Ordinary Or Proportionate Care
In medical terms, ordinary or proportionate care, which is beneficial, useful, and not unreasonably burdensome to the patient, is morally obligatory. On the other hand, extraordinary or disproportionate care, which may include exotic, experimental, or excessively burdensome treatments that are unlikely to benefit a patient or that include unreasonable costs relative to benefits, is not morally obligatory, though a patient may choose to accept it.
The categories of proportionate and disproportionate care therefore, allow us to navigate between two dangerous extremes: the fundamentals that would have us preserve life at all costs by any means necessary without regard for the burdens imposed on the patient, and the fatalism that would tempt us to give up on gravely ill patients before their time and violate their rights to life and basic care.
In the case of Roger Allen, his directive not to undergo surgery anymore if there is no guarantee that he will recover and assume a normal life is based on his right as an individual to decide what he wants to do with his body and to be protected from unwanted interference from others. In his perspective, Mr. Allen may be thinking that the burdens of treatment in terms pain, effort and costs are disproportionate relative to the anticipated benefits of the treatment.
In the first place, there is no guarantee that the surgery will restore his health. If it fails, either he will die or he lives, only to be a burden to his two daughters and relatives in terms of financial costs as well as efforts of caregiving, not to mention the emotional pain that his daughters and relatives will be experiencing due to his condition. On the other hand, if we look at the daughters’ perspective, it is only natural that they will try to exhaust any means to save their father’s life.
If surgery fails and in the end their father dies, at least their minds and hearts are at peace knowing that they have done their best to save him rather than being tormented for the rest of their lives with the idea that they could have tried at that slim chance to save him. In my opinion however, the request of the daughters to monitor their father’s condition after surgery for six months is too long. I think one to two months would be long enough. By that p of time, the medical professionals would be able to assess if there is improvement and a chance that the father will recover.
Also in that p of time, the daughters’ decision may also change considering the physical, mental and emotional toll that they had experienced in the care of their father. On the part of the doctor, I think that he has no other choice but to insist the father’s wish. He himself, cannot guarantee the success of the surgery and medical treatment may only be prolonging the agony of everyone concerned. Furthermore, in his perspective, discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate.
No doubt, Mr. Allen’s treatment falls under this category since the diagnostic tests reveal significant brain damage and internal bleeding of unknown origin, requiring exploratory surgery. In his case, one does not will to cause death; one’s inability to impede it is merely accepted. The decision is made by the patient himself assuming that he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.
