Trust her inner voice

The ethical dilemma herein is resolvable on the basis of two non sequiturs : The avoidance of a ventilator does not always spell death. Insisting on it is no guarantee of survival. It is incidental that Mrs. SBG managed to recover – because of the ventilator, or, may be, DESPITE IT.

It is ethical to pay heed to a sprightly 80 years old, to trust her inner voice, and even to concede that she be allowed to embrace death of dignity at home, in case of an exit while struggling against a ventilator, in an alien setting, much against what the patient had patently expressed, merely endorses Bigelow’s comment of mid 19th century- ” Most men form an exaggerated opinion of the powers of medicine”.The 1986 Oxford companion to medicine, writing about the role of doctors, echoes Bigelow-” It needs to be more generally recognised that most of medicine is about relief of, and comfort in suffering and in main very little to do with saving life.”

An editorial in the New England Journal of Medicine (305: 1467-269,1981)entitled “The toss-up” bears eloquent testimony to the rationale of the above. It is common experience that, on a given case, the proposed diagnostic or therapeutic thrust ranges from extreme conservatism to surgical ultra- radicalism. After attributing such divergence in medical thinking to the idiosyncrasies of the physicians, the authors propose: ‘perhaps all these factors are involved in clinical controversies, but we propose that one explanation has not been sufficiently recognised: that it simply makes no difference which choice is made. We suggest that some dramatic controversies represent” toss-ups” – clinical situations in which the consequences of divergent choices are, on the averages, virtually identical. ‘the identicality of the consequences, no matter what the investigations and what the therapy, is a result of the basic fact that the problem being tackled is beyond the limits of technology.

Bottomline: We would have honoured the dictates of Mrs. SBG, avoided the ventilator without being unethical.