Wednesday, May 18, 2005

The right to live

The Schiavo case has recently raised troubling issues over the right to die - the right of people to refuse medical treatment or even actively choose death rather than a life of pain and suffering - and of who decides when someone is not competant to decide for themselves. But what about the flip side of the issue? In the UK, doctors are currently challenging a patient's right to demand life-prolonging treatment on the basis that leaving that decision in the hands of patients is not in their best interests. Instead, the UK's General Medical Council insists that doctors should be able to refuse to provide care which may cause suffering or be "too burdensome in relation to the possible benefits". There are two reasons for opposing this paternalistic attitude. The first is that while we may not be competant in diagnosis, or to choose which treatment is best suited to resolve a particular problem, we are competant to choose the ends of treatment, whether it be "make my headache go away" or "keep me alive". And we're perfectly entitled to insist that doctors do what they can towards those ends within certain parameters of cost and risk. But more importantly, it does not respect patients' autonomy.

Autonomy - the idea that people are both owners and authors of their own lives - is the central issue in many "right to die" cases. Respecting autonomy means allowing people to choose how much pain and suffering they are willing to tolerate. But if we accept that individuals are allowed to choose to die to avoid suffering, there should be absolutely no question that if they instead want to fight to the last and squeeze every precious second out of life regardless of how much it hurts, then that wish should be respected. If we accept a right to die, we must also accept a right to live.


It's not quiet so simple. People can be denied treatment on the basis that the resources could be better used on someone else.

People who smoke or who otherwise compromise their health may be denied costly procedures on the basis that their actions compromise the effectiveness of the procedure.

Some procedures are also not performed on people over a certain age because the cost is so great and the money would produce better results in a younger person.

Organ transplants are only carried out when there is reasonable chance of success. If the potential recipient has other complicating factors that make success unlikely then it makes sense to use the scarce resource on someone else. That is not a decision that can be left to the individual.

One could argue that there should be resources made available so that this sort of thing does not happen but resources will never match demand in the health system.

Posted by Sock Thief : 5/19/2005 09:03:00 AM

Yes, I'm inclined to agree with socks. I don't mind sick old codgers prolonging their lives indefinitely but I don't think I necessarily want to pay for it- either as a tax payer or through higher insurance premiums. To me it's more of a priority to make sure not one child has their life and learning messed up by treatable things like glue ear. Not to mention doing something about all the poor kids in the third world who are unvaccinated against things like polio and measles

Of course ideally there would be enough to go round for every single person to have every high tech medical treatment possible but there isn't and choices have to be made.

Posted by Amanda : 5/19/2005 01:05:00 PM

As Richard (philosophy et cetera0 and I have been saying on his blog and as sock thief implies above if you give peopel treatment as they demand it is quite possible infact likely that you will have resource drains - such as an individual who demands treatment that may save his live but will be unbelievably expensive.
Hospitals must be able to make the decision to cut of these poeple. For example I might be dying from a total inability to oxygenate my own blood but if i had new blood pumped into me constantly and then discarded it would help keep me alive - however that would severely deplete the national blood supply. We have to be able to realise that that diversion of resources would kill people.
Such optiosn are always available and doctors constantly dont even bother to consider them and that must be the case.

Posted by Genius : 5/19/2005 06:09:00 PM

I find Idiot's autonomy arguemnt generally persuasive. But in this issue I suppose the age old push and pull between the community and the individual is highlighted.

I've worked in a haematolgy ward where death is sadly quiet common and treatment often very expensive. It is not uncommon for family members to push for contuuing treatment for a loved one when the hospital staff consider the chances of any improvement to be minimal. People in such circumastances naturally often want to keep hope alive.

This in my experience is more common than the situation of a dying person themselves demanding ongoing but futile treatment but the issues are similar.

Posted by Sock Thief : 5/20/2005 10:19:00 AM

I have a general dislike for systems where only sqeeky wheels get the oil so to speak (partly because I am not really a squeeky wheel).

Anyway - the government should take care of me EVEN IF there is no one to plead my case. They can safely assume I dont want to die any more than the next guy.

Posted by Genius : 5/20/2005 10:44:00 PM