Question
5: Where do you draw the line between a quality of life worth
preserving and the remnants of biological life that
should be mercifully shut down?
It is extremely difficult to decide just when to 'pull the plug' for
other persons, especially people we have loved and cared about. One
very significant help in making this determination would
be a written statement from the person whose life it was, laying
out some tests or criteria for making life-ending decisions. So
this is the place in your Advance Directive where
you should explain as clearly as you can how
your proxies should proceed in these difficult situations.
You should be careful about being merely negative when
you write your Advance Directive. Sometimes
people merely make a long list of
the medical treatments and interventions they do not want. But
they fail to explain clearly when they do want these procedures. And
often their objections to the treatments seem
to be esthetic rather than medical or philosophical. For
example, some people say they do not want any tubes. Perhaps
they remember seeing others attached to complex machines when
they were dying in the hospital intensive care unit. They
do not fully understand what these tubes and machines do; but
they know that they did not like the sight. The
image they retain was one of undignified dependence. And
they hope to avoid such scenes by
refusing to have any tubes
used in their own care.
But if we think more deeply, we might welcome tubes as
a temporary means to return us to meaningful life. Most
of us would gladly accept a week in the hospital recovering
from a surgery that saves us from death and
enables us to return to a rich and meaningful life. And
almost all surgeries include having tubes inserted
in various parts of our bodies serving various purposes.
So you probably should not focus on the medical means that
might be used but focus on the goals and the outcomes. Unless
you are a doctor yourself, it
is probably not meaningful to second-guess the
means employed by your
doctors in your treatment. But
it is wise for you to establish your own goals for medical care.
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YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE
A conservative Answer to this Question would
say that the primary goal
of all medical treatments should
be the sheer preservation of
life. You
might want all treatments that have any hope of
keeping the biological functions of your body going, even
if the length of that 'survival' is short.
A middle-of-the-road Answer would focus on meaningful survival as
the fundamental purpose of your medical care. You
might want all medical treatments that can restore you to
a level of functioning that you find meaningful. What
limitations would be too burdensome for you? Might
you later change your mind about living a diminished existence if
the only alternative is certain death?
A more radical position might say that medical treatments should
restore full personhood,
as defined in your previous Answer. The
quality of life you
want to result from medical treatment includes:
consciousness, memory, language, & autonomy. The
hardest of these to achieve will be autonomy —being
able to set your own goals in life and to carry them forward. What
limitations on your autonomy would you accept and
still find that you have a sufficient quality of life to continue
living? You
might in this answer cite some other persons you have known (or
former persons) whose 'lives' were preserved even
tho they had a very low level of autonomy. If
life as a former person would not
be acceptable to you, you
should say so in your Advance Directive, since
that level of function might be so low that
you would not be able at the time to
make meaningful decisions or to express your wishes.