A REALISTIC SCENARIO
IN EXERCIZING YOUR RIGHTS UNDER
(
Introduction
The following scenario is meant to
illustrate your rights and freedom of action and decision-making which are protected
under Part 2 "Instructions for
Health Care" of the
Scenario under 2.1, a
You have the right to edit this section,
for example you could choose to cross out the last sentence and thereby allow
medical staff to feed and hydrate you with tubes. If you have not crossed out that sentence and
you have fallen into an irreversible coma, or persistent vegetative state(PVS),
then you have, by initialing at 2.1 a, decided
to accept your death as the natural outcome of your state and have rejected
medical intervention since it can neither cure you nor add to your comfort. It
should be noted that this decision on
your part is in no way contrary to the traditional moral constraint against
suicide since the medical interventions cannot cure you and your dying is due
to whatever put you in the states described. If bystanders were to argue that
you could be kept alive in the coma or PVS indefinitely, their opinions will
not count against your decision, which is essentially to reject interventions
which do not cure or add to your comfort and to accept death in the most timely
fashion.
In (2) you see that even should you not
be in a coma or PVS, and you are, by competent medical judgment, dying from a
cause whose progress medicine can at most slow down, then you still have the
freedom noted in (1) above. For example,
your heart and circulation are so damaged by disease and are getting so
steadily worse that you will surely die from this disease. . A natural event
would be for blood clots to develop and end your life. Medicines can prevent
the clotting but not stop the advance of the disease. Your freedom here is to decline
these medicines since they neither cure nor add to your comfort. Once again you
are simply saying that it is not the job of medicine to drag out the dying
process.
In (3) not much is added. It is just another
way of saying that if medical experts have decided that you are heading toward
death with this condition, you have decided to reject any mere slowing of the
process. The same can be said about (4) because it is not significantly
different from (1). It is not simply because you are unconscious, but because
your unconsciousness is going to end in death no matter what. So you are free
to say: "I don't want any interventions which simply drag out the dying
process."
Sometimes the situations described in
(1) to (4) are not so clear, and there may be legitimate differences of opinion
about whether some kind of temporary "benefit", which might be
considered a temporary "cure" might be possible. For example you
might be suffering from advancing kidney or liver disease which is going to
kill you fairly soon. At the same time you have a heart condition which very
expensive surgery could correct and the resulting improved circulation might
slow down but not stop the advance of the kidney or liver disease. Your
decision in signing 2.1 a and not
crossing out (5) is that you want
your agent and medical staff to know that you do not want the heart surgery
because, in part, it costs too much for what it can provide by way of benefit.
It may be curing your heart, but it is not really curing you since it at most slows down your dying process, which is not
what we mean by "curing."
Summary
In sum, what 2.1 a makes clear is that those who are really dying retain the
freedom to choose the time of their death where that is possible. Their dying
has causes outside of this decision and outside of their control, so there
is no question of suicide here, nor any question of asking medical staff to
kill them. The right to choose a more merciful (and even less expensive) time
of dying belongs to the dying person. It is not a function of medicine to
lengthen the dying process. And the dying person is not introducing any new cause of death, which is what it is to kill a
dying person.