Should Nursing Homes Have the Option to Prolong life?

Jennifer Garcia

Reagan IB High School

CP Candidate Class of 2020

Word Count:2110
Introduction

"Approximately 60% of Americans die in hospitals and 20% to 25% die in nursing

homes, [a major problem that occurs in nursing homes is that ] patients preferences for care

often are not honored, even when those choices are clearly conveyed" (Fieser, J. 2010). One of

those preferences that patients can choose from is either having their life prolonged or not. As a

health science student the debate on either giving nursing homes the option to prolong life or

not interest me because it regards a human life which I am concerned for and in my future

career I would like to be able to respond to any situation like this in an ethical manner. Giving

nursing homes the option to prolong life, allows families to spend more time with their loved one

even though they are almost at their final stage of life. During the process of prolonging a

patient's life, there is the use of palliative care which can improve the patient's health and extend

it for a longer period of time. Also by providing resources to prolong life, there is an honor to the

Jewish tradition which is "that when life is threatened by illness and injury, it must be sustained

if possible" (Vanderpool,2004). However, not everyone in this situation has the same opinion on

prolonging life. The process can be painful and a long wait which can cause even more

complications in the patient rather than providing comfort. There is also controversy between

who has the right to take life away or to extend it, regarding religions like Christianity. Where

they believe that "God is the creator and sustainer of human life"(Vanderpool, 2004).Therefore

the big question is to what extent should nursing homes have the option to prolong life?

Nursing Home Should Have the Option to Prolong Life

Placing a person in a nursing home comes with a lot of decision making, the major

decision to make is to prolong the life of a patient. "Prolonging life is the act of extending a

patient's life through medications or through medical equipment such as life support when
organs stop working well"( Martin L. J. 2018). Other life saving medical treatments are "feeding

tubes, blood transfusions, mechanical ventilators, and medications" (Vanderpool, 2004).

Through the process of prolonging life, there is also a chance for a patient to have their

health state improved and extended with the use of palliative care. Palliative care "improves

quality of life of patients and their families facing life-threatening illnesses, through prevention

and relief of suffering" (Fieser, J. 2010). According to Lara C. Pullen "The United States now has

1800 hospitals with palliative care programs, which means that more than 80% of US patients

who are hospitalized for serious illnesses have access to palliative services" (2018). Denoting

that reason many patients have that option to improve their quality of life is that many hospitals

provide palliative care for patients. In contrast to other countries like Mexico where access to

palliative care services and to medicines essential for pain treatment is very limited"(Kashi,

2014).

The cultural perspective that can be implemented on why prolonging life in nursing

homes should be allowed is the Jewish tradition. Where everything possible should be done to

save a life. Withholding treatment like not providing palliative care or offering life support items

in order to prolong a patient's life is be considered immoral. The reason being that Jewish take

the obligation to prolong life from the scriptures in the bible, in "Leviticus 19:16 [stating] You

shall not stand idly by the blood of your neighbor" (Vanderpool, 2014). Meaning that when a

person sees a life endangered by illness treatment should be given to save that life, this stands

for prolonging life if possible. " A case report of an elderly Jewish male who ventilated in an ICU

reflected the contradictory position of secular and Orthodox Jewish laws"(Chakraborty,2017)

regarding decision making of prolonging life. This patient had three daughters "two of whom

were secular Jews and wanted to discontinue the life-sustaining support. The other daughter

wanted all life-sustaining therapies, including artificial nutrition and hydration (ANH), to be
continued after consultation with the rabbi" (Chakraborty, 2017). In the Jewish religion, palliative

care is seen as an improvement of life and not a way to increase lifespan. What should be of

more importance is the quality of a patient and this is based on the autonomy of a patient.

Which is according to Meisel it is "the core value that has driven the development of the right to

die"( 2004).

Nursing Homes Should Not Have the Option to Prolong Life

Like any other case in this society, different opinions arise and not everyone agrees with

prolonging life in nursing homes. While prolonging the life of a patient it can bring other

complications, for example instead of improving the health of a patient prolonging life can cause

more suffering like developing worsen side effects can. There are also many conflicts between

religion and prolonging life. Many believe that God is the giver of life and when the time comes

for the end of a person's lifespan, then there should not be a man to prevent his will from

working.

There was a case where this daughter, Katy who had a father that had been placed a

pacemaker in his heart in order to prolong his time of living, which later on it was not something

they saw as a benefit. "A year later, to correct a slow heartbeat, he'd been casually outfitted with

a pacemaker that kept his heart going until his life became a curse to him rather than a blessing.

