Treating babies with brain tumours is one of the most heart-wrenching dilemmas faced by health carers, as this normally requires aggressive treatment which will see the baby living a maximum of two years in constant suffering.
“Should we intervene, or not, and let the neonate live – for less time – but without suffering?” Mater Dei Hospital doctors asked.
Various moral and ethical conflicts were raised by hospital Anaesthesia Department chairman Joseph Zarb Adami and other health carers during a talk, Caring For The Dying, attended by Archbishop Paul Cremona last week.
Mgr Cremona’s right hand man on bioethical issues, Rev. Prof. Emmanuel Agius, said that ethically medics should always work towards prolonging life if it was to the benefit of the patient.
However, Prof. Agius, Faculty of Theology dean and lecturer in moral and bioethics, said aggressive operations which would only result in interminable suffering would not be of benefit to neonates.
Doctors on the frontline of caring for the dying highlighted the fact that at times, not withstanding this knowledge, parents keep pushing for treatment to take place.
“In a situation like this the medical prognosis is very important. Parents do not have an ultimate say. The humane aspect has to be given weight,” Prof. Agius said.
He stressed that while medical paternalism was an outdated approach – “the consultant is there to lead the team and not to dictate” – relatives had to be educated that “medicine cannot prolong life indefinitely”.
“We have to understand that we are not here forever – there is no such thing as medical utopia,” Prof. Agius said.
If the doctors’ considered and prudent judgment is that further treatment would be useless but relatives of unconscious patients keep insisting, then a doctor cannot comply with relatives’ wishes.
“It is here that the role of counsellors is crucial – to explain that if quality of life is so poor and the patient is not responding, then treatment must stop, for it would be unethical.”
Ethics were also discussed in the case of relatives of advanced cancer patients who implore consultants and health carers not to inform the patients about their diagnosis.
“Hiding the truth from the patient is no longer tenable,” said Prof. Agius. Breaking the news, he said, should not necessarily be carried out by the consultant but ideally by a person close to the patient.
This would help to prepare the patient emotionally and psychologically.
It was important for the patient to go through the five stages of grief: denial, anger, bargaining, depression and finally acceptance.
Some doctors expressed their concern that their professional judgment was not infallible, that they could not always predict the future and that often theirs was just an educated guess.
“We all do errors in our judgment. When in doubt and in a rush, as health carers we have to take the decision which is in favour of saving lives – the health carer is always the patient’s advocate,” he said.
“We need health carers with values,” Prof. Agius added, referring back to Greek philosopher Aristotle’s saying that a good medic “was not one with a good clinical judgment but with a good character trait”.
“That’s why it’s called the art of medicine. As a doctor, you have to be an artist, constantly taking creative decisions,” said Prof. Agius.