It is, perhaps, obvious to say that medicine should improve one’s health. But, what does it mean to improve health when death is imminent? Medical futility refers to the continued administration of treatment at a point in which it can be reasonably understood that the proposed intervention has no ability to ameliorate a patient’s physical condition. Considering the resources required in administering any intervention, futility is a consideration at every point in medical decision making. However, medical futility is particularly prominent in end-of-life conversations, especially when the patient is not able to advocate for himself.
Death is a condition to which the notion of health cannot be accurately applied, and, as a result, it can be difficult to assert that any living state represents an inferior level of health. Consider a patient who would swiftly perish if left to persist on the residual faculties of his own body but, through the wonders of modern medicine, is able to hold on to life in a perpetual comatose state. The assessment as to whether such an existence is worse than death is innately a subjective one. Some believe that death is preferable to a state of perpetual physical pain, but others are not so conservative. My father once told me that if he ever got to a point in which he could not comfortably watch a Manchester United game he would prefer to pass on. Attempts to improve health have a very clear goal in his case (pun intended). However, the point at which life is no longer worth living is much less clear for those of us who are not soccer fans or still carry a profound fear of what Shakespeare called “that undiscovered country from whose born no traveler returns”.
I have contemplated the prospect of being faced with the decision between life support and death. In theory, I like to believe that I would prefer death to being kept alive artificially. The idea of being hooked up to machines, barely clinging to life, feels disconcerting. I want to maintain my dignity and not prolong suffering needlessly. However, the fear of death is also very present in me, as it likely is for so many. The uncertainty of what lies beyond this life is daunting. Perhaps, in reality, I would grapple with a desire to exhaust every possible avenue to cling onto life. Maybe by then what I would want is to feel reassured that I've explored all options, leaving no stone unturned, before facing the inevitable.
Medicine, as it stands now, does not take a definitive stance on this issue, preferring instead to defer to other authorities like established criteria on the definition of brain/cardiovascular death or the wishes of the patient’s family. Consequentially, one routinely encounters news coverage of people kept alive for decades on mechanical ventilation and feeding tubes, measures with no clinical value beyond their ability to prolong life. These life sustaining treatments not only carry a financial cost to the healthcare system but also an emotional cost to the family and supporting staff who expend energy subsisting in a state of limbo, caring for one who is absent but alive.
However, it must be acknowledged that what some call futile others call faith. Many medical treatments are exorbitantly expensive or dubiously effective. Considering again the original example, if one can reasonably assume that the patient is in no pain, what would be the physical benefit of subjecting the patient to death? Perhaps, the potential distress of unmitigated grief or religious turmoil in the patient’s loved ones justifies such extraordinary measures.
One other hand, if you believe, as some philosophers do, that all living involves some degree of suffering then death could be considered a beneficial treatment in that it initiates the end of one’s ability to suffer. In any case, the real question lies in whether the medical community believes that life in itself is worth preserving in its own right. Provisions already exist that allow physicians to override a patient’s wishes, including religious beliefs, and physician involvement in facilitating patient death has become less taboo with the growing popularity of physician assisted suicide. However, unlike in the legal system, we are a long way away from the day when the medical system can unilaterally decide that an individual who is technically alive should be made to die, especially against the family’s wishes. And, until some sort of moral consensus to the contrary can be achieved, perhaps that day should never come.