This is the final post of the series reviewing Professor Thaddeus Pope’s analysis of why clinicians perceive that not following a patient’s preferences about end-of-life care carries little risk for them. Additional legal remedies (causes of action available against clinicians who ignore patient choices), along with administrative penalties, and possible criminal liability for clinicians in some jurisdictions are discussed.
In Part 4 of this review of Professor Thaddeus Pope’s analysis of liability for a clinician’s providing unwanted life-sustaining medical treatment (LSMT), the focus is on on why clinicians perceive that not following a patient’s preferences about end-of-life care carries little risk for them and looking at more recent successful causes of action against clinicians.
In this, Part 3 of my review of Professor Thaddeus Pope’s paper about the legal issues surrounding unwanted life-sustaining medical treatment (LSMT), I focus on problems with advance directives (ADs).
In Part 1, I provided an actual case of unwanted life-sustaining medical treatment (LSMT), listed Professor Pope’s “Twelve Leading Causes of Unwanted Life-Sustaining Treatment,” gave the causes of action that may be available for unwanted LSMT, and briefly discussed Physician’s Orders for Life-Sustaining Treatment (POLST) and other similar documents used in various states. Here, in Part 2, I delve further into Professor Pope’s research on unwanted LSMT.
An important right in managing end-of-life medical treatment is the right to make our own decisions, either directly or through a surrogate, about when to refuse unwanted treatments. No one has done more to call attention to the right to reject unwanted medical treatment than Thaddeus Pope, who tracks litigation against medical providers who treat patients in ways the patients do not want to be treated, in direct violation of their expressed written choices, their verbally-expressed decisions, or the decisions of their medical agents.
Thanks to everyone who made suggestions to deal with Jane’s presumptive problems (see previous post). If Jane had an independent social worker–one not in her healthcare system–that person might respond to Jane’s difficulties with something like the following:
Many people with debilitating and irreversible health conditions do not have supportive family and friends. They include include people with metastatic cancer, irreversible neurological conditions, and multiple medical problems that have taken away any enjoyment and quality of life as determined by them. They no longer want to continue living because they know that their condition will only worsen, and for them it is already beyond bad. There is no realistic hope that their lives will improve. Most of the time, family members and friends are able to see the suffering in their loved one’s life and understand a desire to end the suffering. But this is not always the case, as illustrated in this post.
If we use “existential suffering” as a stand-in for all of the related terms we use, it will help us discuss what we may mean by them. Certainly, distress, dread, angst, anxiety, anguish, or crisis all suggest suffering at least in a mental or psychological sense, a kind of suffering that all people encounter at one point or another in their lives, or even daily. Some existential suffering can be mitigated through changes in circumstances or with the help of others, but when one is dying, whether slowly or rapidly, one may wish to forego the suffering whether or not there may be temporary relief for it.
There is no medical reason why a person who hastens their death because of suffering or unacceptable quality of life should be precluded from being an organ or tissue donor. What is important is the medical history of the prospective donor, the location at time of death, and the timely discovery of the body after a non-hospital death, which affects tissue donation.
A Dutch contribution to how we look at death and dying is provided by Cornelis J. “Jack” van Dyjk.
