Most cultures in the world treat death as a sacred calling for the dying person to join the afterlife. Major religions such as Christianity hold that death on earth ushers in an eternal chapter in the life of the deceased. Despite the general views held by a particular society, individual opinions and beliefs regarding death and the dying process often vary greatly. The emergence of modern medicine has brought about artificial technology that may be used to prolong the dying process. This situation raises the question of quality of life. People are often divided over the usefulness of life support machines when the dying person can barely breathe. Some of the dying person’s family members would wish to have him or her around much longer, even if it means staying in a vegetative state for years. The other category of people are worried that the dying person is unnecessarily subjected to pain, yet there is no hope of meaningful recovery. There is also the question of the dying person’s wish and the need to strive to ensure it is fulfilled.
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The research seeks to fulfill the following objectives:
- To investigate the ethical issues that underline the issue of death and dying
- To examine how such ethical issues are applied in the subject of death and dying
According to Lichtenthal, death poses a challenging time for people, especially when they attempt to deliberate on interpersonal issues, financial concerns, and issues of medical care (311). Those left behind make these decisions since they will be the most affected in the end. For example, questions of how much to spend on the medical care of the dying person may be difficult if faced with financial constraints (Sudore and Fried 256). Ordinarily, family members and friends of the dying person would rather exhaust all their finances attempting to secure a longer life for the dying person. However, other family members may regard the efforts to prolong the dying person’s life as unhelpful, especially if the chances of recovery are minimal. The dying person may also experience a difficult time trying to come to terms with the fact that he or she is about to die, leaving behind loved ones. Often, the wish of the dying person is to leave his or her loved ones living comfortably, despite his or her obvious absence. However, according to Cook and Rocker, if the dying persons are not in a state to express their wishes due to conditions such as dementia or a coma, it is difficult to understand how they feel regarding their imminent death and its impact on those to be left behind (2509).
One of the emerging ethical concerns regarding death and dying is the actual definition of life. As Sudore and Fried assert, in the United States and most developed countries, end of life care is available for terminally ill individuals (258). The aim of the end of life care is to ensure that the dying person encounters the least discomfort during the dying process. This process may involve placing the dying person on life support to slow the death process, even if he or she is terminally ill. According to Lichtenthal, experts and the public alike are often divided regarding what constitutes death (312). In the past, death was understood to refer to a state when the heart stopped functioning or when a person ceased from breathing (Randhawa 89). However, this definition would not be conclusive today because technology has emerged that can perform these bodily functions, including artificial breathing. The scientific invention has produced a type of patient who has a nonfunctioning brain but with a functional heart and lungs. With the advanced technology, a dying person can be kept in a vegetative state for as long his or her family wishes or is capable of sustaining the financial cost of doing so.
Defining death is important since it enables people to safely regard a person as either dead or still alive. The Uniform Determination of Death Act (UDDA) defines death in two different ways. According to the first definition, death occurs when a person’s circulatory and respiratory organs irretrievably cease to function (Wijdicks 1912). The second definition states that death is the irreparable termination of functions of the brain (Wijdicks 1912). “Brain death” implies that the person’s intelligence has eternally ceased from functioning. Doctors may use various tests to determine if brain death has occurred. The tests include electrical activity, blood flow, and clinical brain function (Wijdicks 1914).
Family members will often approach the issue of life support based on whether or not they believe the dying person (who is in a coma or vegetative state) is still alive. Others will feel saddened that the dying person can no longer see them or even feel their presence and proceed to declare him or her practically dead. For this category of people, it is difficult for them to see the importance of life support for the dying person since they believe he or she is dead anyway. The other category consists of people who are more hopeful to the extent of believing that the dying person may still recover or have his or her life prolonged (Cook and Rocker 2508). For these people, life support machines are a convenient way of postponing the nasty experience that would befall them with the person’s death.
Another key ethical issue regarding death is the quality of life of the dying person. Issues of pain and suffering inform decisions concerning the quality of life. Most people hold the common understanding that life is sacred and that it should be preserved for as long as it takes. However, pain and suffering are seen as inhibiting the dying person’s ability to lead a quality life even in his or her final days. End of life care is particularly concerned with the need to eliminate unnecessarily prolonged and painful death (Sudore and Fried 257). This painful situation may call for the deliberate termination of life. Of course, stakeholders have to deal with an ethical dilemma. On the one hand, they battle with the feeling they are robbing the patient of a chance to live. On the other hand, they feel that letting the patient continue living amounts to exposing him or her to unnecessary pain and suffering. Alternatively, the patient can be placed in palliative care where his or her pain is managed as part of the end of life care.
