PROTECTING VULNERABLE PATIENTS FROM DISCRIMINATION
When we are dying, we are more vulnerable than any
time since we were born.
We are often completely incapable of doing anything for ourselves.
Others must feed us, clean us, keep us warm, etc.
And sometimes merely omitting to do something
that is necessary for our survival will result in our deaths.
In addition to all such normal vulnerabilities,
some patients at the end of their lives are even more vulnerable
because they lack strong advocates
who are trying to protect their best interests.
We hope that most of us will have close family and friends
who will watch out for us when we are in the last year of our lives.
But many people come to the end of their lives
after many of their friends and relatives have already died
and when their remaining family members are distant and uninvolved.
Another kind of vulnerability arises when the
patient
comes from a different social group than the care-givers.
Sometimes the doctors and nurses cannot easily relate to the patient
because the patient speaks a different language,
belongs to a different racial or ethnic group,
or has a very limited education and/or low intelligence.
There are valid worries that patients with whom the
staff cannot identify
will not get the same level of care as given to patients
who are very similar to the professionals who are providing the care.
Do doctors give the very top level of care to other doctors like
themselves?
This is like the feeling anyone can have for close
family members.
We 'naturally' want to do the best for the persons we care most about.
And if this means that someone down the hall gets less attention,
that is not our problem.
We demand the very best for the people we care about.
And all the other patients do not matter as much to us.
All medical care-givers are subject to the same feelings,
even tho they are trained to give the same care to all patients in need.
When it comes to life-ending decision,
doctors and nurses might favor patients of their own ethnic group.
At least this is a valid question raised by members of minority groups.
Since minorities are not as well represented in the health-care
professions,
they might worry that they will not get as good care
from people they have sometimes seen as oppressors.
Even if such tribal thinking is absent from the minds of the
care-givers,
it might still be present in the minds of the minority-group patients
and their families.
And even baseless worries need to be taken into account.
PROTECTING VULNERABLE PATIENTS
Several safeguards would be helpful in protecting
those patients
who worry that they might be subject to discrimination for any reason.
Here is a listing of twelve safeguards,
beginning with the most effective for protecting vulnerable patients.
REQUESTS FOR
DEATH FROM THE PATIENT
INFORMED
CONSENT FROM THE PATIENT
UNBEARABLE
SUFFERING
THE PATIENT
MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
REQUESTS FOR
DEATH FROM THE PROXIES
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING OR
QUESTIONING THE CHOSEN DEATH
STATEMENTS
FROM
ADVOCATES FOR
DISADVANTAGED GROUPS
IF INVITED BY
THE PATIENT AND/OR THE PROXIES
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
A
MEMBER OF THE CLERGY APPROVES OR QUESTIONS THE CHOICE FOR DEATH
REPORT TO THE
PROSECUTOR BEFORE THE DEATH TAKES PLACE
CIVIL AND
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH