Video Excerpts: At the End of Life

.Interview Statements — What does "quality of life" mean?

Option 1: Real Media Format
Option 2: Windows Media Player

The Quality of Life at the End of Life video excerpts explore the current ethical and social dilemmas arising from the significant medical advances that are changing what people experience during that last and, often, most burdensome illness. Many of these advances have caused people to think about the meaning of "quality of life" and what they might want if that quality of life slips away. In speaking with several community members of varying age, race, gender and ethnic background, we heard the following views:

"The quality of life is the general happiness that a person has with living, of which one component is good health - which means free of pain, free of fear."

"Quality of life, to me, means being as independent as possible."

"For me, it means being able to continue having relationships with others in a fashion that is pleasurable to me."

"I think, with the rising costs of everything, money is of great importance and I think about it a lot."

"I've had a full life. I've been fortunate. I don't want to go through a painful end. I don't want to be a problem to society or my family. I just hope that a truck hits me. I don't want to go to a hospital for months, and I hope eventually our society and our institutions will preclude that sort of thing. The church has been preaching the beauty of heaven for centuries but nobody seems to want to go there."

"If I'm totally dependent and in no way going to get better, I think in that case, I would not want to live anymore."

"When my personal health wouldn't allow me to enjoy those things, to enjoy the people I was around, or the activities I enjoy in life; when my quality of life would be diminished to the point that living couldn't be a quality situation, I think the quality would have to come from ending that situation probably."

"I think that right now people have not clearly thought out what should be included, or what they mean, when they say physician-assisted suicide. And I think that there are a lot of ramifications there. But the bottom line is that it places too much power in the hands of a physician, and I think that there are many other alternatives for a person."

"Personally, I like what hospice does. I would want to be at home with the people that I cared about and who I knew cared about and loved me. I would want support from them. I would want a holistic approach so that I could be able to deal with, not only my physical symptoms, but my emotional, my spiritual, and my economic and social situation."

"The big spiritual issue for me, or theological issue, is our fear of death. We treat death as though it is always an enemy and it strikes me that there are plenty of circumstances in which it is no longer an enemy, but even a friend. The fundamental issue for people is how they regard death and what kind of comfort they have when facing their death. Once we come to terms with that, then I think it's less of a problem from the theological and moral point of view to acknowledge that sometimes death needs to be welcomed."

Main Session — Vignettes & Video Excerpts

Here you will find excerpts from the main session of the 1994 forum. These video excerpts are the central element of this learning module.

First, meet the moderator, lawyer Nancy Buc, and panelists:philosopher and physician Howard Brody; bioethicist Michael Garland; theologian and ethicist Therese Lysaught; ethicist Haavi Morreim; and lawyer Charles Sabatino.

Introduction to the Panelists and Moderator (pdf)

Real Media Format
Windows Media Player

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Vignettes
Video Excerpts

Vignettes

Specific case studies dealing with end-of-life issues were used during this forum to provide a common basis for discussion. These case studies, which appear in the transcripts and video clips, are summarized below:

Vignette 1 reveals a woman in her mid-fifties diagnosed with cancer, struggling to maintain what she believes to be her right to control the manner in which she dies. It is not so much fear of pain or death that motivates her as the fear of loss of control and dignity. She attempts to gain the promise of assistance in ending her life when she feels the appropriate time has come, first from a trusted friend and then from her doctor. The vignette calls attention to how end-of-life decisions raise ethical, legal, medical, and religious concerns. (Real Media Format / Windows Media Player / pdf)

Vignette 2 looks at the possibility that this same woman, instead of seeking a planned end to her life, might instead request that extraordinary and expensive measures be taken to lengthen her life and, perhaps, against all odds, to cure her of the cancer that her physician believes will end her life. This vignette attempts to reveal the potential tension that exists between a woman who wishes to live at all costs, those who care most for her and believe that her wishes are misguided and unrealistic, and society's desire for a fair and cost-effective health care system. (Real Media Format / Windows Media Player / pdf)

Video Excerpts

Finally, onto the excerpts from the main session!

The excerpts are organized around the specific case study vignettes and by questions posed by the moderator and audience members.

Note: the files formatted for Windows Media Player have better sound quality than those using the Real Media Format for this module. Both are available below.

If you have difficulties when attempting to play either type of streaming video, you may wish to save the file to your hard drive, and then open the appropriate media player. When saving files — real media files should end with *. rm; windows media player files should end with *.wmv.

Vignette 1
Panelist reactions to the first vignette
Why does Elizabeth (the patient) not have the right to commit suicide?
Is there a power imbalance between the patient and the medical and ethical establishments?
Advance Directives and Living Wills: How certain is it that individual choices, even if they are voiced and put into print, will really be honored?
Assisted Suicide: Where is it legal? Who wants to engage in assisted suicide?
What is the physician's responsibility to his or her patient's quality of life at the end of life?
Vignette 2
Panelist reactions to the second vignette
What would make physician/patient communication better?
What is the role of the religious community as decision-makers about quality of life at the end of life?
Is it reasonable to ration health care on the basis of any individual's lifestyle?
What are the legal and ethical implications for the professional nurse and other care-givers when discussing assisted suicide with the patients?
Could physician assisted death become a cost-cutting option; a way to reduce health care cost?
How prevalent is the attitude among medical professionals that that Medicare money would be better spent to save the lives of younger, more productive people?
What is the role and responsibility of hospice workers and other medical professionals in working with the patient to get them to know they are terminal?
Concluding Thoughts

Download Full Transcript as PDF File

video 1
Real Media Format OR Windows Media Player
(transcript)

Vignette 1