Friday, June 09, 2006

Why Yes, I Do Want to Burden My Loved Ones

via, an excellent reflection on how altruism in end-of-life medical care veers into isolating suicide:

Perhaps it is a good thing, lest we be tempted to injustice, that the dying burden the living. Some years ago Robert Burt wrote a book about medical decision-making for incompetent patients. The book's title was Taking Care of Strangers. Burt's point, which carried a double entendre, was essentially this: Patients who are unable to make decisions for themselves are often in a state (e.g., severely demented, comatose) in which they become strangers to us. They make us uneasy, and we react with ambivalence. And to say of such a patient, "I'll take care of him," may be a statement freighted with ambivalence. Burt worries that, no matter how devoted our care, our uneasiness with a loved one who has become a stranger to us may prompt us to do less than we ought to sustain his life. (Nor, we should note, are physicians immune to such uneasiness.) It is, therefore, essential that we structure the medical decision-making situation in such a way that conversation is forced among the doctor, the medical caregivers, the patient's family, and perhaps still others, such as pastor, priest, or rabbi. Advance directives, designed to eliminate the need for such extended conversation--lest it should burden loved ones--are, from this perspective, somewhat problematic. They may not force us to deal with our own ambivalence in "taking care of" a loved one who is now a burdensome stranger.
-Gilbert Meilander,
"I Want to Burden My Loved Ones"(PDF)
(First Things, October 1991, pp.12f)

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