Research into trends concerning medical futility reveal that aggressive treatment at the end of life is not equating to better outcomes (Colello 2008). In fact, not only is it providing no benefit, all too often it imposes unnecessary pain and suffering. In the case of patients who lack decision making capacity and do not have an advance directive, families are often approached by nursing staff and asked “Do you want us to do everything?” or if they would prefer a Do Not Resuscitate status (DNR), meaning CPR will not be initiated if breathing or the patient’s heart were to stop. This sends a confusing message to families, that there is something worthy of offering their loved ones; ...view middle of the document...
With the proliferation of technology and decreased costs to consumers, health care has become increasingly sought after. The ability to cure and manage disease and illness that in the past would have been fatal, eventually gave way to preventive medicine. This in turn, extended life expectancy, while enjoying a significantly better quality of life. According to a report commissioned by the Department of Health and Human Services (DHHS), the average life span has increased from just 49.2 years in the early part of the 19th century to an average of 77.8 years today (Colello et al. 2009). The trade off, however, is that while people are living longer, our population is growing increasingly older and sicker at an alarming rate.
The demand on health care resources in the U.S. has increased exponentially. The DHHS reports that health care spending is nearly twice that of other developed countries, consuming roughly 18% of the nation’s gross domestic product (GDP). Each day, an estimated 10,000 baby boomers become eligible for Medicare benefits, a rate that is expected to continue through 2035, at which time Medicare expenditures are expected to consume roughly 31% of the federal budget (Colello 2009). These figures reflect a rapidly changing demographic in our nation which will present a vastly different, much more complex set of health care needs. We must therefore, prepare for the challenge ahead.
Right to Die
The context and culture of health care today bears little resemblance to that which previously existed. It has now become possible to extend, postpone, or delay death for days, weeks, months or even years to accommodate the whims and desires of everyone other than the patient. What does this say for patient autonomy? Not much. Now it seems that duty to patients takes a backseat to duty to their families. Logic and reason has been forfeited in the relentless pursuit of victory over death. The new found ability to manipulate death, denies humans their right to a dignified death and has given way to a delusional and perverse belief that engaging in a perpetual tug of war with God is not only acceptable but appropriate. If we are granted rights to life, liberty, and the pursuit of happiness, perhaps by the same token, death ought to be included. The obligation now felt among providers to prolong clinical death at the request of families has given rise to unrealistic expectations. Further, caring, compassion, and the relief of pain and suffering have been overshadowed by a preoccupation with the miracles of modern medicine (Ferrell 2006).
Before the emergence of modern medicine Schneiderman points out, physicians managed the care of patients according to their own treatment preferences. Patients had limited roles in the management of their care and generally trusted without question the judgment of physicians. This, however, began to change as scientific research took on a more prominent role and human subjects...