Expanding the scope of nontreatment considerations: Forgoing treatment in end of life settings

Abstract

This paper takes a look at the goals of medicine, its shortcomings and how to respond to them. It will do this by looking at the history of the goals of medicine starting with the Hippocratics in ancient Greece, working its way to contemporary biomedicine. This will show a trajectory in which medicine has gone from a holistic project to an increasingly reductionistic one. The “scientification” of medicine has brought with it many advances, but these advances have left with a lot to be desired when it comes to end of life settings. This shortcoming is made tangible through a case in which an elderly, demented woman with a hip fracture keeps being treated with curative intent until she dies after two-and-a-half months of pain and delirium whereas nontreatment would have resulted in a quick and relatively pain free death. The reason for this ‘inhumane’ treatment traditional biomedicine’s inability to handle these situations. Therefore, this paper will argue for a shared decision making approach where physician and patient fully share both medical options as the goals and projects one desires in order to make an informed and individualized choice that is in the patient’s best interest.