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Chapter 11
Death, Medicine, and Moral
Significance of Family Decision
Making
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We Die Differently Now…
• Contemporary medicine has made the dying
process very complex.
• This causes patients and families to make
many difficult choices.
• Families often play important role in end-of-
life decisions.
• Therefore, families need to be considered in
end-of-life decisions.
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Romanizing Death and Demonizing
Families
• The consensus is that end-of-life decisions
should respect patient autonomy and the
right to balance benefit with burden.
• This consensus sometimes conflicts with the
autonomy of the professional.
• The main issue is the ability of the patient to
make this decision.
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Romanizing Death and Demonizing
Families
• There is a need for others to convey the
patient’s preferences when he/she cannot do
so.
• The family is assumed to be in the best
position for this decision.
• However, they may not be disinterested
parties.
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Romanizing Death and Demonizing
Families
• We need to guard our judgments concerning
starting or stopping life-sustaining therapy
when the patient is not able to authorize this
action.
• There may not be a match between what the
patient wants and how the family member’s
understanding matches this want.
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Romanizing Death and Demonizing
Families
• Society has generated laws to empower
patients to make their own decisions about
death and dying.
• These laws attempt to protect their ability to
die in agreement with their beliefs and who
they are as people.
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Dying in Intimacy
• Previous claims about the role of families in
the dying process have been overstated.
• Few people have taken advantage of advanced
directives.
• The medical practice may be confused about
the patient’s definition of a good death.
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Dying in Intimacy
• Many people think of their families as
advanced directives.
• However, many people are not able to express
their preferences for action in a future crisis.
• Advanced directives do not consider the
nuances of a romantic death.
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Dying in Intimacy
• The ill are not excused from their obligation to
family because of their illness.
• Selfishness is not the only approach to illness.
• Policies should be made to recognize the role
of the family in making proxy decisions.
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Dying in Intimacy
• Hospitals have their own agenda when it
comes to the dying patient.
• Patients need to be empowered in a setting
which has the power to control their
autonomy.
• Patients must be able to have contact with
their sources of protection and personal
affirmation.
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Solution
s
• When people trust their families, they should
be allowed to have them make proxy
decisions.
• When they do not, non-family proxies could
be appointed.
• Specific treatment directives could also be
available.
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