Right to refuse

One of the big ethical questions is the patient’s right to refuse treatment. Particularly a thorny issue when the treatment is life or limb saving. By not intervening are we fascilitating/assisting in his/her demise? Or are we respecting personal autonomy?

None of us can walk in another’s shoes. How can we judge what they have gone through? When they have had enough? Is one year of Chemo Hell enough?  is six months of nausea, weight loss and bad news enough? Who can say?

There was a case in Texas a long time ago where this young man and his father were working on a fuel pipeline. they were both burned severely with the father dying. The son survived with horrible burns. The treatment was painful beyond understanding. He refused treatment. The doctors ignored his pleas. This went on for many months. It is important to note that the treatment was not benign. It was excrutiating. Simply existing was excrutiating. And at the time it was anyone’s guess if it would work.

He did survive. He became a lawyer. Had a family. Yet continued to insist that they were wrong to do what they did. I wouldnt have. Would you? Could you say,” Sorry guy, but my ethics tell me that I need to torture you for an indefinite period of time for a vague hope of a good outcome.”  I remember hearing about the case and wondering what the doctors were thinking? Some of the other students tried to explain the thinking ( Really, there was thinking?) to me but we might as well have been from different planets. To me it was nothing short of barbaric human experimentation.

As I see it, if I have severe emphysema and diabetes with a heart condition, I am completely free to smoke as much as I can afford, eat all the fatty carbs I want, indulge in vast amounts of alcohol, see no doctor, refuse all medical treatment without any problem.

Yet if I am near death and there is little hope of recovery, I can be subject to the whim of whatever doctor happens to be on call at the ER. And the only real distinction is that in the latter case I may not be physical capable of walking out of the ER.

Very weird thinking from my point of view.