Different beliefs exist regarding what should be done to the body of the dead person. Since the origin of humankind, different practices have been conducted on the dead. They include burying, cremation, and throwing the body. The treatment of the dead person’s body is an ethical concern. Some people maintain that a dead body is no longer important since the significant part (the soul) has already departed. Therefore, these people do not see the need to pay respect to the dead body. However, another category regards the person, whether deceased or not, as part of God’s work and hence the need to be valued and/or accorded a befitting treatment. Besides, other opinions exist between these two categories. Perhaps, in this case, the most relevant view is that of the dying person. Dying people will often give their wishes regarding what should be done to their bodies once they die. Options range from burying and cremation to donating the body for research. Those left behind are ethically bound to follow the dead person’s wish (Morar, Dumbrava, and Cristian 75).
The use of the dead body for scientific purposes raises ethical concerns because how the dead person’s body is treated is often a projection of respect for his or her life. A major dilemma prevails between the need for medical research on the one hand and the need to preserve the dignity of the dead person (Morar, Dumbrava, and Christian 75). Dissecting the body, such as during autopsies, may be seen as being disrespectful to the dead person. However, this concern may be alleviated where the dying people expressly authorizes (while alive) their bodies to be used for scientific research once they die. Despite this express authorization, it is important to note that some family members may still be opposed to the idea. The prevalent cultural values call for the dead to be buried properly or cremated. The issue of organ donation after death equally raises moral issues among those left behind by the dead person. Nevertheless, it is commonly agreed that using authorized bodies is more ethical compared to relying on unclaimed bodies for scientific research.
Despite the reigning question on when a person can be declared medically dead, there is an eminent concern regarding the quality of life. The quality of life is often viewed against the concept of the quantity of life as two contrasting variables in the life of the dying person. Hence, a prolonged life may mean that the person leads a low-quality life that is not worth living in the first place. A proper example of this scenario is where the patient is in a prolonged coma and with no hope of recovery. People who advocate for quality life will often favor the dying person to be subjected to a quicker death to alleviate suffering. In sharp contrast, some people believe that life is sacred and must not be terminated prematurely. This belief could be informed by religious underpinnings. For these people, the quantity of life supersedes quality. However, the ethical question arises concerning whether it is fair to let the dying person continue suffering in pain, yet he or she will almost definitely not make a meaningful recovery.
Findings on Ethical Issues on Death and Dying with Reference to Different Cultures
While the subject of moral principles seeks to separate the correct and permissible deeds from any prohibited actions, it is remarkable that many ethical matters do not put forward allowable or mistaken outcomes. This observation is not different when it comes to issues of death and dying. For instance, the US has witnessed an everlasting debate on whether discontinuing feeding for people who cannot feed themselves and yet cannot communicate their wishes constitutes an ethical decision (Meier and Ong 888). In some cultures, this decision is easily made. As such, it does not constitute a dilemma. For example, in the religion of Jainism (practiced in India), suicide by fasting is appreciated and seen as a way of ending the dying person’s suffering. Therefore what is considered ethical in one culture will not necessarily be so in another because many factors are often in play when determining ethical issues regarding death and dying (Cook and Rocker 2510). The most relevant factor is the imminent pain of loss that faces those who are to be left behind. Religion teaches courage in the face of challenges, especially regarding death, which brings about an irreversible change in the lives of those affected.
Different religions are divided on the concept of death. Monotheistic religions, of which Christianity is the most widely practiced, hold that death opens the door to eternal life with the maker. Life on earth is diminished in the face of what is to come: eternal life.
With reference to Christ overcoming death to rein in eternity, Christians believe that death is only temporary and that it will be overcome by eternal life. This way, death may be seen as God’s wish (Lichtenthal 317). Therefore, while Christians view life as sacred (for instance, suicide is viewed as a sin), they do not believe that it should be preserved at every cost. In Roman Catholic, extraordinary measures meant to prolong life at the expense of the patient are discouraged.
Given the opinions from different cultures regarding death, especially with respect to termination of life, it would appear wise to consider the view of the dying person where practical because the issues affect the dignity, religious beliefs, and the quality of life of the dying person. For this reason, the dying person would be best placed to decide if he or she should continue being kept on life support. However, the practicality of this argument is questionable since most people on life support can barely breathe, leave alone, making a ‘life and death’ decision. Importantly, death does not affect the dying person alone. However, it has lasting effects on those left behind. The best approach would be the involvement of both the dying person and those being left behind in making a meaningful and conclusive decision regarding the dying person’s life. This goal could be achieved by making decisions early into the dying person’s illness while his or her brain function is still in good condition. For instance, the dying person may express his or her view regarding the issue of being kept on life support for a prolonged period. This decision can then be invoked when the right time comes.
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Traditionally, the concept of ethics is limited to what is right or wrong. However, ethical considerations become relevant when it comes to death and dying in the context of different cultures. Important questions such as the definition of life, the quality of life, and/or how to treat the dead person’s body often raise ethical issues. Culture and religion, as well as the personal views of the dying person, play a key role in informing ethical decisions regarding death.
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