Making decisions about end-of-life care is a difficult and emotional experience for loved ones. Terminal illness and old age present numerous medical and ethical dilemmas that caregivers must address. Honoring the person's wishes, withdrawing care, withholding care or choosing a long-term care facility are all decisions with difficult ethical implications. Someone who is elderly or terminally ill can make these decisions easier for her loved ones by creating a living will that specifies what she wants.
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Significance
End-of-life issues surround all aspects of looking after an elderly or terminally ill patient, and caregivers face many difficult choices. These moral end-of-life issues take an emotional toll on caregivers that often lasts long after the death of a loved one. What should be primary on a caregiver's mind is the person's preferences and religious beliefs, if any.
Major Issues
If the person does not have a living will, one of the largest ethical dilemmas facing caregivers is the decision to withhold or withdraw treatment. Often, this means taking a patient off of a ventilator, removing a feeding tube or choosing to end chemotherapy or drug treatments. Caregivers must consider a patient's pain level, personal wishes, religious beliefs and quality of life when deciding whether to withhold or withdraw treatment.
Caregivers also face moral dilemmas when deciding on the type of care. At-home nursing care, placement in a nursing facility and hospice care all have their own benefits and drawbacks. Finances and caregiver stress may influence these decisions. Organ donation is yet another moral decision caregivers often must make.
Considerations
Before making a end-of-life care decision, there are a number of variables to consider. If the person is unable to communicate, consider her beliefs and wishes about remaining on a ventilator, staying in a coma or exhausting all treatment options. Consider her religious or spiritual beliefs about medical care and end-of-life treatment. Also consider the financial costs associated with continuing treatment, as well as the emotional and moral implications of terminating care. Would she want you to spend down her savings on uninsured treatments that would not give her any quality of life? Would you do this just to make yourself feel better or to make her feel better?
Misconceptions
Many caregivers wrongfully believe that withdrawing or withholding treatment is equivalent to euthanasia. But ethicists draw a distinction between killing a patient and letting a person die. If the patient is kept alive solely by medical machinery, withdrawing treatment is not equivalent to euthanizing the person. Euthanasia or physician-assisted suicide take place when a doctor knowingly administers a lethal dose of drugs or assists a patient in doing so.
Prevention/Solution
Many of the difficult moral issues surrounding end-of-life care can be circumvented by creating an advance directive. These documents, sometimes called living wills, are legal documents that state the person's wishes regarding end-of-life treatment. Advance directives inform family members about the kind of care the person wants, eliminating the confusion at the end of life. Everyone, regardless of circumstance or health, can make an advance directive.
Expert Advice
The moral issues associated with the end of life can seem overwhelming and emotionally taxing. If you are struggling with end-of-life decisions, consult someone you trust to help you think about the implications of the decision. Clergy members, counselors and medical ethicists help caregivers think about end-of-life issues and answer questions about care. A grief and bereavement counselor can help you work through the emotional difficulties associated with these decisions. Ask your doctor or hospital for resources.
