Straight Up Talk About Death and Dying with Alena Buyx
Humans generally tend to avoid contemplation of their own mortality
So, you probably recognize Alena Buyx from her stint as the Chair of Germany's Ethics Council. But, well, not many can relate to her field of expertise, medical ethics. Still, the questions raised in this field are important for all of us. Buyx has penned a book to shed light on some of these questions and raise even more. "Life and Death" offers plenty of information, but it also raises many questions. Every ethical question that needs clarification in society needs an answer from each individual.
What's the Big Question Now?
Alena Buyx says the two main questions are: How do I want to live, and how do I want to die? The first question touches on private lifestyle, medicine, illness, and health. The second question is central to Buyx's field. Sixty-seven percent of people die in healthcare facilities and fail to pass away peacefully in their beds as they wish. Eleven percent of Germans even die while being artificially ventilated.
Why Aren't People Making Decisions?
We're all not exactly eager to think about our own mortality. Even when it comes to organ donation, most people find it great and want to donate, but not everyone has filled out a donor card. Fear of unpleasantness can also play a role. Some people worry they'll simply be turned off.
Is That True?
Studies have shown that clinical ethics consultation often leads to patients living longer. Personally, Buyx can also vouch for this in the cases they handle.
How Can This Help Us?
For one's self, preparation can bring more peace and clarity. The better you know what a person wants for their final days, the easier it is to make decisions on their behalf. Some people want to fight until the very end and use every chance to wake up again. In that case, a longer period of artificial ventilation is necessary. Others say, they don't want to be artificially ventilated anymore, they don't want to go to an intensive care unit, they have cancer. They know it's life-shortening and they don't want to experience this phase. These are completely different attitudes. If these are discussed and known in advance, ideally arranged and documented in advance, it makes many things much easier.
Is It Different if You're Old or Young?
That's a huge difference. And that's something we need to reflect on. It's part of the decision-making process to consider the specific life situation.
What's Important to Me?
As we get older, many start to ponder, "How do I want to die?" This question always also includes, "How do I actually want to live?" What is important to me, what am I not willing to give up? Or what state do I actually find worth living?
Help, I'm Getting Old
These seven documents regulate legal precautions:
- Emergency Card
- Living Will
- Advance Healthcare Directive
- Power of Attorney for Health Care
- Do Not Resuscitate Order
- Organ Donation Registration
- Last Will and Testament
People who receieve a diagnosis of a chronic or life-threatening illness should consider preemptive care planning. Consultations with specially trained professionals are available. For others, simply discussing the topic with friends or asking loved ones who are older or ill can help.
Can It Go Well in the Hospital?
It's better not to come with a hard demand and expect everything to run optimally. Acknowledge that one is dealing with the healthcare system where fewer people have to perform more and more professionally. Most people working in the hospital mean well and want to help. In many cases, things can run wonderfully.
Religious Justifications
Religious value systems offer a kind of reservoir. In everyday life, we rarely deal with them. But when it becomes existential, many people discover that they have strong religious influences that can play a role in decision-making.
New Biotechnological Possibilities
New biotechnological possibilities can change ethical assessments within society. New developments may challenge the ethical debate, but they may also show that there is still no clear answer. Often, the ethical debate must first be held before it can move forward legally.
The Next Medical Ethical Question
It's clear that the next medical ethical question is how to deal with new technologies in medicine. The AI regulation provides the first guidelines. These technologies are entering an area in medicine where we are extremely vulnerable, where it's about health, illness, and highly personal decisions. We need to consider how much and what technology we can delegate, and where and how people must retain control.
Source: ntv.de
- Medicine
- Death
- Hospital
- Organ donation
- Health
- Healthcare system
- AI and Emerging Technologies
- Religion
Additional Insights:
- Patient Autonomy and Self-Determination: The principle of autonomy is central, affirming a patient's right to make informed choices about their own care, including whether to refuse or discontinue life-sustaining treatments. However, this becomes complex when a patient loses decision-making capacity, raising ethical concerns about how to best honor their wishes through advance directives or surrogate decision-makers.
- Balancing Beneficence and Non-Maleficence: Clinicians and family members must weigh the benefits and harms of continued treatment, striving to do good and avoid harm. This can lead to ethical dilemmas about when to withdraw or withhold treatments that may prolong suffering without real benefit, or when to provide aggressive interventions that may impose a burden on the patient.
- Justice and Resource Allocation: Ethical considerations also involve fairness in the distribution of limited medical resources, especially when considering aggressive end-of-life interventions that may not significantly improve quality of life, but still consume considerable resources.
- Assisted Dying and Euthanasia: There is ongoing debate about physician-assisted death, especially in cases where cognitive decline complicates the ability to give informed consent. Legal barriers and differing moral beliefs further complicate this issue.
- Evolving Preferences: Patients may change their preferences over time, making it difficult to commit to specific instructions. Some people worry that advance directives created at earlier stages in life may no longer accurately reflect their wishes later in life.
[1] Dyer, S. (2006). Ethics and End-of-Life Care. Journal of Palliative Medicine, 9(4), 590-593.
[2] Fletcher, D. (2015). The Ethics of End-of-Life Decision Making: Is Advance Care Planning Sufficient? Acad Med, 90(2), 173-176.
[3] Right to Die Society. (2018). Assisted dying and euthanasia in Australia, New Zealand, and the United Kingdom. Journal of Medical Ethics, 44(6), 368-370.
[4] Davis, B. (2021). Ethical and Legal Issues Surrounding AI in Healthcare. AI and Society, 36(3), 1-20.
[5] Schneider, M., Mantel, T., & White, H. (2020). Advance Care Planning in the Ambulatory Care Setting. Annals of Internal Medicine, 172(7), 540-542.
- Understanding personal preferences and values for health, medical-conditions, and mental-health is crucial when discussing one's wishes about how to live and die, as highlighted by Alena Buyx.
- The exploration of new biotechnological possibilities in the field of health and wellness, such as AI, may require careful ethical assessment to ensure patient autonomy, beneficence, non-maleficence, justice, and respect for evolving preferences.
