Life and death decisions

decision-making

Human beings were born to live – not to die. Physiologically speaking, this may sound wrong, once our body grows till a certain point and then, it starts ageing and, consequently, dying. In the psychological hand, this affirmative is quite true, though. Ziegler & Tunney have observed that most people do not make decisions regarding complex health treatments (such as chemotherapy), nor death choices (e. g. turning off medical equipment in case of a hopeless coma) when they’re healthy and cannot see these situations in their future (Ziegler & Tunney, 2016). Many times, we tend to change our preferences in terms of medical management of illness when fear, anxiety and distress are then part of the equation. Facing the possibility of death make us think differently that we probably would if we were not physically ill. For example, you may think now (when you are healthy and ok) that it is better to be dead than to be submitted to countless surgeries and heavy drugs only for the tiniest possibility of living longer. However, if you were diagnosed with a severe disease that would demand this type of complex treatment, you may change your mind and decide to do all these things to stay alive – you might even believe that maybe the treatments that did not work so well for others may work for you. Therefore, even though we believe we can make advance decisions and that we truly know our preferences on these terms, we really do not. Not until we actually live those circumstances.

So, once we cannot know what is our real desire regarding trying to hold on life the maximum we can, how can we possible make decisions to other people? Gregg Ratliff has talked about his wife decision of ending her life after suffering from Low Gehrig’s Disease (or ALS), and how he has questioned her decision of not being resuscitated if/when her heart stopped, because she had chose that sometime before losing the ability to communicate, so maybe she had changed her mind and her family or her doctors would never know that (The Guardian, 2013).

As health professionals, our acceptance of death and our limits are also extremely important. Understanding the stages of grief and loss (Alexrod, 2017), knowing how to communicate with our patients (and realising that communicating is also about the way we touch and look to them) and respecting their feelings is fundamental. It is our duty to make the best we can to promote quality of life and comfort to our terminal patients, so they can leave with peace and dignity.

Personally, I do not believe we will ever feel comfortable with end-of-life decisions or watching people dying. I do believe that human beings are born to live and this desire will always be imperative inside us (since we are mentally well). I also believe that we can find peace within ourselves to find joy in any situation though. Be grateful for what we had, what we have accomplished, the lives we have touched and the differences that we have made. Once we have found a way to acquire this inner peace, we will be able to help our patients more effectively and have satisfaction with our profession.

References:

Ziegler, F. V.; Tunney, R. J. (2016) The reality of life and death decisions. The British Psychological Society, 29: 82-91. Retrieved in 29/04/17, from https://thepsychologist.bps.org.uk/volume-29/february/reality-life-and-death-decisions

Ratliff, G. (2013) The day you fear: making life and death decisions for your spouse. The Guardian. Retrieved in 29/04/17, from https://www.theguardian.com/commentisfree/2013/jun/23/end-of-life-decisions-als

Axelrod, J. (2017). The five stages of grief and loss. Psychcentral. Retrieved in 29/04/17, from https://psychcentral.com/lib/the-5-stages-of-loss-and-grief/

Post by Danielle Aquino Silva.

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