Quality of Life and Sanctity of Life Judgements

A 62-year-old woman has had multiple sclerosis for 25 years. Initially the disease followed a relapsing and remitting course, and Nora would have long periods of good health in between months of various disabling side effects, such as temporary paralysis and visual problems. For the past 10 years, however, her condition has become more disabling and Nora has had to move into a nursing home. The staff are friendly and she is well cared for. As a result of the insidious effect of her illness, most of her bodily functions have ceased to work and she is doubly incontinent. On the days when she is well enough to be aware of her surroundings, she finds her condition extremely distressing. She is embarrassed by her lack of bodily control and the fact that she has to have 24-hour nursing care. Her swallowing is unsafe and, following an admission with aspiration pneumonia a year ago, the decision was made to insert a percutaneous endoscopic gastrostomy (PEG) to provide all the nutrition she requires. She now does not even get pleasure from eating or drinking. Some days she is described by staff as being barely conscious, but when she is, they are concerned that she is lonely as she rarely gets visitors.

• Does respect for the principle of sanctity of life require that life-prolonging treatment should always be provided, irrespective of the quality of that life?
• From whose perspective is quality of life to be judged?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme