Language and Reality at the End of Life

1. Language and Reality at the End of Life Raphael Cohen-Almagor University of Haifa, ISRAEL

2. Every Profession Has Its Keywords That Are Important to Help Categorize Phenomena, Save Time and Provide a Framework for Working Together.

3. The Thesis: The Keywords Primarily Serve the Physicians, at Times at the Expense of the Patients’ Best Interests.

4. Death With Dignity • To have dignity means to look at oneself with self-respect, with some sort of satisfaction.

5. ‘Quality of Life’ • Positive connotations, for example, in rehabilitation, cosmetic treatments, psychiatry, and psychology

6. However, when dealing with end of life issues, ethicists who support euthanasia use the term ‘quality of life’ in a negative sense more often than in a positive one, meaning that they do not seek to improve the patient’s life but to end it

7. This phrase often serves to justify the termination of life • A subjective concept, meaning that one’s quality of life is determined by one’s personal life circumstances

8. Patients in ‘Persistent Vegetative State’ • Prolonged unawareness and post-coma unawareness (PCU) • The term ‘vegetative’ dehumanizes patients and therefore is offensive to patients and their beloved people

9. We should strive to describe the condition without offending patients or their beloved people • We should not strip patients of their human and moral characteristics

10. ‘Terminal’ Patients • The doctor’s task is to help patients to live when they want to continue living, not to hold a clock over their heads and count their days • When patients are labeled ‘terminal,’ doctors send them several simultaneous negative messages:

11. Not only that death is near, but also that the medical staff are giving up, • The patient’s beloved people should begin the mourning period while the patient is still alive • A difference exists between discussions among medical staff, and discussions that involve the patients and their beloved people

12. ‘Futility’ • Means any effort to provide a benefit to a patient that is highly likely to fail and whose rare exceptions cannot be systematically produced

13. First, a treatment that does not produce positive effects

14. Second, it is futile to provide a radical treatment whose side-effects outweigh the good emerging from the treatment

15. Third, it is futile to treat a disease when the patient is suffering from another life-threatening disease

16. Concerns about costs often underlie the appeals to futility in the clinical setting and public policy discussions • In public policy, the concept of futility can sanction restrictions in the allocation of health care resources

17. The problem is that physicians disagree about the type of clinical evidence necessary to justify a futility claim • What is required is a fair process approach for determining and subsequently withholding or withdrawing, what is felt to be futile care

18. ‘Double Effect’ Two basic presuppositions: • (1) the doctor’s motivation is to alleviate suffering • (2) the treatment must be proportional to the illness • The rule is not a necessary means to adequate pain relief because informed consent, the degree of suffering, and the absence of less harmful alternatives suffice

19. ‘Brain Death’ • 1) when should life support be withdrawn for the benefit of the patient? • 2) when should life support be withdrawn for the benefit of society? • 3) when is a patient ready to be cremated or buried? • 4) when is it permissible to remove organs from a patient for transplantation?

20. there is a significant disparity between the standard tests used to make the diagnosis of brain death and the criterion these tests are purported to fulfill.

21. Conclusions • A need to introduce more ethics into the medical school curriculum, equipping the medical staff with communication skills • A need to invest more time talking with patients and their beloved people

22. Clean the language and clarify it sincerely • Use elaborate explanations instead of concise, obscure or unethical terms