He'd told my mother, "I'm living too long"(Butler, K. 2017). The pacemaker was meant to extend

his life but after time that pacemaker was causing many doubts in the family if it should have

been placed there at all in the first place. After he had been placed pacemaker he believed he

had lived longer than his actual time given. In the case of Katy's father living longer brought

other health deficiency like "going blind and falling in to dementia" (Butler, K. 2017), which was

not only hard for him but hard on his wife and his daughter to have to see him go through those

conditions when he didn't ask for that outcome. The major effect that this pacemaker had on the
family was making the decision to turn off that pacemaker. The guilt that haunted them was if it

was considered as "homicide or criminal neglect, or simply mercy" (Butler, K. 2017) if the

pacemaker was turned off. This is a stage were usually a patient gives his or her preference on

what should be done, however when a patient is in the stages of dementia which means that

they have" loss of memory and brain function"(Engelbright, 2017), dementia causes "impaired

decision making [which] can have important consequences when considering medical capacity

assessments or the legal determination of competency in patients"(Darby, R. 2017).

Consequently, if a patient does not provide any guidepost the system takes control over the

decision to make. It "provides increasingly intensive and invasive care that ultimately prolongs

dying, leading to a poorer quality of life, unnecessary pain and suffering and increased rates of

depression, anxiety and even post-traumatic stress disorder for the surviving family"(Postmedia

News, 2012).

There is a controversy with prolonging the life of a patient regarding religion. Many

religions like Christianity believe " God as the creator and sustainer of human life and opposed

suicide in response to suffering or despair" (Vanderpool,2004). Also "the early Christian

philosopher St. Augustine of Hippo (354-430) taught that people must accept suffering because

it comes from God."(Alters, S. M. 2013). The use of medications and medical equipment

prevents God from doing his "will" as many believers would say, this also prevents people from

accepting God's purpose. The bible states "Not my will, but thine be done (Luke 22:42)"

(Vanderpool, 2014), "thine" meaning as His will. As Christians, the will of God should be

accepted and no man should interfere with his purpose.

Is it Ethical?
 As health science, student ethics means doing the right thing based on morals and

cultural values. Perspective 1 is more ethical because while prolonging a patient's life you are

doing everything to find a cure and not let that person die and it follows the Jewish cultural

values of saving a sacred life through all means possible. Helping someone overcome

circumstances is the right thing to do than letting a patient die. However, perspective 2 is also

more ethical because a person that would be living for an extended time should not live in

suffering through health. Life is meant to be enjoyed and not constantly be racked with pain until

the end of life. Similar to the case of Mr.Butler where his wife and daughter had decided to allow

the pacemaker to be placed into his heart in order to live longer with the condition of living a

happy, healthy life, which later turned into a disgrace and led to regret from the family.

There are consequences to all the decisions taken, especially when the decisions are

taken on the life of a human being who is in a stage where they are on their last days. With both

perspectives stated I would say that nursing homes should not have the option to prolong life is

more ethical because it allows God to do his will. For something to be ethical in my opinion it is

based on morals that one has to follow depending on one's culture. As a Christian believer that

I have been raised, I believe God has the right to end a life or either prolong it. Certainly, people

should enjoy family and if there is an extra lifetime that can be given it should. However, the

question I ask in order to make an ethical decision, in this case, is what decision will do the most

good and the least damage? Take utilitarianism as an example it is based on the "greatest

happiness principle in which actions are right based on how much happiness they create"

(Nubcaek, 2011). The principle of utility "principle of utility states that actions or behaviors are

right in so far as they promote happiness or pleasure, wrong as they tend to produce

unhappiness or pain"(White, n.d). If this was the measuring scale of how ethical dilemmas are,

the dilemma of nursing homes having the option to prolong life would be unethical, prolonging
life causes pain and some happiness at the moment but later on, it causes regret like the case

of Mr. Butler.

Conclusion

While nursing homes are places where elderly go when they need extensive care and it

cannot be provided in their own homes, there are decisions that need to be taken especially

when it comes to end-of-life care. There are many debates on the ethical dilemma if nursing

homes should have the right to prolong life. Many opinions arise with both perspectives, for

example, prolonging life for an elder is not worth it because they have lived enough time for

being an elder and no man should interfere with God's will. On the other hand, others have the

opinion that prolonging life should be allowed in nursing homes because it is more ethical than

letting a person die when there are medical treatments that can prevent a person from dying. In

conclusion, there are a lot of parts to decision making either prolonging life of a patient to see

improvement or to have an outcome of suffering. There are conflicts between the beliefs of each

patient, depending on what is right or wrong. What is most important for this ethical issue is

evaluating the situation, and coming to an ethical decision on whether nursing homes should be

allowed to prolong life or not. According to a systematic review of religious belief about

end-of-life issue with elders, "Mohankumar found that Asian, Indian,[and] Hindus are more likely

to refuse life-sustaining interventions compared to non-Hispanics, and whites, and [they] are

more likely to engage in autonomous decision making regarding advance directive" (2009). Not

everyone will agree with the same opinion everyone has different beliefs, religion and a different

culture, which makes it even harder to find an agreement with something so sensitive like the

lifespan of a human being. I believe that nursing homes should not be allowed to prolong life it
will do a greater good to a patient and later on, family members will not be found in a situation of

regret and guilt.

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