Can We Restore Meaning of Life to Patients Who Have Given Up? Commentary on Hui-Ying Li, Ekan Ikeguchi & Tatsuya Hobara

- Yeruham Frank Leavitt, Ph.D.
Chairman, The Centre for Asian and International Bioethics
Faculty of Health Sciences
Ben Gurion University of the Negev, Beer Sheva, Israel
Fax: + 972-7-6477633
Eubios Journal of Asian and International Bioethics 9 (1999), 76-77.

It would seem that one's last moments might be one's most meaningful ones: reflection on an entire lifetime. Why did I exist? Why does the world exist at all? Is there meaning to life or is it all: "A tale told by an idiot, full of sound and fury signifying nothing" as Lady Macbeth once said? or: "A meaningless moment, and our only purpose is to get free of it" as a Buddhist in Chennai-Madras once told me? Is there a God, or maybe there are many gods. or maybe God and the universe are one and the same? Is there a soul or are we just meat? And what awaits us after death? Total emptiness? Or heaven or hell? Or reincarnation as other people or animals or plants or stones? And did I live my life as I should have? Or maybe I was cruel to people I should have been kind to? Stingy when I should have been generous? And can I ever make amends for what I did to so-and-so thirty-five years ago? But people in their last days don't always have the ability to think of bioethical questions like these. Their pain may be too great. Or they are depressed or senile, or in such great fear over what awaits them that questions of meaning never arise.

Theoretically, I think that the Meaning of Life is the fundamental metaprinciple of clinical bioethics (EJAIB l997; 7:l04-l05), without which the other principles are inapplicable. But theory is a long way from practice. The major challenge is to develop practical ways to restore meaning, or at least a desire to wonder about meaning, to patients who have lost it. I have raised this question in many medical and nursing seminars in Israel but still have not heard really practical answers. Finding answers to this question should be a central goal of nursing ethics in particular. What the authors of the paper which we publish here call "spiritual care" should be a step in this direction. But we need more details about what exactly is meant by spiritual care. How exactly is it performed for Buddhist patients? Shinto? Atheists? Etc.? (And incidentally, the religious beliefs or lack thereof of the doctor or nurse are totally irrelevant to clinical ethics. What are important are the patient's beliefs and what can be done to help this patient.) I would like to ask our authors to devote a future article for EJAIB to the question of what "spiritual care" consists of in detail, and to practical guidelines for its clinical application, not only in hospices but also in internal medicine, oncology, neurosurgery and other wards caring for dying patients. Meanwhile perhaps others in our Eubios family can make some practical suggestions, maybe based on personal experience, for restoring meaning to patients who have lost it.

An attempt at restoring the meaning of life could be a practical alternative to euthanasia. We waste too much time debating the ethics of euthanasia without realizing that a patient's request to be allowed to die might be a problem for which we should be seeking a solution. I am not denying that in some cases some patients should be allowed to die in peace. (Active euthanasia is not being discussed here.) But if the patient's request to be allowed to die is the result of something which has gone wrong, then perhaps that thing which has gone wrong might be corrected. A scientific approach to a problem is to seek the cause of the problem and then to try to attack the cause. If pain is the cause of a request to be allowed to die, then before considering euthanasia the medical staff's first question should be whether or not proper use is being made of analgesics. And if a loss of meaning in life is the cause of the request, then the thing to do first is to ask whether enough effort has been made to restore meaning to this patient's life. This does not mean preaching at the patient or pressuring in any way, but it does mean an openness to consider alternatives before the question of allowing the patient to die is considered.

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