Module 4: Supporting families and friends

4.9 Ethical concerns

Many people have ethical concerns about discontinuing clinically assisted nutrition and hydration. Some people believe it is always unethical to stop CANH (if it could be clinically effective) as they see it as a form of euthanasia.  Indeed, in some jurisdictions (but not in the UK) that is also how the law sees it. Some people also have strong religious objections. Family members often had to think through how the person might have applied their religious faith to their current situation and some consulted a relevant religious leader. (You can see more about this in our course on ‘Law an Ethics).

However, no family member who had agreed that their loved one would want treatment to stop expressed any regret about the decision to discontinue CANH. This did not mean all ethical concerns were completely absent.

Indeed, some family members  felt that discontinuing CANH, inevitably meaning the person would die, was an ethically dubious decision precisely because it was so close to ‘causing’ death. Some were angry and distressed about this being the only option, without active assistance to die. They found the whole idea of withdrawing ‘food’ and ‘water’ disturbing and some felt it was, in principle, ‘barbaric’.

Given the inevitability of death in this situation, some felt it was hypocritical not to allow active steps to hasten death. One person commented:

‘you wouldn’t do it to a dog – you wouldn’t let a dog die like this, but then you wouldn’t keep a dog alive in this state either’.

In that sense although they felt they had supported ‘the least worse’ option under the circumstances, they continued to question why this was the only option available.

Other people we interviewed thought active euthanasia was totally wrong  – and discontinuation of CANH was more acceptable. However, they continued to be troubled by the relationship between the decisions to stop CANH and their own religious affinity or cultural context. It is important to ensure families have access to the relevant spiritual or religious support and there is a need to be sensitive to cultural context (e.g. a family member may feel discontinuation is in their loved one’s best interests but be clear that it is not their place to say this and that their view can not be shared within their community).

Below you can listen to Professor Lynne Turner-Stokes address the issue of euthanasia. She chaired the RCP working party on PDoC and has supported many patients and families through the process of making best interests decisions about CANH.

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Optional Continuing Professional Development 4.9

If you’d like to do more learning about the ethical debates and have the time to devote to this – click on the optional CPD exercise below.

If you’d rather just continue with the core learning, simply scroll down to the ‘Post a Comment’ box

CLICK HERE for optional CPD exercise: Ethical debates

 Analyse court case addressing ethical debates about clinically-assisted nutrition and hydration

In a recent court hearing the patient’s eldest son felt it was morally intolerable to stop CANH. He wrote an eloquent statement to the court detailing his objections and this was discussed at length during the hearing. In the end the judge said he respected the son’s moral concerns but that it was still not in his father’s best interests for CANH to continue.

  • Read Jenny Kitzinger’s blog about this court hearing
  • Read some sections of  the published court judgment too. Don’t read it all – focus on paragraphs 19 to 26 (addressing the son’s concerns), and 42-91 (section on dignity).

Write a summary analysis in relation to the following questions.

  1. What are the arguments for seeing CANH as different from, or the same as, any other form of life-sustaining treatment?
  2. How did the judge navigate competing understandings of CANH during the hearing and in his published judgment?
  3. What links did the judge make to different legal and human rights frameworks?
Post a comment below

Families may worry about what to tell other people about the death and are sometimes concerned about ‘admitting’ that the person (finally) died following discontinuation of life-sustaining treatment (and that they perhaps agree with, or at least did not object, to this). This comes up when people book time off work in order to be present during the dying process for example, or after the death when they inform friends or organise the funeral.

How have you (or would you) discuss this concern with families?

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