Prolonging Living or Prolonging Dying

It has been a long time since pneumonia was accepted as "the old man's friend." As one organic system after another slowed to a halt, the aged person was released from nausea, pain, delirium, and the degradation of lingering deterioration by finally developing pneumonia and dying. The family doctor merely showed concern and support; before antibiotics, there was not much to do but stand by and "let nature take its course." With improved medical care, however, a dying process that might have taken only a few days in previous years now may drag out for months (Veatch, 1972). Modern technology allows improved medical care to be taken to unrealistic extremes; one person was kept alive in a vegetative state for over 37 years (LORAN Commission, 1989).

Protraction of the dying process is a modern epidemic. Some physicians seem to forget that their primary responsibility is to relieve suffering, not prolong it. Greater clinical skill often is required to provide daily supportive care than to cure acute illness. Tenderness and caring must be included in the protocols of terminally ill patients so that the ravaged patient is allowed to die peacefully, without tubing and respirators. Patients should be allowed "to experience those waning moments unencumbered by high-tech devices that serve only to impede their capacity for human interaction. Here it is the patient's comfort, not the caregiver's need 'to do something,' that should prevail" (LORAN Commission, 1989, p. 29).

In some situations, therapeutic restraint is necessary to permit a patient to die with dignity. When a cure is no longer possible, care should focus on the comfort of patient and family. At St. Christopher's Hospice in London, feeding is provided by human hands instead of nasogastric or intravenous tubes; "even if the patient does not get enough physical nourishment, he or she gets what is more important—the personal nourishment of someone who cares enough to sit by the bed several hours each day" (Nelson and Rohricht, 1984, p. 174).

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