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Ethics in America II
Three Farewells: Medicine & the End of Life
This program looks at the difficult choices a loving family makes as they confront the end of life. When a perfect pregnancy ends in unforeseen complications, and the newborn suffers very severe brain injury, how should the parents decide what is best for their baby? When, a few years later, the baby's grandmother descends into dementia from Alzheimer's, should her earlier wish to forego all medical treatment be honored, even though she may no longer understand — or agree — with the statements she made when she was competent? Still later, another family member receives a diagnosis of pancreatic cancer. If she is terminally ill, should she be able to avail herself of medications to aid her in dying?
“Three Farewells” looks at the difficult and sometimes heart-rending choices a loving family makes as they confront the end of life.
Our story begins with Hope, literally and figuratively. Hope is the name Faith and her husband picked out for the baby they were having if it were a girl. For Faith’s mother, Charity, still in her fifties, becoming a grandmother would take a little getting used to. But the pregnancy went perfectly. And, at forty weeks on the dot, Faith went into labor. Then something went wrong. On the way into the hospital there was a prolapse of the umbilical cord, cutting off oxygen to the unborn baby. At the hospital, everything that could be done was done; but now Baby Hope is on a respirator, her brain waves are very weak, and she shows no response to anything. How should the parents decide what is best for Baby Hope now?
A few years later, the baby’s grandmother Charity learns that she is in the early stages of Alzheimer’s disease. Always a strong, independent person, Charity asks her husband to promise her that, if she can no longer remember her family, nothing at all should be done to prolong her life. Five years later, Charity doesn’t know what day it is, what she used to do for a living, or who the president is. She doesn’t recognize her husband, her daughter, or anyone else. Then Charity has a small stroke. She recovers from it, and while she can no longer speak, her other abilities and her attitude toward life seem unchanged. There is just one problem. Because of the stroke, she can no longer swallow. She can only receive food through a feeding tube. The doctors ask the husband’s permission to insert the tube. If Charity’s husband follows the wishes Charity expressed when she was competent, then he would refuse to have the tube inserted, and Janice would die. But Charity’s daughter Faith says that Charity recently expressed a fear of dying, and says that Charity still enjoys some simple pleasures. Faith says that Charity now would not want to die. What should Charity’s husband do?
Eventually, Charity dies. A few years later, there is still more tragedy in Faith’s life. Faith develops pancreatic cancer. For Faith, this is the last straw. She tells her physician that she is willing to try treatment, but that if it’s unsuccessful, she wants control over what will happen to her. Faith’s state has passed a law similar to Oregon’s Death with Dignity Act, and she wants to get a prescription from her doctor that would allow her to end her life. What should the doctor do?
This program looks at the difficult choices a loving family makes as they confront the end of life. When a perfect pregnancy ends in unforeseen complications, and the newborn suffers very severe brain injury, how should the parents decide what is best for their baby? When, a few years later, the baby’s grandmother descends into dementia from Alzheimer’s, should her earlier wish to forego all medical treatment be honored, even though she may no longer understand — or agree — with the statements she made when she was competent? Still later, another family member receives a diagnosis of pancreatic cancer. If she is terminally ill, should she be able to avail herself of medications to aid her in dying?
Credits
EXECUTIVE PRODUCER
Richard Kilberg
PRODUCER
Barbara Margolis
WRITER
Joan Greco
SENIOR EDITORIAL DIRECTOR
Ruth Friendly
BROADCAST PRODUCER/DIRECTOR
Mark Ganguzza
EDITOR
Rob Forlenza
ASSOCIATE PRODUCERS
Jason Steneck
Ann Yoo
SCENIC DESIGN
H. Peet Foster
LIGHTING DESIGN
Dan McKenrick
SENIOR AUDIO ENGINEER
Bob Aldridge
ETHICS CONTENT ADVISOR
Lisa H. Newton, Ph.D.
PROGRAM CONTENT ADVISOR
Alan R. Fleischman, M.D.
AUDIENCE COORDINATOR
Rachel Ward
SPECIAL THANKS
Molly Collins
Ahmad Corbitt
Anne Hansen
Herbert Hendin
Robert L. Klitzman
David Leven
Betty Wolder Levin
John Lorenz
Anne Pearl
Kathy Powderly
Meet the Participants
| Arthur Miller (Moderator) Marcia Angell Daniel Brookoff Deborah Campbell Arthur Caplan Kenneth L. Connor Melinda Delahoyde |
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Barney Frank Diane Hoffmann Dallin H. Oaks John J. Paris Denise V. Rodgers David Satcher Kathryn Tucker |
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View Program and Text Highlights
The video highlight shows our panelists in action. The Discussion Guide frames their debates in contemporary terms, while the Ethics Reader grounds the discussion in the philosophy of the past.
In this video highlight, a picture-perfect pregnancy ends tragically when the baby’s umbilical cord becomes compressed during birth, cutting off oxygen and depriving the unborn baby of nutrients. At the hospital, everything that could be done was done; but now Baby Hope is on a respirator, her brain waves are very weak, and she shows no response to anything. The panelists assume hypothetical roles. As Hope’s mother and father, Melinda Delahoyde and Art Caplan fight to keep the baby alive on the ventilator, despite her lack of responsiveness. Others, such as Dr. Marcia Angell, argue that since Hope has no higher brain function, she has no best interests. How should the parents decide what is best for Baby Hope now?
Read Text Highlights
Framing This Discussion (from the Discussion Guide)
It used to be thought that a baby lacking basic human attributes like speech, laughter, curiosity, and love was not really human. About 25 years ago, the philosophers who specialized in medical ethics, or bioethics as it is called, moved away from that line of thinking. Of course the impaired baby, described above, is human. She has not transformed into some animal, nor, despite the popularity of the phrase “vegetative state,” into some vegetable. The question is not, What is she? let alone, Is she worth saving? But rather, What sort of medical interventions are appropriate for her, given her medical condition?
The answer implied by current medical practice is to offer interventions that promise benefit for the baby proportionate to the burden of the treatment, interventions limited to support for breathing on a ventilator, feeding tubes, kidney dialysis, surgery, and the like. This is straightforward and wise, but as the discussion in the clip demonstrates, often difficult to apply.
For a deeper examination of the analysis abridged here, see the Discussion Guide.
Philosophical Grounding of This Discussion (from the Ethics Reader)
Would the Greeks intervene in the case of Baby Hope? The Hippocratic Oath has set the standard for medical ethics since the fifth century B.C., binding all physicians who made the pledge. The following passage is an excerpt from the Oath.
I will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and in holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
To read selections from philosophical texts relevant to this program, see Ethics Reader.
Read Related Articles
Improving End of Life Care
A Hastings Center Special Report
This collection of essays examines issues surrounding end of life care, including the place of death and dying in modern medicine and conflicts over decision-making at the end of life. A list of end of life care resources is provided.
End of Life Care: A Human Rights Issue
Kathryn L. Tucker
Why does the undertreatment of pain during the end of life remain a routine problem in the United States? What legal and institutional steps must be taken to help the medical establishment fulfill its responsibilities to dying patients?
The Supreme Court and Physician-Assisted Suicide�The Ultimate Right
Marcia Angell, M.D.
What are the arguments against physician-assisted suicide, and why might they be unpersuasive? Should physician-assisted suicide be legalized?
