10/17/2009

The goal of ethical caregiving in the clinical setting.

"In caring for those who cannot care for themselves, our primary goal is to do everything we reasonably can to benefit their lives-from meeting basic needs and sustaining life, to easing pain and curing ailments, to offering comfort in difficult times and, in the end, keeping company in the face of looming death. Medical interventions that sustain life are, of course, often a benefit to those whose lives they sustain. But extending life and delaying death are not the only or primary goals that should guide caregivers, and there are times in which pursuing those goals would require imposing new and unjustified burdens on the patient. Caring well for the patient does not require always choosing interventions that would prolong his life or delay his dying, and sometimes best care requires forgoing treatments that may sustain life at the cost of imposing undue misery or offering palliative care that accepts an increased risk of an earlier death. Some interventions, even if life-sustaining, do not benefit the life the patient now has. Some interventions, aimed at benefiting the patient's present life, may not be life-extending. Moreover, in caring for the life the patient now has, we care also for the manner and humanity of his dying. Feeding tubes and respirators are not always obligatory. Neither is hospitalization or the intensive care unit. And if these measures are used for a time, there are circumstances when it is morally permissible-and even, perhaps, morally required-to desist. Dying as well as possible-or, more modestly, in as little misery as possible-is also one of our concerns and cares. Even as we must never seek or aim at the patient's death, so we are also under a positive obligation not to impose treatments that would unduly burden the patient, make his dying more difficult, or otherwise deprive him of a more peaceful end of life or of final hours in the company of those who love him. Dying, like living, is a human matter, not merely a medical or technological one."

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