A time to live or a time to die?

Editor—My sympathy, congratulations, and deep respect to the unnamed author (and her husband) of “A time to live or a time to die?” for having the courage to present her harrowing account of being kept alive by percutaneous endoscopic gastrostomy.¹ Too often we hear of such tragedies and of well meaning but fundamentally misguided examples of medical intervention.

I believe the most challenging aspect of all forms of medical practice is the need for, and the exercise of, judgment. These days, in many walks of life, “judgment” carries connotations of authority and control which are often viewed as being unacceptable.

Figure 1.

Ecclesiastes: A time to be born, and a time to die

Credit: Ms 1f.235, Souvigny Bible/BAL

But judgment is really about making a decision. While, globally, the move within medicine is increasingly towards the objective goal of “evidence based medicine,” this philosophy must inevitably struggle with the conflicts of subjectivity. And there is little that is more subjective than the morality of what is right and what is wrong in such a situation as that presented by your correspondent.

It's easy to be objective. It's easy to base one's decisions on evidential data and, of course, such decisions do not bear the same degree of individual responsibility for their outcomes which more subjective decisions might entail.

Having qualified in 1975 I have seen numerous such cases and, regrettably, more so in recent years. Clinicians have always faced such ethical and moral dilemmas, but I fear that our increasing commitment to “evidence” may be undermining our need to exercise compassion. In our drive for objectivity, are doctors losing that compassion? Has the intellectual status quo of medicine shifted so much that subjective considerations can be discounted? Or, worse, can it be an excuse not to exercise compassion?

Perhaps as we continue down the path of increasingly scientific objectivity, it may be time for us to remember the humanities as well as the science.