Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T11:23:28.243Z Has data issue: false hasContentIssue false
  • English
  • Français

Testing the Medical Covenant: Caring for Patients with Advanced Dementia

Published online by Cambridge University Press:  01 January 2021

William F. May
Get access Rights & Permissions [Opens in a new window]

Extract

A word, first, about the religious sensibility that I have found helpful to describe the care professionals owe to dying patients, particularly patients with advanced dementia.

That word is covenant. It is a biblical term; but, today, it covers such dubious devices as real estate covenants. A real estate covenant often operates below the moral level of a contract to wall some people out of a neighborhood. Classically understood, however, the word covenant helps probe the obligations of doctors to their patients more deeply than the notion of a contract. Covenants of the sort I have in mind and contracts appear to be first cousins; they both include an agreement and an exchange between parties. But, in spirit, contracts and covenants differ markedly. Contracts are external; covenants are internal to the parties involved. We sign contracts in order to discharge them expediently. Contracts are limited and time-bound — whether a contract to fix plumbing or to charge such and such for a medical procedure.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 40 , Issue 1 , Spring 2012 , pp. 45 - 50
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Daar, J. F., “Medical Futility and Implications for Physician Autonomy,” American Journal of Law and Medicine 21, nos. 2 & 3 (1995): 221–240.CrossRefGoogle Scholar
Helft, P. R. Siegler, M. Lantos, J., “The Rise and Fall of the Utility Movement,” New England Journal of Medicine 343, no. 17 (2000): 293–296, at 295.CrossRefGoogle Scholar
See Daar, , supra note 1, at 229.Google Scholar
Veatch, R. M., “Why Physicians Cannot Determine If Care Is Futile,” Journal of American Geriatric Society 42, no. 8 (1994): 871–874. See also Veatch, R. M. Spicer, C. M., “Medical Futility Care: The Role of the Physican in Setting Limits,” American Journal of Law and Medicine 15, nos. 1 & 2 (1992): 15–36.CrossRefGoogle Scholar
Schneiderman, L. Jecker, N. Jonsen, A., “Medical Futility: Its Meaning and Ethical Implications,” Annals of Internal Medicine 112, no. 12 (1990): 949–954, at 951.CrossRefGoogle Scholar
See Gillick, M. R., “Artificial Nutrition and Hydration Therapy in Advanced Dementia,” The Lancet: Neurology 2 (2003): At 76 for a compact gathering of the information in this paragraph largely contrasting practices in the Netherlands and the United States.Google Scholar
Gillick, M. R. Volandes, A. E., “The Standard of Caring: Why Do We Still Use Feeding Tubes in Patients with Advanced Dementia?” Journal of the American Medical Directors Association 9, no. 5 (2008): 364–367.CrossRefGoogle Scholar
See Helft, et al., supra note 2, at 295.Google Scholar
Lynn, J., “Living Long in Fragile Health: The New Demographics Shape End of Life Care: Improving End of Life Care: Why Has It Been So Difficult?” The Hastings Center Report 35, no. 6 (2005): S14–S18.CrossRefGoogle Scholar
See Schneiderman, et al., supra note 5, at 953.Google Scholar
See Gillick, Volandes, , supra note 7, at 365.Google Scholar
The phrase “strive officiously” to keep the patient alive captures the spirit of Paul Ramsey's criticism of mistargeted care of the dying in his book, The Patient as Person (Yale University Press, 1970), at chap. 3, “On (Only) Caring for the Dying.” I have added “at the end of the line.” It refers of course to death, but also a phrase used by the elderly in nursing homes to refer to a colleague who has been intubated; that is, he is “on the line.”Google Scholar
See Helft, et al., supra note 2.Google Scholar