1 Chapter 11 Death, Medicine, and Moral Significance of Family Decision Making 3 We Die Differently Now… • Contemporary medicine has made the dying process very complex. • This causes patients and families to make many difficult choices. • Families often play important role in end-of- life decisions. • Therefore, families need to be considered in end-of-life decisions. 4 Romanizing Death and Demonizing Families • The consensus is that end-of-life decisions should respect patient autonomy and the right to balance benefit with burden. • This consensus sometimes conflicts with the autonomy of the professional. • The main issue is the ability of the patient to make this decision. 5 Romanizing Death and Demonizing Families • There is a need for others to convey the patient’s preferences when he/she cannot do so. • The family is assumed to be in the best position for this decision. • However, they may not be disinterested parties. 6 Romanizing Death and Demonizing Families • We need to guard our judgments concerning starting or stopping life-sustaining therapy when the patient is not able to authorize this action. • There may not be a match between what the patient wants and how the family member’s understanding matches this want. 7 Romanizing Death and Demonizing Families • Society has generated laws to empower patients to make their own decisions about death and dying. • These laws attempt to protect their ability to die in agreement with their beliefs and who they are as people. 8 Dying in Intimacy • Previous claims about the role of families in the dying process have been overstated. • Few people have taken advantage of advanced directives. • The medical practice may be confused about the patient’s definition of a good death. 9 Dying in Intimacy • Many people think of their families as advanced directives. • However, many people are not able to express their preferences for action in a future crisis. • Advanced directives do not consider the nuances of a romantic death. 10 Dying in Intimacy • The ill are not excused from their obligation to family because of their illness. • Selfishness is not the only approach to illness. • Policies should be made to recognize the role of the family in making proxy decisions. 11 Dying in Intimacy • Hospitals have their own agenda when it comes to the dying patient. • Patients need to be empowered in a setting which has the power to control their autonomy. • Patients must be able to have contact with their sources of protection and personal affirmation. 12 Solution s • When people trust their families, they should be allowed to have them make proxy decisions. • When they do not, non-family proxies could be appointed. • Specific treatment directives could also be available. 13 ...

1. 1
Chapter 11
Death, Medicine, and Moral
Significance of Family Decision
Making
3
We Die Differently Now…
• Contemporary medicine has made the dying
process very complex.
• This causes patients and families to make
many difficult choices.
• Families often play important role in end-of-
life decisions.
• Therefore, families need to be considered in
end-of-life decisions.

2. 4
Romanizing Death and Demonizing
Families
• The consensus is that end-of-life decisions
should respect patient autonomy and the
right to balance benefit with burden.
• This consensus sometimes conflicts with the
autonomy of the professional.
• The main issue is the ability of the patient to
make this decision.
5
Romanizing Death and Demonizing
Families
• There is a need for others to convey the
patient’s preferences when he/she cannot do
so.
• The family is assumed to be in the best
position for this decision.
• However, they may not be disinterested
parties.
6

3. Romanizing Death and Demonizing
Families
• We need to guard our judgments concerning
starting or stopping life-sustaining therapy
when the patient is not able to authorize this
action.
• There may not be a match between what the
patient wants and how the family member’s
understanding matches this want.
7
Romanizing Death and Demonizing
Families
• Society has generated laws to empower
patients to make their own decisions about
death and dying.
• These laws attempt to protect their ability to
die in agreement with their beliefs and who
they are as people.
8
Dying in Intimacy

4. • Previous claims about the role of families in
the dying process have been overstated.
• Few people have taken advantage of advanced
directives.
• The medical practice may be confused about
the patient’s definition of a good death.
9
Dying in Intimacy
• Many people think of their families as
advanced directives.
• However, many people are not able to express
their preferences for action in a future crisis.
• Advanced directives do not consider the
nuances of a romantic death.
10
Dying in Intimacy
• The ill are not excused from their obligation to
family because of their illness.
• Selfishness is not the only approach to illness.
• Policies should be made to recognize the role

5. of the family in making proxy decisions.
11
Dying in Intimacy
• Hospitals have their own agenda when it
comes to the dying patient.
• Patients need to be empowered in a setting
which has the power to control their
autonomy.
• Patients must be able to have contact with
their sources of protection and personal
affirmation.
12
Solution
s
• When people trust their families, they should
be allowed to have them make proxy
decisions.

6. • When they do not, non-family proxies could
be appointed.
• Specific treatment directives could also be
available.
13