End of Life

Revitalizing Medicine: Empowering Natality vs. Fearing Mortality Part II

One of the great accomplishments of modern medicine is arguably the gains that have been made in extending longevity. Throughout the twentieth century, average life expectancy increased dramatically across the globe, a trend being continued in the twenty-first century with the notable exceptions of sub-Saharan Africa and Russia. For the first time in history it now seems “normal” that a person should live a long, healthy, and active life. Although the trend line is still moving up, it has started to plateau.

Podcast Episode: 
128

Revitalizing Medicine: Empowering Natality vs. Fearing Mortality

One of the great accomplishments of modern medicine is arguably the gains that have been made in extending longevity. Throughout the twentieth century, average life expectancy increased dramatically across the globe, a trend being continued in the twenty-first century with the notable exceptions of sub-Saharan Africa and Russia. For the first time in history it now seems “normal” that a person should live a long, healthy, and active life. Although the trend line is still moving up, it has started to plateau.

Podcast Episode: 
127

When I Was Hungry, You Gave Me to Eat: The Dignity of Hand Feeding in Persons with Dementia

Preserving the dignity of those who inhabit Nursing Homes at the end of life—individuals frequently bearing the concurrent burden of dementia— is a critical feature of cultures that embrace compassion. In the United States, such persons comprise a demographic estimated at five million. One demanding aspect of care in this population is feeding. The ethical dilemma resides in the choice between hand feeding by staff or family versus feeding tubes. Hand feeding is adopted when it is comfortable and safe, that is, unaccompanied by aspiration; and although human intimacy integral to hand feeding would be preferable, feeding tubes have become de rigueur in contemporary medical practice. As Kenneth Ludmerer poignantly asked, might the efficiency in time and effort derived from feeding tubes, as well as their reimbursement as medical procedures, be the dynamic driving choice in this context?[1] Recent publications are noteworthy in this regard.

Podcast Episode: 
145

What Has Healthcare Reform Got to Do with Ice Floes? The Déjà Vu of Rationing, the Elderly, and Social Valuation

For those whose worldview picture is framed by biblical anthropology, the recent tenor of the healthcare reform debate should come as no surprise. When Americans have been forced to ration healthcare in the past—e.g., the early dialysis era, organ transplantation—social valuation explicitly and implicitly crept into decision-making.[1] Unfortunately, contemporary discussion, once again, is openly engaging the same wrong-headed direction.

Podcast Episode: 
123

On the Permissibility of a DNR Order for Patient with Dismal Prognosis

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Is it ethically permissible to write a DNR order and withdraw the ventilator from this patient with a dismal prognosis?

Podcast Episode: 
121

Introductory Explorations in the Ethics of Neonatal Futility

How should the expectant couple react when they learn that their pregnancy will quickly end with the birth of an extremely premature infant? These fragile infants—at the margins of viability—demand the extremes of life-sustaining care and typically remain in the Intensive Care Nursery (ICN) for months. After such a prolonged length of time, all involved—infant, family, and doctor—experience the gamut of emotions. In a world filled with technological prowess and promise, what are parents to expect during the process? Should they be mad at God, or at themselves, or the medical system? How should the parents’ spiritual faith interface with any current hope and future uncertainty?

Podcast Episode: 
100

Is it Permissibile to Forgo Life-Saving Dialysis?

Is it permissible to forgo life-saving dialysis in this man with a stroke based on his family’s refusal?

Podcast Episode: 
97

Permissibility to Accept Refusal of Potentially Life-Saving Treatment

This column presents a case that poses an ethical dilemma for patients, families and healthcare professionals. It is based on a real case, though some facts have been changed to preserve confidentiality. The story is presented to a Fellow of the Center for Bioethics and Human Dignity, and his or her analysis is published for our readers. Our goal is to offer careful ethical analyses and recommendations that are consistent with biblical standards.

Podcast Episode: 
59

A Good Death

Issues: 

The ethical dilemmas presented at the end of life are increasingly frequent and complex. At least two factors contribute: First, the dramatic developments of medicine over the past three decades have significantly decreased the incidence of sudden death in developed countries. We now have a national 911 system ready to summon advanced life support ambulances staffed by excellently trained emergency medical teams and portable defibrillators. They transport the critically ill to hospitals where teams are waiting to do emergency angioplasties, offer trauma units, and have ICU’s to preserve the life of the critically ill. As a result many who formerly would have died suddenly are now dying gradually of other diseases; many at an advanced age.[1] Sudden death does, after all, avoid many ethical ambiguities. Gradual death raises more ethical challenges.

Podcast Episode: 
58

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