“Letting Die”
“Letting Die”
• Allowing own/another’s death by withholding or withdrawing
medical treatments necessary to maintain life
• Removing “artificial” means of keeping one alive
Clarification …
1. Applies to patients at end stages of terminal disease, or
whole brain-death patients
2. Does not apply to patients with functional brain stem (Terry
Schiavo)
“Letting Die” vs. Euthanasia & Assisted Suicide
Moral difference involves motive …
• Euthanasia/assisted suicide => Directly will or intend death
• Letting die => Don’t will or intend death, although death results
Moral difference involves direct action(s) …
• Euthanasia/assisted suicide => Act directly ends life
• Letting die => Don’t directly cause death …
a. Remove artificial means of maintaining biological life
b. “Let nature take its course”
“Letting Die” vs. Euthanasia & Assisted Suicide
“Letting die” as morally permissible…
“Euthanasia must be distinguished from the decision to forego socalled aggressive medical treatment … In such situations, when
death is clearly imminent and inevitable, one can in conscience
‘refuse forms of treatment that would only secure a precarious and
burdensome prolongation of life, so long as the normal care due to
the sick person in similar cases is not interrupted.’”
John Paul II, Evangelium Vitae - “The Gospel of Life,” #65
“Letting Die” vs. Euthanasia & Assisted Suicide
“Letting die” as morally permissible…
“Withholding or withdrawing such treatments [“letting die”] is
not a choice to kill oneself or another for merciful reasons. It is not
euthanasia. One does not judge a life to be excessively
burdensome (or futile), one judges a treatment to be excessively
burdensome (or futile).”
Catholic Bioethics and the Gift of Human Life, 261
• “Letting die” = “letting go” (Amanda Y.)
How Do We Make the Decision to “Let Die” in a Health Care Setting?
1. Philosophical/Theological Criterion …
• “Relational Quality of Life”
2. Medical Criteria …
• “Burdensomeness” of treatment
• Usefulness of treatment
Relational Quality of Life
Decisions concerning the discontinuation of care are based on the
relationship between …
a. Patient’s medical condition (prognosis)
b. Patient’s perceived ability to pursue “life’s goals”
Relational Quality of Life
“Life’s goals”
1. Physical life
2. Human flourishing
3. Interpersonal relationships
4. Values that transcend physical life …
• Emotional
• Moral
• Intellectual
• Spiritual …
• Values that make human life specifically human
Panicola et. al., An Introduction to Health Care Ethics, 124
•
•
“If the [patient’s] overall condition cannot be improved through
treatment such that he/she will be able to experience life, engage
loved ones, interact with others, participate in society and fulfill
personal interests [life’s goals] at least at a minimal level, then the
medicine has reached its endpoint …
In such situations, treatment ceases to provide a meaningful benefit
[extraordinary vs. ordinary] and as such the goals of care should shift to
comfort and palliation* …
* Palliative care: relieving pain and suffering without curing underlying condition
•
This is, of course, never an easy determination to come to, but it is one
that we nonetheless must make at times if … medicine is going to
serve the best interests of critically ill [patients].”
Good Care: Painful Choices, p.94
• [E]xtraordinary means (of care) [burdens outweigh benefits] are not
obligatory since to demand more than ordinary means (of care)
would be burdensome and would make the attainment of the
higher, more important good too difficult …
• What is this higher good? The Judeo-Christian answer is love of
God and love of neighbor [“willing the good of the other”], that is,
the love given and received in interpersonal relationships. The
Christian insight, moreover, says that the love of God is expressed
in and through love of neighbor and constitutes the meaning and
substance of life …
Good Care: Painful Choices, p.94
• Thus, when the struggle for survival, when focusing everything
(time, attention, energy, resources) on self, destroys the possibility
of relationships or one’s ability to enter into them, these means for
the struggle become extraordinary because they [a] jeopardize or
distort the very meaning life and [b] make mere physical
[existence] the ultimate value, an absolute good. (94)
Overall
Morally obligatory
Treatments that allow patient to pursue life’s goals
• to at least a minimal level
• without excessive burden
Not morally obligatory
Treatments that
• merely sustain life and prolong dying process
• cannot improve patient’s overall condition so that he/she
can pursue life’s goals
• impose excessive burden and/or expense on family &
community
Medical Criteria for “Letting Die”
“Burdensomeness” of Treatment
1.
2.
3.
4.
5.
6.
Experimental treatment or risky nature of procedure/medication
Bad side effects and/or consequences
Interferes with desired activities in time one has left
Excessive pain
Excessive expense
Psychologically repugnant (Jehovah’s Witnesses, organ transplants
from animals, etc.)
Medical Criteria for “Letting Die”
Usefulness of Treatment (ordinary vs. extraordinary means of care)
1. Treatment offers no reasonable hope or benefit
2. Benefits nil or not significant when compared with burdens
imposed