Alexander Pope, the British poet, translated The Iliad of Homer, where he wrote that “It is man’s to fight, but Heaven’s to give success.” Perhaps we can find some wisdom in that statement. The setting I’m thinking of is one that will probably affect you. This is the decision about the use of life support, such as a ventilator or feeding tube. Many of us may be asked to make this kind of decision, but we might not feel comfortable with the responsibility. We don’t want to be the one who has to “pull the plug” on Grandma.
Whether to remove life support for a loved one is one of the most difficult medical decisions we might face. One study found the stress level of being a surrogate decision-maker is similar to surviving a house fire or other disaster.
It doesn’t have to be that way.
Even though end-of-life decisions are never easy, they can be made less stressful. I’d like to talk about two things that cause us stress: 1) uncertainty, and 2) moral concern. One reason that so many people feel stress is because of the uncertainty inherent in the practice of medicine, an uncertainty that will always be with us.
The other reason for stress on surrogates—moral concerns—revolves around the fear that withdrawing life support is morally wrong, maybe bordering on euthanasia. Let me reasuure you. Medically, ethically, and legally, there is no distinction between withholding or removing life support. Because of this, it is important that surrogates are not left to make the decision alone, but receive input from their doctors. The decision should be based on considerations of the medical benefit to the patient. But the patient can still refuse the treatment for other reasons. For example, my mother-in-law has told us firmly that she would not want chemotherapy, even if it might postpone her death for a couple of months. And that’s her choice.
Often doctors and clinical ethicists recommend a life support trial when it is medically uncertain if the patient will recover to breathe or eat on their own. The motive must be to benefit, not harm, the patient. The ventilator might help the patient survive while the underlying disease or injury improves. If the treatment fails, it can be stopped at the end of the trial. In other words, you never know until you try. “It is man’s to fight, but Heaven’s to give success.”
The surrogate is not responsible for the death of their loved one if they choose to remove life support. They are allowing the underlying disease or condition to take its course. They must also understand that limiting treatment is not the same as withholding care. Patients who are dying can still be given comfort care, including pain relief, ice chips or small amounts of food.
Death, whether our own or a loved one’s, is not an easy thing to face. That’s why understanding the issues surrounding the removal of life support is “everyday bioethics.”
The outcome is not in our hands. “It is man’s to fight, but Heaven’s to give success.”
CBHD offers an Advance Directive form that gives guidance to those that will make healthcare decisions for you, should you become unable to do so. http://cbhd.org/resources/advance-directive
For a brief Q&A overview, see Stewart, G. P., W. R. Cutrer, T. J. Demy, D. P. O’Mathuna, P.C. Cunningham, J. F. Kilner, and L. K. Bevington,1998. End of Life Decisions. Grand Rapids, MI: Kregel, 1998.
 Kevin B. O’Reilly, “Surrogate Decision Makers’ Dilemma Requires More Input from Doctors,” American Medical News, November 15, 2010 http://www.ama-assn.org/amednews/2010/11/15/prsb1115.htm (accessed January 14, 2010).