Many times, medical practitioners come across family members that carry the burden of having to choose on whether their loved ones should continue obtaining a certain life support treatment or if the said support should be terminated.

Usually, plenty of factors come into the picture when it comes to deciding on this issue, such as the pain and suffering of the patients themselves, costs borne by their loved ones and if the resources are being held back from other patients who have more chances of survival.

Out of all the decisions and incidences that involve medical issues, the ones relating to death and dying requires the most ethical considerations to be taken into account, especially when the death and dying of the patient in question place the responsibility of decision making on anyone other than the patient himself.

Whilst there have been several countries and jurisdictions that made euthanasia or rather ‘mercy-killing’ as a form of homicide and therefore illegal, deciding to remove life support treatment from a terminally ill person whose functioning of organs depends solely on life support machine remains an issue that is still receiving an ample of opinions both from those who support such decision, and from those who don’t.

Below are some of the advantages and disadvantages of end of life decision making by loved ones:

ADVANTAGES

The utilitarian argument

The utilitarian theory suggests that the advantages of carrying out something should outweigh its drawbacks. When it comes to removing the life support treatment of a terminally ill and unconscious (brain dead) patient, the family members will rarely be put in that position, as it only happens if the medical practitioners suggests the existence of such a choice. In practice, medical practitioners do not suggest them unless there are little to no chances of survival and therefore removing the life support treatment could mean that the resources could be used for someone else, who is in need of the same treatment, and has better chances at survival.

Resources here could include not only the life support machine in itself but also other resources such as the costs of the treatment, time and energy of the medical practitioners and so on.

Unnecessary delays before prompt retrieval of donated organs can be reduced.

Where the brain dead patient is an organ donor, his or her organs may help save someone who is in dire need of organ(s).

Thus, to increase the number of organs available for transplant, organs can be taken from non-heart-beating donors (NHBD).

Respecting the patient’s autonomy.

In some cases, the patients may have already informed their loved ones that if a point comes when they are totally dependent on life support and are unconscious, then they should be “let go”.

These wishes relate closely to patient autonomy that they should be respected.

DISADVANTAGES

There may be a misdiagnosis of brain death.

It is possible for someone to be mistakenly diagnosed as brain dead. In 2008, Zach Dunlap who was involved in a road traffic accident ended up with “catastrophic brain injuries” and was declared brain dead only to be found that he was very much alive just four hours after that diagnosis, just as his family was getting ready to pay their respects and say goodbye.

National Right to Life News reported that “since ‘brain death’ demands that the condition is irreversible, the probable error lies in the diagnosis.”

Procedures involving organ transplantation from non-heart-beating donors can be highly controversial.

There may never be a correct way to determine the proper waiting time between the patient being declared brain dead and is announced to be conventionally dead so that they are ready for organ removal. Also, in some hospitals, loved ones may be persuaded to take the decision even though they are not prepared to do so, especially when someone else needs urgent organ transplantation.

The line between end of life decision making and passive euthanasia may be blurred.

There may be cases where patients voluntarily deprive themselves from common medications for their illnesses even though they have high chances of survival.