Case Study 19 : BURDEN
Challenges
The family of a 23-year old female patient, attached to a respirator for the past three months and in a comatose state, decides whether to discontinue the respirator’s use. They fully understand the patient’s situation, and that ethically speaking (assuming the patient is in fact entering the dying stage), withdrawing the respirator proves acceptable if it offers no reasonable hope for recovery (a fact that the doctors confirm), or if the burden proves excessive.
However, they seek more clarification regarding the concept of burden.
Question
When contemplating withholding or withdrawing certain medical procedures, what kind of and whose burden should be considered?
Solutions
Burden factors into decision-making involving complex topics, such as withholding or withdrawing life support, ordinary and extraordinary means, and the no-CPR or DNR policy (discussed in other issues of Bioethics Bits).
Burden manifests differently – physical, psychological, emotional, financial, spiritual, social, or in terms of spent time, efforts and resources. Too much burden includes, for example, undergoing a treatment extremely strenuous for a person advanced in age. Or it could mean having to sell one’s only house to pay for treatment, leaving the entire family homeless.
Burden also demands examination regarding the different persons involved – the patient, the family or people supporting the patient, and society as a whole. Thus, even though burden no longer presents a question for a patient who permanently lost consciousness (e.g., in a persistent vegetative state), it still merits consideration as it affects those giving care.
Regarding burden to society, a particular issue involves the allocation of scarce resources: even though the dying patient’s family can afford certain scarce resources (e.g., certain limited instruments in a small hospital), what if other patients with more hope of recovery also need them? The family should also take this into account when making the decision.
