Hot Topics: End of Life Care
“Exploring ethical issues in TV medical dramas”
by Craig Klugman, Ph.D.
The Good Doctor (Season 3; Episode 11): Anesthesia and addiction; the limits of compassion; The Resident (Season 3; Episode 12): Dying (or not) on your own terms; Suing patients for medical debt; Chicago Med (Season 5; Episode 11): Quid pro quo—switched embryos, safe injection sites; surrogate withdrawal of life support
Carrie is a patient who arrives with a complicated leg fracture after falling while mountain biking.…Full Article
by Craig Klugman, Ph.D.
A world-famous leukemia oncologist lands in the hospital with occlusion to her coronary arteries and a damaged left side of her heart.…Full Article
by Barbara Ross Rothweiler, Ph.D., ABPP & Ken Ross
In the coming year, we celebrate the 50th publication anniversary of On Death and Dying, by Elisabeth Kübler Ross M.D.…Full Article
by Keisha Ray, Ph.D.
Right now in America there is a growing movement to help Americans die well. Organizations like Life Matters Media and Death Over Dinner aim to help people with end of life decision-making and to help people facilitate conversations about death with their families, friends, and communities.…Full Article
by Mark Siegler, MD
Dr. Elisabeth Kübler-Ross graduated from the University of Zurich Medical School, did her residency training at several hospitals in New York City, and then did fellowship training in psychiatry at the University of Colorado.…Full Article
by Craig Klugman, Ph.D.Full Article
by Suzanne van de Vathorst
In 2018, 6126 cases of physician aid in dying (PAD) (4.4% of all deaths) were reported in the Netherlands.…Full Article
“Based on an Actual Lie”—thus begins The Farewell, a film that follows 30-year-old Billi from her New York City home to Changchun, China, where she and her family visit her dying grandmother Nai-Nai. Billi’s family arrives in Changchun under the guise of a wedding celebration for Nai-Nai’s grandson, but they have really come together to all be with Nai-Nai before she dies of stage IV lunch cancer. The ‘actual lie’ on which the story is based concerns the withholding of grim health information from the family’s matriarch; but this very substantial lie coexists with myriad other well-intentioned lies that various family members tell one another throughout the movie.
The Farewell is a good reminder that disease often affects an entire network, and that medical ethics is, much to the chagrin of many analytic philosophers, embedded in a highly complex web of cultural and sociological forces. Billi’s father admits to Billi that their strategy of lying to Nai-Nai about her condition wouldn’t fly in the United States; yet the viewer discovers, along with Billi, that norms in China dictate against medical honesty when that honesty brings with it bad news.
This cultural clash is most stark when we witness the bilingual Billi speak to Nai-Nai’s doctor in English right in front of Nai-Nai, who speaks only Mandarin. Billi interrogates the physician about whether lying to Nai-Nai is the right thing to do, and he affirms that Nai-Nai has advanced lung cancer and reassures Billi that “it’s a good lie.” Here, the truth is right in front of Nai-Nai, but just out of reach.
The central tension of the film concerns the interplay between informational disclosure, harm, and autonomy. Nai-Nai’s family is deeply concerned about the harm that disclosure of her disease status would cause, and this concern appears to be the main driver of their decision to withhold information. But I have to wonder whether there are other factors in play—e.g. avoidance or denial—that are also contributing to their decision. And in focusing so much on harm, the family ignores Nai-Nai’s autonomy—and with it, her vibrant, hilarious personality—as worthy of consideration and respect. When, if ever, does information cause the type of harm that the bioethical principle of nonmaleficence dictates against? And when, if ever, does this type of harm justify a disregard for autonomy? These are hard questions to answer.
In the film’s coda, we learn that Nai-Nai is still alive six years later. As a viewer, I was not sure how to take this information: is it evidence that Nai-Nai’s family did the right thing by lying to her, therefore giving Nai-Nai the opportunity to live six more years in blissful ignorance? Or does her unexpected longevity make the lie all the more nefarious, since it robbed Nai-Nai of the chance to view each one of those nearly 2200 days as an especially precious gift?
The most likely answer is that it depends—it depends on what Nai-Nai herself would have wanted. And with the exception of Billi, Nai-Nai’s family members do not give this question any thought when deciding on what they think is best for Nai-Nai. We do learn that Nai-Nai lied to her late husband when he was terminally ill, which Nai-Nai’s children seem to think justifies their doing the same to Nai-Nai. But we also witness the sting of humiliation when Nai-Nai learns that her husband lied to her for years about his smoking habit. We see throughout the film, from several different angles, how we often don’t really know the people whom we believe we know best of all.
As for me? Well, I’d want to be told the truth. But I’d also want the opportunity to leave that truth by the wayside, should I deem it too much of a nuisance, and walk away no worse for the wear. If only that were a real possibility—for Nai-Nai, for Nai-Nai’s family, and for the rest of us.
This post is presented in collaboration with the American Journal of Bioethics.
You can read the entire issue by clicking here.…
This post is presented in collaboration with the American Journal of Bioethics. You can read the entire issue by clicking here.…Full Article
The Inner Lives of Doctors: Physician Emotion in the Care of the Seriously Ill
Everything I Really Needed to Know to Be a Clinical Ethicist, I Learned From Elisabeth Kübler-Ross*
Fifty Years Later: Reflections on the Work of Elisabeth Kübler-Ross M.D.
Recollections of Dr. Elisabeth Kübler-Ross at the University of Chicago (1965–70)
Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients
Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?
Medical Aid-in-Dying is an Ethical and Important End-of-Life Care Option
Parity Arguments for ‘Physician Aid-in-Dying’ (PAD) for Psychiatric Disorders: Their Structure and Limits
Concerning the Basic Idea that the Wish to End Suffering Legitimates Physician Aid in Dying for Psychiatric Patients
At age 57, Saran was diagnosed with frontotemporal dementia, a progressive, fatal brain disease. She sold her home and moved to Kendal at Ithaca, a bucolic retirement community in rural New York whose website promised “comprehensive health care for life.” And now, she’s fighting with that community over her right to determine how she’ll die ― even though she has made her wishes known in writing.Full Article
In an essay for Bioethics Forum earlier this month, Alan B. Astrow concludes that medical aid in dying is not a human right, though I will note that it is a state constitutional right in Montana and a legal right for the terminally ill in 10 other jurisdictions in the United States.Full Article
This is the story of the Rinka family and what happened when tragedy befell them. It’s a story that explores how the choices we prefer when we’re healthy may no longer make sense to us when we’re actually confronting death.Full Article
Three books – written by a doctor, psychiatrist, and nurse – shine light on the emotional toll of providing care for critically ill patients.Full Article
Studies suggest that relatives don’t distract the medical team or interfere with decision-making when a patient is in cardiac arrest.Full Article
Darryl Young suffered brain damage during a heart transplant at Newark Beth Israel and never woke up. But, hardly consulting his family, doctors kept him alive for a year to avoid federal scrutiny.Full Article
Few want to think about their own deaths. And forms rarely capture the complexity of real-life medical decision-making. But there are ways to tackle these and other roadblocks.
While the recent legal battle has been a source of confusion and frustration for terminally ill Californians and their physicians, the eventual fate of this law remains unresolved. Even if there are no additional attempts to invalidate the law, it will “sunset” in 2026. Without further legislative action medical aid-in-dying will disappear from California yet again.Full Article
A little more than one year has passed since John McCain was diagnosed with glioblastoma, an aggressive form of brain cancer that carries a grim prognosis. On Saturday, only one day after it was announced that the Arizona senator had decided to “discontinue medical treatment,” he passed away.Full Article