Thriving vs Surviving: Should One Trump the Other?
“Thriving vs surviving", it all comes down to the issue as to whether the patient’s life is worth living (thriving) in the view of the patient. Take for example the scenario I posted in October 2006 which was based on a real case.
After 4 years on the ventilator, the 34 year old quadriplegic finds nothing to encourage him to live longer in his current condition. He lost his girl friend and no longer can be a motorcycle officer and is fully dependent on others to care for him. He is requesting that the physicians withdraw his life supporting ventilator treatment. The decision seems clear when the patient is conscious and has the capacity to make his own medical decision. But is not always accepted by the physicians as what occurred in the scenario presented.
Hospital ethics committee experience is that the decision is much more difficult to establish when the patient is unconscious and may never awaken to tell the physicians what “thriving” means to the patient’s own life and whether life supportive treatment should be continued or discontinued. The committee must look to family members or friends who know the patient and may report on what their sense is of the values in life for the patient so that some decision can be made.
On the other hand, do you think that under all circumstances including even the conscious patient but especially when the patient is unable to communicate, that the morally correct decision would be that surviving always trumps any consideration of thriving? ..Maurice.
Graphic: Digital photograph taken by me today.
posted by Maurice Bernstein, M.D. @ 10:28:00 AM
3 comments
3 Comments:
With regard to this topic of "surviving vs thriving", you might be interested in a current thread that I am participating in on the Encyclopedia Britannica Blog begun November 21 2008 by psychologist Dr. Normal Fried. It is about a 13 year old girl from the United Kingdom who for years has been sick with leukemia and heart disease and is now offered a heart transplant but despite others supporting a heart transplant decision, she has refused the procedure. The issue does involve her decision to the effect that she doesn't want just to survive but also to thrive. The main direction of the blog thread is whether a 13 year old child has the capacity and the legal power to withhold treatment that might keep her alive. ..Maurice.
Maurice, this is an incredibly important issue to me and to my friends with disabilities. My first and primary question when any person with a disablity requests removal of life support or assisted suicide is whether they have been treated for depression. When *any* other person expresses suicidal wishes over major life changes, they are given counseling and support. Moreover, what in his or her life is a result of inaccessibility--to transportation, to social networking, to the outside world--rather than the disability itself?
In addition, the legal right to die quickly becomes the *obligation* to die. People don't see our lives as worth living and rank our lives as unbearable. News stories about why we should be "allowed" to die are more prevalent than those about "thrivers." And how many of us have heard, "I'd kill myself if I were in a wheelchair?"
Please don't forget such social problems as the Medicare homebound rule--to get in home nursing care, one must be confined to home except for doctor's appts. and church. This is wrongful imprisonment. The alternatives are nursing homes/state facilities--*if* those are available and there's space, or full time caregiving by a family member without any reprieve--if a family member has the ability to devote themselves to 100% of someone's care, neglecting their own needs/working to support the family.
I do know someone on a ventilator who enjoys life, but the majority of her free time is spent on the phone dealing with insurance/Medicare and negotiating for her health care needs. This is a social problem, not a problem inherent in disability itself.
I can attest to the problems in accessibility. Saturday I came up to a building--my kids already had gone in with friends--my daughter comes running out, concerned--there's no ramp, Mom, no way to get in. There were a couple of guys to lift my 150-pound scooter--I can stand/walk for a while, so don't have the transferring issues others do. But I have to tell you, my initial reaction was grief, feeling unwelcome and unwanted. This happens all the time. Stores, schools, churches, people parked on the disabled ramps, people literally cursing me.
Transportation--minivan and lift--is hugely expensive and not covered by insurance. Public transport is inadequate--4 hours each way, which is my time limit out for most days before I am suffering!
Most of my difficulties are not posed by disability itself but by lack of social or systemic support. We're not a society that cares about people with disabilities. Laws are widely ignored; just because there is one doesn't mean it is followed, even in new construction!
Oops, I did mean 2 hours each way, 4 hours roundtrip for public transportation. Quite a lot since bumpy buses are painful and it's difficult to be out that long.
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