PULLING
THE PLUG:
A PARADIGM FOR
LIFE-ENDING DECISIONS
PULLING
THE PLUG:
A
PARADIGM FOR LIFE-ENDING DECISIONS
by
James Leonard Park
As the 21st century advances,
more of us might be supported by
machinery and drugs
in the last few days or weeks of our
lives.
If we die from some disease or condition
that normally
takes months or years to bring death,
then our dependence on
life-support systems might be even longer.
If we are being kept alive by some form of medical technology,
then
any decisions we make about the best
time to die
and
about the best
means to allow our deaths
will
have to include questions about what
to do
with
the life-support systems in place—keeping us alive.
1.
ENDING LIFE-SUPPORTS
—A WELL-ESTABLISHED MEDICAL PROCEDURE.
Medical ethics in the 21st century includes discontinuing
life-supports.
And some end-of-life decisions include never
starting life-supports
when it is clear in advance that
putting us on a ventilator, for example,
will only prolong the
process of dying.
If there are no particular reasons to keep
us alive for a few more days,
then everyone involved in this
end-of-life decision
will probably agree not to extend the process of dying.
And even when there is no clear decline into death
because further deterioration is being prevented by the
life-supports,
reasonable people can agree that if there will be
no recovery,
there is no point in keeping us in a coma on
life-supports indefinitely.
On the other
hand, when we are drawing our lives to a close,
we might have some
very meaningful things we want to achieve
before the end of our
lives.
And usually these will be quite independent
of any
objective facts found in our medical charts.
For example, we might have some religious practices or good-byes
that
we want to complete before we 'allow nature to take its course'.
We
might want to have our sins forgiven before we 'meet our Maker'.
We
might want to make amends with estranged family members.
We might
want to see a grandchild or great-grandchild before we die.
If we imagine our lives as a movie or play,
we know what scenes
we would like to have before the end of the show.
And if we are
realistic about the amount of time left,
we will know which
projects we can complete within that time-span
and what new
projects would be unrealistic.
2.
SOME FORMS OF 'PULLING THE PLUG'
ARE MORE
CONTROVERSIAL.
'Pulling the plug' on our life-support systems carries no stigma,
as
might be the case with taking a lethal chemical to bring
death.
Perhaps this is because we can see clearly (and sometimes
dramatically)
that 'life' in the intensive care unit (ICU)
has almost
no similarities to the life we lived
in all the years leading up
to this final scene.
When we are being supported by a heart-lung
machine
that is keeping our blood circulating and oxygenated,
we
know that this situation cannot continue indefinitely.
Our feelings about 'pulling the plug' are somewhat different
when
the life-supports seem more like daily living.
For example, our
lives might be sustained
by medication to control our
blood-pressure
to keep our hearts and blood vessels operating
well.
If we go
off that medication,
we know that we could easily die
from the cardio-vascular problem now controlled by the drugs.
At
least in the advanced parts of the world, if we live long enough,
most of us will be using various medications at the end of our
lives.
And we might have so
many different
prescription drugs
in our bodies that we cannot remember them
all.
We might have experienced continual adjustments of our
drugs
because of the subtle interactions among them:
One drug
causes a particular side-effect,
which needs to be controlled by
another drug, etc.
In such situations, when
we are ready for our lives to end,
we can simply refuse to take
any
of the drugs
keeping us alive.
Our doctors can tell us how long we can expect
to live
without the medications that have been assisting our vital
functions.
A somewhat more controversial
situation arises
when the life-support is a feeding-tube
or other means of
supplying food and water.
At the end of our lives, if we cannot
eat normally,
then we might be attached (either temporarily or
permanently)
to a feeding-tube that puts special foods directly
into our stomachs.
Or
we might have fluid and nutrition put directly into our
veins
—by-passing
our digestive systems completely.
But even
discontinuing artificial feeding
has now become a part of standard
medical practice.
Such decisions should not be taken lightly
and
without considering all the implications for everyone involved.
But
from the perspective of medical practice
discontinuing artificial
nutrition and hydration
is a common method of managing dying.
When we think of our own lives coming to an end
by means of
withdrawing or withholding a feeding-tube,
we know that the utmost
caution is needed
in the decision-making process that might lead
to this action.
Each of us should consider just how such a
life-ending decision
should be reached with respect to our own
lives.
And we should explain our plans in our Advance Directives for
Medical Care.
If we clarify our own medical ethics well in advance
of any situation
in which withdrawing a feeding-tube becomes a
real option,
then we
have considered this method of managing dying,
probably years before it becomes a real-life choice.
4.
