Language and Reality at the End of Life

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Language and Reality at the End of Life

• Raphael Cohen-Almagor
• University of Haifa, ISRAEL

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Every Profession Has Its Keywords That Are
Important to Help Categorize Phenomena, Save Time
and Provide a Framework for Working Together.
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The Thesis The Keywords Primarily Serve
the Physicians, at Times at the Expense of the
Patients Best Interests.
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Death With Dignity

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

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Quality of Life

• Positive connotations, for example, in
  rehabilitation, cosmetic treatments, psychiatry,
  and psychology

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• 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 patients life but to end it

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• This phrase often serves to justify the
  termination of life
• A subjective concept, meaning that ones quality
  of life is determined by ones personal life
  circumstances

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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

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• 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

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Terminal Patients

• The doctors 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

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• Not only that death is near, but also that the
  medical staff are giving up,
• The patients 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

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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

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• First, a treatment that does not produce positive
  effects

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Second, it is futile to provide a radical
treatment whose side-effects outweigh the good
emerging from the treatment
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Third, it is futile to treat a disease when the
patient is suffering from another
life-threatening disease
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• 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

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• 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

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Double Effect

• Two basic presuppositions
• (1) the doctors 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

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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?

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• 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.

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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

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