IX. How to care at the end of life?

The end of human life is inevitable. Technology can the dying process longer, often less painful, and more uncertain. In the face of this challenge, what are our ethical possibilities? Should we extend life as much as we possibly can? Should we abandon our efforts to the "destiny" of the human condition and let patients die the moment death seems the proximate outcome? Who decides? Does the patient have absolute autonomy? What happens when that autonomy cannot be exercised? What are the ethical parameters to make decisions at the end of life?

79.  Never kill, always care. Cure when proportionate.

80.  Letting die may or may not be killing.

81.  Proportionate therapies are obligatory.

82.  Disproportionate therapies may be withheld or withdrawn.

83.  We judge treatments; not people.

84.  Quality of life is good but insufficient.

85.  To be or not to be, should be the question.

86.  Plan for the end of life responsibly; not dogmatically.

The danger of moral absolutisms is the greatest temptation at the end of life. For some, the principle should be to extend life as much as we can, for we seem to have an absolute imperative to care for our own lives and those of our loved ones, even if it includes aggressive treatments. For others, the "self" is the only ethical center of reference and the ethical outcome is to obey and respect the authority of the patient as much as we can, even if it includes active voluntary euthanasia. Perhaps the most common and tempting absolute today is "quality of life."

The first task is then to realize that only negative commandments very precisely defined can turn into moral absolutes. For our purposes here the moral absolute is, never kill intentionally a human being, even when they consent it. The moral principle of caring and treating patients need to be governed by the virtue of prudence: always care but the obligation to treat is subject to the consideration of whether the treatment is proportionate to its intended purpose.

In this way, we are not giving way to the delusion that the individual has the authority to dictate what constitutes good and evil and neither are we invested in futile prolongations of dying patients that may even go against the holistic benefit of the patient.