SINCE WE CAN
BE REASONABLE
ABOUT
'PULLING THE PLUG',
PERHAPS
THE SAME DECISION-MAKING PROCESS
COULD
BE APPLIED TO OTHER LIFE-ENDING DECISIONS.
As more of us gain experience with terminating life-supports,
we
will become more familiar with the safeguards that should be used
to
make sure that any harm
to the patient is less
than
the harm
already being inflicted by the life-support systems themselves.
Of
all deaths that now occur in hospitals,
about 80% involve some
important
elements of choice.
If no choices are made, the patients will
continue to be maintained
on life-support systems until they die
despite
the 'tubes and
machines'.
How often are patients 'treated-to-death'?
As a culture, we have
not given much attention to life-ending decisions.
But if
over half of deaths in
America now include some choices,
then we
are already making over a million life-ending decisions each
year.
Implicit
safeguards are already being used for these medical decisions.
And
as we become more aware of medical decisions that bring death,
we
can make the safeguard-procedures more
explicit
—perhaps
with an eye on other life-ending decisions
that are not so
completely within the control of doctors.
As we learn to make wise decisions about terminating
life-supports,
we are also learning how to articulate the
safeguards
that should be applied to all
life-ending decisions.
The
right-to-die means being able to make wise choices
so that we
can die at the best
time and
by the best
means.
Pulling the plug is sometimes the wisest end-of-life medical choice.
How
has this chapter changed your mind?
Did
you once think that 'pulling the plug' was not permitted?
Did you
think that once life-supports were started,
it would be wrong to
discontinue them?
If someone you love is ever on life-supports,
how would you decide to disconnect the tubes and machines?
If
you yourself are ever kept alive by life-supports,
do you now
think you could authorize your death by withdrawing them?
AUTHOR:
James Park is an independent thinker
with deep interest in medical
ethics,
especially the many issues that arise at the end of life.
Medical Ethics and Death are two of the ten sections of his website:
James
Leonard Park—Free
Library
This essay about
withdrawing life-supports
as a medical method of managing dying
has become
a chapter in a small book entitled:
Right-to-Die
Hospice
WOULD
YOU LIKE TO MEET OTHER SUPPORTERS
OF
RIGHT-TO-DIE HOSPICE?
If
you agree with disconnecting life-supports as a valid method of
managing dying,
consider joining a Facebook Group and Seminar
called Right-to-Die Hospice.
This
discussion group is completely free of charge.
And
members are welcome to join from anywhere.
The
above discussion of disconnecting life-support systems
has
become Chapter 7 of Right-to-Die
Hospice.
Here
is a complete description of this on-line gathering of advocates of
the right-to-die:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-RTDH.html
And
here is the direct link to our Facebook Group:
Right-to-Die
Hospice:
https://www.facebook.com/groups/145796889119091/
The above
exploration of ending life-support systems
is
also Chapter 48 of How
to Die: Safeguards for Life-Ending Decisions:
"Pulling
the Plug: A Paradigm for Life-Ending Decisions".
A
few related essays:
A
New Way to Secure the Right-to-Die:
Laws against Causing Premature
Death
Losing
the Marks of Personhood:
Discussing Degrees of Mental Decline
Advance
Directives for Medical Care:
24 Important Questions to Answer
Fifteen
Safeguards for Life-Ending Decisions
Will
this Death be an "Irrational Suicide" or a "Voluntary
Death"?
Will
this Death be a "Mercy-Killing" or a "Merciful Death"?
Four
Medical
Methods of Managing Dying
Voluntary
Death by Dehydration:
Safeguards to Make Sure it is a Wise
Choice
The
One-Month-Less Club:
Live Well Now, Omit the Last Month
Choosing
Your Date of Death:
How to Achieve a Timely Death
—Not
too Soon, Not too Late
The
Living Cadaver:
Medical
Uses of Brain-Dead Bodies
Depressed?
Don't
Kill Yourself!
Further
Reading:
Best
Books on Terminal Care (from the Doctor's Point of View)
Terminal Medical Care from the Consumer's Point of View
Books
on Advance Directives for Medical Care
Best
Books on Voluntary Death
Best
Books on Preparing for Death
Books
on Terminal Care
Medical
Methods of Managing Dying
Books
on Helping Patients to Die
Books
Supporting the Right-to-Die
Books
Opposing the Right-to-Die
Go to the Right-to-Die Portal.
Go to
the Book
Review Index
to discover 350 reviews
organized into 60
bibliographies.
Return to the DEATH page.
Go to the Medical Ethics index page.
Go to
other
on-line essays by James Park,
organized into 10
subject-areas.
Go to
the beginning of this website
James
Leonard Park—Free
Library