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Comfort Care, Period.

Fundamentals


Patients must be provided with comfort care until natural death.

In theory, it’s possible to sustain and support life indefinitely. However, this is not the ideal of the human person that we aspire to. There are myriad ethical issues with indefinite preservation of life through the artificial means that are available in a medical setting. Life support equipment and protocols have their place, but we ought to be careful not to overuse them. Life has an end and the patient has a right to the dignity of death when the weight of their illness overwhelms their faculties.

Dignity
There is some confusion surrounding death and dignity. Dignity refers to the human person’s inherent worth because of who they are as a human person, as opposed to the utilitarian value they provide to a community. In recent times, certain intellectual movements have co-oped the word “dignity” in order to promote an immoral and unethical theory. They would claim that the human person has a right to determine the method, manner, and timing of one’s own death. This calculation is based on flimsy criteria that builds almost exclusively on an nebulous barometer of pain.

Control over one’s death is an alluring idea. After all, whom among us wouldn’t wish to pass quietly in their sleep without pain? However, ascribing the term dignity to what is little more than sanctioned suicide, and in some cases homicide, is patently false. The taking of one’s own life, even with assistance or permission, is an affront to humanity. Indeed, it is an act that rebukes upon the dignity of the human person and preys upon the weakest among us.

The human person has innate dignity from the moment of conception until their natural death. While we can agree that some kinds of death are rather undignified, the descriptor is assigned to the manner of death, not the person. Regardless of whether you die quietly in your sleep or are painfully crushed in a baler, you’re still a person.

Without question, there is no greater acknowledgement of the dignity of the human person than accompanying a person in their final days, hours, and moments, appreciating and loving them for whom they truly are.

Pain As A Goal
We long for a life without pain. Comfort is, after all, rather pleasant. Our health system is overburdened by patients seeking a life with zero pain. This has led us into the downward spiral of pain pill addiction and our societal opioid epidemic. Zero pain is not realistic. Pain management is a much more practical goal.

Patients wish for their final days to be without pain, as do their loved ones. Management of the patient’s conditions must be maintained. Consider a patient with high blood pressure who is suffering from pneumonia. Their blood pressure management should be continued for comfort even if they will ultimately succumb to infection.

Comfort Care, Defined
Comfort care refers specifically to the reasonable management of pain and chronic conditions within the standard of care for terminally ill patients. More broadly, it refers to those structures and routines that continue to respect and promote the dignity of the human person.

Think of how good it feels to take a shower after spending days in bed with the flu. That’s the relief that comfort care can give to the dying. Patients, though they may be terminally ill, still have functioning systems that need attention. Regular bathing, clean sheets, reasonable pain control, family time, and toileting maintain the patient’s concrete sense of that dignity.

In the final months, weeks, and days, continuing to treat the patient as a person and not as already deceased, is paramount.

Easing the Transition
There is a very fine, albeit grey, line between easing the transition to death and willful homicide. Each patient’s specific mix of conditions and prognosis will help to guide the decision making process. Regardless, in no uncertain terms, no therapy can be utilized with the intent of hastening or directly causing death.

Instead, a better standard for this component of comfort care, would be “easing the transition.” This idea refers to those therapies and treatments which alleviate acute suffering while unintentionally, but knowingly, bringing the body and its systems to the point of failure.

Consider a terminally ill patient who experiences acute respiratory distress. They be administered an appropriate dosage of morphine to ease the pain of struggling to breathe. At the same time, while not intending to cause death, the physician ordering the treatment understands that morphine reduces the respiratory drive, which could lead to the patient’s death.

In this scenario, we can see that the physician didn’t administer a massive, fatal dose of morphine. Instead, by responsibly using an appropriate treatment to mitigate the pain associated with acute respiratory distress, the understood, but unintended, result was the death of the patient.

Absolute Necessity
In order to address end of life conditions and treatments from an ethical perspective, it’s an absolute necessity that each patient be provided with comfort care until the moment of natural death. To hasten or quicken death by any means, medically sanctioned or otherwise, amounts to homicide.

About the Author

CHET COLLINS is a full-time sidekick to three small humans. He gets his best creative work done during their nap time. He’s had a keen interest in bioethics since 2003.

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