: When is Treatment Futile? – Do Everything You Can 6.1.1 Discussion 6.1.2 Suggested Professional Responsibilities 6.2 Case 2: DNR and Family Disagreement – When God Might Intervene 6.2.1 Discussion 6.2.2 Suggested Professional Responsibilities 268 Module 6 The Ethics of Life-Prolonging Treatments (LPTs) 6.3 Case 3: Requesting Ventilator Withdrawal – ‘My Life has Lost Value for Me’ 6.3.1 Discussion 6.3.2 Suggested Professional Responsibilities 6.4 Case 4: Withholding LPT in a Neonatal Unit – A Low Birth Weight Baby 6.4.1 Discussion 6.4.2 Suggested Professional Responsibilities 6.5 Case 5: Artificial Nutrition and Hydration (ANH) – Is PEG Feeding Optional? 6.5.1 Discussion 6.5.2 Suggested Professional Responsibilities 7. Module 6 Further Discussion 318 7.1 Euthanasia and Physician-Assisted Suicide 7.2 Legal Positions: Euthanasia and Physician-Assisted Suicide 7.2.1 The Law – Ireland 7.2.2 Switzerland 7.2.3 The Netherlands 7.2.4 United States 7.2.5 United Kingdom 2009: The case of Debbie Purdy 7.3 Ethical Positions: Euthanasia and Physician-Assisted Suicide 7.3.1 Arguments in Support of Euthanasia 7.3.2 Arguments Opposing Euthanasia 7.4 Physician-Assisted Suicide (PAS) 7.4.1 Arguments Supporting PAS 7.4.2 Arguments Opposing PAS 7.5 Insights from Oncologists on Euthanasia and PAS 269 Module 6 The Ethics of Life-Prolonging Treatments (LPTs) 8. Summary Learning Guides 328 8.1 Central Issues and Concepts in Decisions about LPTs 8.2 Futility 9. Module 6 Activities 330 10. Module 6 References and Further Reading 332 270 Module 6 The Ethics of Life-Prolonging Treatments (LPTs) 1. Module 6 Key Points 1.1 Advance care planning (ACP): is at the centre of efforts to promote patient-centred care. ACP offers choice and respects the right of persons to consent to or refuse treatment and care offered. At present, legislation in Ireland covering advance care plans such as advance directives is not available, though in 2009 the Law Reform Commission published a report recommending that provisions be put in place to recognise validly drawn up advance directives. Nothing in ACP can authorise a health professional to do anything that is illegal. 1.2 Withholding and withdrawing LPTs: such as ventilators, dialysis machines, chemotherapy and the sophisticated technology of the intensive care unit are ethically and legally accepted practices that should ideally be specified in advance care plans or directives. 1.3 Withholding a particular treatment: for a particular patient is generally viewed as morally justified if the treatment...