COPING WITH THE REALLY BIG STORM
Living in Minnesota, with snow a huge part of the winter lifestyle, we are often told by the TV and the National Weather Service weather persons, “A BIG winter snow storm is coming! A really, really big snow storm.” You think to yourself as they stand in front of some “blue screen” and point their fingers and click the advance button on the images on the TV set, “Will it really arrive, and how big is BIG?” You also think to yourself, should I get gas for the snow blower just in case it does arrive, or can I wait until it arrives, hoping the roads will be plowed and the snow and wind will not be so bad that I can't go get gas for the snow blower?
Life can also be like that. We don't know when the “BIG storm in our lives” will arrive. For some of us, regardless of our ages, it may be soon and sudden, for others it may be further down the road. But the “storm is coming.” It will hit our family, our mobile. The question is, “Did we prepare for it, or did we assume it really won't happen to anyone in my family, or to me?”
Families are constantly changing during their normal life cycles and stages, and any therapeutic interventions and strategies must look at all the parts, at the entire mobile, not just the person with the illness. Again, at what stage of this illness is the idea of a health care directive introduced to the patient, or has the discussion between health care provider and the patient not yet taken place, as it might be seen as too premature or too negative during a time of fighting for curative care? However, we buy car, home, and life insurance, hoping not to use them. We study the best plans at the time and then proceed to purchase what is needed for our family and our immediate and future needs. Can we afford not to talk about a health care directive early on in our relationships with health care professionals? Can we afford to continue hoping that a sudden, traumatic accident or illness will not take place?
STEWARDSHIP, JUSTICE, AND PROFESSIONAL ETHICS
Health care professionals also need to be realists in the area of ethics related to stewardship and justice. From an ethics perspective, the principle of justice is described as the moral obligation to act on the basis of fair adjudication between competing claims. As such, it is linked to fairness, entitlement, and equality. In health care ethics, this can be subdivided into three categories: fair distribution of scarce resources (distributive justice), respect for people's rights (rights-based justice), and respect for morally acceptable laws (legal justice) (Gillon, 1994). Ethical stewardship on the other hand refers to principles and morals that guide an individual or an organization, and generally refers to management, particularly of others' finances, goods, or household.
Because my father stated, “Do anything you can to keep me alive,” should the health care system have gone along with his or our family requests if he would have needed additional care, and especially “nonbeneficial” care? He was fortunate: he did not need to be ventilated, and in turn our family was not placed in the situation to make the decision later to withhold technology or to have a do not resuscitate (DNR) order written.
What would the health care establishment have done if they knew any additional treatments were non-beneficial for our father? Would the health care professionals have felt they could/should say no, or would they have been too concerned about legal issues to meet our father's and our family's EOL request?
So, the question of what would be nonbeneficial treatment should also be part of the patient/family dialogue. Health care professionals and health care systems today are clearly at the point where they will no longer just nod their heads and agree to extend non-beneficial treatments. Rather, providers are refusing to provide additional treatments if these treatments are truly non-beneficial.