Due to the paranoia over COVID-19 (new coronavirus disease), it has become quite common to jump hastily to the conclusion that somebody who has died of respiratory failure has succumbed to the coronavirus. In fact, even if the primary cause of death was unrelated to the respiratory system, it is almost always connected to the wretched virus. It is as if every kind of death now is attributed to COVID-19; somebody died of COVID-19, or during the time of the pandemic.
Be that as it may, dying must also be seen as a process. In the eyes of faith, it is a spiritual journey. Along the way, toward the end of life, what bioethical steps are worth taking?
First of all, treatment must be made available, safely and efficiently. With regard to the availability (or scarcity) of treatments or apparatuses, decisions must be based on impartiality, transparency, equitability and fairness. All things considered, Christian charity calls for a spirit of sacrifice, even to the point of a supreme one. Our thoughts go to St. Maximilian Kolbe, in prison in Auschwitz, who volunteered to be executed in place of a man with a family.
Recently, an Italian priest who died of COVID-19 reportedly gave up his ventilator in favor a of younger COVID-19 patient.
Meanwhile, in the field of medical care, an ethical dilemma could arise on the use of a ventilator. Up to when will it be utilized, or at what point should its use be discontinued? Can a patient, too, have a right to refuse a treatment?
Especially in end-of-life cases, questions arise on medical interventions, whether these would be moral obligations or merely optional. In other words, it is important to distinguish between ordinary and extraordinary interventions. Ethically speaking, there is what we call the proportionate (ordinary) measure, as opposed to the disproportionate (extraordinary) one.
A proportionate measure is “grounded on objective state of affairs regarding both the concrete clinical condition of the patient and the present state of the medical art.” (Taboada) On the contrary, what is disproportionate is judged as not morally binding. In so many words, when all medical means have been exhausted and all factors have likewise been considered (risks involved, the necessary expenses and the prognosis), this should indicate that it is time to “pull the plug” or to simply give up.
DNR
There has been the recent bizarre call of a DNR (do not resuscitate) order by some hospitals on COVID-19 patients. “The main concern is the shortage of personal protective equipment (PPE) and exposure to fluids that could endanger the health and lives of the doctors, nurses and others involved in the resuscitation. Concerns include not only losing health-care personnel who could become ill, but also the amount of PPE needed for each attempt.” (A.J. Plunkett)
Whether this is ethically sound or not depends on the principle of informed consent on the part of the patient, along with the relatives, attorneys, a spiritual adviser, among others. If and when the patient himself or herself chooses the DNR option, those on the medical side must prudently consider it an order. In the event that the patient is incapacitated, a legal proxy must be appointed (usually, an immediate family member).
In such a circumstance, it is always wise, especially for the elderly and those with grave illnesses, to provide an advance directive so as to unburden everybody of the guilt and and the further distress of finger-pointing.
Caution must be observed, however, so as not to make DNR a universal policy or a blanket order for every case. Informed consent, in the name of justice, is the bedrock of moral-bioethical judgment. Needless to say, people, especially the sick and the dying, should never be coerced into decisions.
A Spanish quote captures well our duty to care for patients. “Si puedes curar, cura. Si no puedes curar, alivia. Si no puedes aliviar, consuela. O mejor: consuela siempre, reza una máxima médica.” This can be understood as, “If it can be cured, cure. If it cannot be cured, relieve. If it cannot be relieved, comfort. Or better yet: comfort all the time and pray for what is best.”
Put simply, prayer is the best medicine, and God is the Divine Healer and Miracle Worker. —CONTRIBUTED INQ