Death and dignity - Preparing for the inevitable

Scientific advances force us to reconsider many dearly held beliefs.

Discoveries in the natural world and new technologies mean we must realign our relationships with the world around us and the ethics we subscribe to in supporting those essential, life-sustaining relationships.

Medical advances have probably brought us to the point where we can no longer defer agreeing new policies that will allow terminally ill people to die with dignity, composure, and in comfort.

These advances can prolong a life that is, by any rational assessment, at its end.

It is not to diminish the sanctity of life to consider that continuing medical intervention can, in some cases, be cruel and delusional — in fact, it is probably protecting that sanctity.

It can be heartbreaking for families to watch as a loved one, no longer competent, capable, or even remotely robust, struggle with life’s conclusion.

Most of us would prefer to die at home, surrounded by those we love, rather than in a hospital with an array of tubes and drips attached to us in a forlorn effort to defer the inevitable for a few painful days.

If that extended treatment is driven by religious beliefs, then it can be especially cruel. The Journal of Medical Ethics recently described situations in which the lives of terminally ill children were prolonged because that child’s parents believed divine intervention might save their child. But then who will decide?

The heartbroken parents clinging to belief-based hope, or the medical professionals whose dispassionate experience leads them to only one conclusion?

Is it right to artificially sustain an inviable life in the hope that it might be saved by something as unlikely as a miracle?

As ever, the frontline between religions and the sciences is a quagmire. Nevertheless, healthcare advances oblige us to confront the issues dispassionately.

Most of us are aware of families or individuals forced to come to terms with possibly the most harrowing, the most hollowing, death we can imagine.

We all know of people who, long ago, because of old age and some form of dementia, have forgotten who they are, who they were, or who their loved ones are. Though physically present, nearly every other quality that defines life has slipped away. Some people are sustained in this solitary twilight for years.

In many cases, for a time at least, a person loses their intellectual faculties but at least remains physically well. But for how long, and to what purpose, is it right to medically support utterly dependent lives?

Earlier this summer, the HSE concluded a process of public consultation on Do Not Attempt Resuscitation orders. These let sick people formally request that their illness be allowed take its course should they require resuscitation that might not protect their quality of life.

It might be foolish to pretend that some sort of strategy for confronting these hard issues does not already exist, but surely these life-and-death decisions should involve more people than just the ranking medical professional?

Surely it would be better if we all knew what our options might be and could be confident that our wishes, whatever they are, might be respected when life’s only inevitable moment is reached?

We all need to find the courage to face our death, so surely we can find the courage to face and resolve these issues. Avoiding them is not an option.