Opinion – Front Line: Maria Laura’s living will

by

Medical students have their first regular contact with inpatients in the course of clinical propaedeutics, basic knowledge of the discipline. At this moment, they learn to do anamnesis, production of a story from a structured interview, and semiology: recognition of signs and symptoms. From the association between narrative and observation, almost all diagnoses arise, since when Hippocrates of Cos presented humanity with his clinical method.

Young people are amazed when they put on the doctor’s clothes, somewhat insecure, somewhat ecstatic, they enter the wards. Many of them are convinced that once they master the art they will be capable of exceptional diagnoses, unlikely cures and, in the extreme, as Asclepius did, bring the dead back to life.

The patient of the day, Laura Maria, eighty-four, smiles despite some respiratory distress caused by pneumonia that required hospitalization, supplemental oxygen, and intravenous antibiotics. The diagnosis does not offer a challenge, but a document that the lady carries, laminated, very well taken care of, arouses the curiosity and, eventually, the consternation of those present.

She insists on showing her living will. It states that she would not accept under any circumstances having her life extended by mechanical ventilators, artificial feeding by tubes, would not tolerate being submitted to resuscitation if she suffered a cardiorespiratory arrest, her decision is based on the ethical-professional regulations in force in the country. Document signed and notarized.

Astonished, a young student in her twenties wanted to know why. Why would Maria Laura not accept the interventions that medicine could offer to prolong life?

Because everything that starts one day ends, and I don’t want to end up dying in machines. I suffer, who takes care of us suffers, nurses suffer, why?

Autonomy. First principle of bioethics. We discussed the case in three consecutive classes. It does not need to be concluded, but it is necessary to assume that people can decide what they consider most appropriate for their own care. They can live to the full until the end of their days.

Hippocrates also taught us in his aphorisms that to sedate pain is divine; that art is long and life is short; that opportunity is fleeting, experience is deceptive, and judgment difficult.

In time, Maria Laura was discharged with the pneumonia resolved, no extraordinary measures were necessary and her living will will complete thirteen years with her eighty-fifth birthday.

Everything that starts one day ends. The end.

You May Also Like

Recommended for you