Bioethics

            Although, perhaps, this except is not too subtle, I found it interesting in its questioning an aspect of technology and its influence on life.  It is taken from the February 9th, 2011 edition of JAMA in the article “Life Imitates Work” by Tia Powell.  I connected it with three pieces of literature we read last semester.

“My mother’s mother had dementia and heart block and received pacemaker back in the 1980s.  My grandmother lived for 12 years with that pacer, and her six children deeply regretted every agreeing to this intervention.  Her dementia culminated in years of immobility and muteness and an apparent lack of joy.  Because of that experience, my mother told us never to give her a pacemaker.  She repeated these instructions on various occasions, telling one of my sisters not to do it during a dinner at which my demented grandmother was rattling away in a nonsense version of French.  She told me not to do it a few years ago when we talked about her mother, and my father also reminded me not to give my mother a pacemaker.  As far as advance directives went, my mother did everything right.  She had a child who is a physician and appointed that child as health care proxy.  She formed a specific opinion about a treatment and expressed that opinion in unambiguous terms to many people on more than one occasion.

And yet because the cardiologist had been called, along he came.  An earnest, thoughtful, and respectful young man, he spent a lot of time talking with my family.  He told my siblings that ‘No one is allowed to die of heart block.’  He further opined that no palliative care could be offered, since any symptom would come without warning and would be untreatable.  He supposed that her death would feel ‘like drowning.’  He noted that most cardiologists would refuse to turn off a pacemaker once it was installed.  He himself would consider stopping the pacemaker, but only if all six of my mother’s children agreed I writing that this was the correct choice.  Not only could we lose the option of ceasing treatment if the cardiologist moved or changed his mind, but this last condition-of unanimity- was a way to override my mother’s selection of a health care agent. Now there would be no tie-breaker.  Rather, our large family would be required to maintain the pacemaker if any one of us wanted it.”

Powell, Tia. “Life Imitates Work.” JAMA 305.6 (2011): 542. Print.

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