‘….but need not strive officiously to keep alive’. An ethical principle of my nurse training along with ‘do no harm’. Googling today, I learned that rather than an established medical dictum, it is from satirical verses on the 10 Commandments by Arthur Hugh Clough, 1862.
Medical ethics have changed in my 40 years’ nursing as new treatments evolved. People routinely survive diseases that were once certain killers. Tiny premature babies can be cared for and thrive. Life can be prolonged by maintaining artificial nutrition and hydration. In some countries, people can receive medical treatment to end their own lives, still a future debate for the UK. All these require ethical decision-making as a central part of care in many settings: acute medicine, cancer care, neonatal care, and now covid-19 where choices may need to be made about prioritisation of limited resources, withdrawing or withholding treatment.
These are emotional, difficult issues, often without clear answers. In the 1970s it could be accepted that death was inevitable in a very sick patient, or that a baby with serious congenital disorders would not survive. Today because of treatment advances there are more options and so more complex decisions to be made between healthcare staff, patients and families. Withdrawing food and fluid can be seen as a means of ending life in someone who could have survived: but continuing these can prevent moving to palliative end-of-life care. The hospice movement has done much to address these issues and improve care of the dying. Seeing someone die with dignity and at peace, without pain, is a marked contrast to seeing a failed resuscitation attempt in an older, frail person.
In reality, a balance is needed to enable decision-making that is ethical, moral and common-sense. Everyone matters equally, but this does not mean everyone will be treated the same. Everyone has a right to compassionate care, whether living or dying. Let’s hold before God today those working in healthcare who face daily ethical decisions.
Lord God We thank you for all who work in health care May they be compassionate at all times Able to express complex issues in ways that people can understand Support people in making difficult decisions And care for each other as well as those in their care In the name of Jesus the healer Amen