Death by Bedsores

My friend and colleague William Peace writes about bioethicist Art Caplan over at Bad Cripple in a post about an elderly man who had a series of debilitating strokes and decided he wanted to die of bedsores–in effect he instructed his nurses not to turn him over in bed. Caplan argues that the man should have the right to demand withholding medical treatment–though he spends a good deal of time arguing that the process of letting a patient die of bedsores inevitably affects the morale of caregivers. Caplan argues that there’s a delicate balance between end of life decision making and the morale of caregivers but in the instance above, the old man’s wish to die should trump the feelings of the nursing staff. It’s interesting to assess Caplan’s argument because its a palimpsest of philosophical assertions and I must confess I like a good palimpsest as much as Umberto Eco. Caplan writes:

 

If I thought the care of others was being compromised by these morale issues and staff problems, I might override a patient’s wishes. I might not honor his request in the name of other people’s rights. In my opinion, there may be limits to what you can request when it affects the care that others can receive. That is a tradeoff that has to be weighed at all times. As tough as this case was, it provides lessons to take home. Autonomy and patient rights may have some limits when they begin to affect others and the care that others can get. It may be important to think about this kind of dilemma in advance, and be ready to say as soon as a request comes that this is the patient’s right, but it is not something we can accept at this facility.

This is a tautological argument driven by good old fashioned Freudian “reaction formation”–“these morale issues and staff problems” are not consequential to Caplan because they are simply emotive and the role of a philosopher is to embrace logic. And all looks well enough until one considers what is not being said: the patient in question has asked to be allowed to die in terrible pain, to die slowly, and by extension, to ask a staff of trained medical professionals to bear witness with no more feeling or morality than an encyclopedist might possess while erasing a word. 

Human beings cannot be erased in secret. And whether Caplan likes it or not, medicine, even hideous, post-modern, corporatized, neo-utilitarian “hospitalist” driven medicine is still a community. The passive acceptance of pain in others undermines not only medicine but civic life itself, a matter that Franz Kafka underscored famously in his story “A Hunger Artist”. 

Author: stevekuusisto

Poet, Essayist, Blogger, Journalist, Memoirist, Disability Rights Advocate, Public Speaker, Professor, Syracuse University View all posts by stevekuusisto