In the Service of Human Life
Budding flowers
Applied Bioethics in stylized text
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Comfort Care, Period.

In theory, it’s possible to sustain and support life indefinitely. However, this isn't the ideal of the human person. There are myriad ethical issues with indefinite preservation of life through the artificial means available in a medical setting. Life support equipment and protocols have their place, but care must be taken in their use. Life has an end and the patient has a right to the dignity of death when the weight of their illness overwhelms their faculties.

There's some confusion surrounding death and dignity. Dignity refers to the human person’s inherent worth because of who they are as a human person. This stands opposed to the utilitarian value they may provide to a community. In recent times, certain intellectual movements have co-oped the word “dignity” in order to promote an immoral and unethical theory. The claim states that the human person has a right to determine the method, manner, and timing of one’s own death. This calculation is based on flimsy criteria that builds almost exclusively on a nebulous barometer of pain.

Control over your death is an alluring idea. After all, who wouldn’t wish to pass quietly in their sleep without pain? However, ascribing the term dignity to what is little more than sanctioned suicide, and in some cases homicide, is patently false. The taking of one’s own life, even with assistance or permission, is an affront to humanity. Indeed, it is an act that rebukes the dignity of the human person and preys upon the weakest members of society.

The human person has innate dignity from the moment of conception until natural death. Some kinds of death are regarded as undignified, the descriptor is assigned to the manner of death, not the person. Regardless of whether you die quietly in your sleep or are painfully crushed in a baler, you’re still a person.

Without question, there's no greater acknowledgement of the dignity of the human person than accompanying a person in their final days, hours, and moments, appreciating and loving them for whom they truly are.

Pain as a Goal
There is a societal longing for a life without pain. Comfort is, after all, rather pleasant. The healthcare system is overburdened by patients seeking a life with zero pain. This has led to the downward spiral of pain-pill addiction and the opioid epidemic. Zero pain is not realistic. Pain management is a more practical goal.

Patients wish for their final days to be without pain, as do their loved ones. Management of the patient’s conditions must be maintained. Blood pressure management should be continued for a terminally ill patient with high blood pressure. This will add a level of comfort even if they will ultimately succumb to an unrelated complication.

Comfort Care, Defined
Comfort care refers specifically to the reasonable management of pain and chronic conditions within the standard of care for terminally ill patients. More broadly, it refers to those structures and routines that continue to respect and promote the dignity of the human person.

Comfort care gives relief to the dying. It can have the same impact as a long shower after a multi-day bout of influenza breaks. Patients, though they may be terminally ill, still have multiple functioning systems that need attention. Regular bathing, clean sheets, reasonable pain control, family time, and toileting maintain the patient’s concrete grasp of that dignity.

In the final months, weeks, and days, continuing to treat the patient as a person and not as already deceased, is paramount.

Easing the Transition
There's a very fine, albeit grey, line between easing the transition to death and willful homicide. Each patient’s specific mix of conditions and prognosis will help to guide the decision making process. Regardless, in no uncertain terms, no therapy can be utilized with the intent of hastening or directly causing death.

Instead, a better standard for this component of comfort care, would be “easing the transition.” This idea refers to those therapies and treatments which alleviate acute suffering while unintentionally, but knowingly, bringing the body and its systems to the point of failure.

Consider, for example, a terminally ill patient who experiences acute respiratory distress. They be administered an appropriate dosage of morphine to ease the pain of struggling to breathe. At the same time, while not intending to cause death, the physician ordering the treatment understands that morphine reduces the respiratory drive, which could lead to the patient’s death.

In this scenario, we can see that the physician didn’t administer a massive, fatal dose of morphine. Instead, by responsibly using an appropriate treatment to mitigate the pain associated with acute respiratory distress, the understood, but unintended, result was the death of the patient.

Absolute Necessity
In order to address end of life conditions and treatments from an ethical perspective, it’s absolutely necessity that each patient be provided with comfort care until the moment of natural death. To hasten or quicken death by any means, medically sanctioned or otherwise, amounts to homicide.