Is it Okay to Let Daddy Die? [Scott]

Here's a variation on a question I've been asked more than once, and one we'll cover in the graduate course I'm co-teaching next month at Biola:

My father is nearing the final stages of terminal cancer. He’s refusing further aggressive treatment and is content to die. His physician tells us that food and water may soon be an unnecessary burden and will only enhance his discomfort. At the same time, the doctor said that without increased doses of morphine (pain control), dad will suffer greatly as death approaches. Two questions: 1) Is it ever morally permissible to remove food and water? 2) Isn’t increasing his morphine levels tantamount to hastening his death, perhaps a gentle form of euthanasia?

Me:
In both cases, it comes down to intent.

1) Concerning nutrition, we must distinguish between euthanasia and the justifiable withholding of treatment. That is, are we withdrawing treatment because we intend to kill the patient or because it no longer benefits him? Agneta Sutton makes a great point: A truly medical (as opposed to quality of life) decision to withdraw treatment is based on the belief that the treatment is valueless (futile), not that the patient is so. So while doctors are indeed qualified to determine if a treatment is futile, they are no more qualified than anyone else to determine that an individual life is futile. In the case of your dad, food and water should only be withdrawn in the final stages when they no longer benefit him and will only cause additional suffering. On this understanding, the withdrawing of treatment is not intended to kill, only to avoid prolonged and excessive agony for the patient. True, death will come, but it comes as the result of the illness not my direct action.

Gilbert Meilaender puts it well: “The fact that we ought not aim at death for ourselves for another does not mean that we must always do everything possible to oppose it.” Thus, rejecting a treatment that is burdensome is not a refusal of life. But here the physician must be both careful and honest. Instead of asking, “Is the patient’s life a benefit to him?” the physician should inquire “What, if anything, can we do that will benefit the life that he has? Our task, writes Meilaender, “is not to judge the worth of this person’s life relative to other possible or actual lives. Our task is to care for the life he has as best we can.”

2) Regarding morphine, we must again draw careful distinctions, this time between euthanasia and sufficient pain relief to dying patients. Put differently, Meilaender says we must distinguish between an act’s aim (intension) and its foreseen results. A patient in the final stages of terminal cancer may request increasingly large doses of morphine to control pain even though the increase might (though not necessarily) hasten death. In this particular case, the intent of the physician is to relieve pain and provide the best care possible given the circumstances. True, he can foresee a possible result—death may come slightly sooner—but he does not intend that. He simply intends to relieve pain and make the patient as comfortable as possible. Thus, instead of directly killing the patient with a heavy overdose, he provides a carefully calibrated increase in morphine aimed at controlling pain, not bringing about a quicker death. Though death is foreseen it is not intended.