Another Tragedy -- Janet Rivera
Vice President for Aging and End of Life
Center for Practical Bioethics
August 1, 2008
No one knows what Janet Rivera would want. The 46 year old California woman, who suffered a heart attack two years ago, has become the latest pawn in this country’s debate involving those who claim to speak for those in interminable situations. This tragic case causes gut-wrenching feelings in just about all of us.
In health ethics when we do not know, or cannot determine what a patient would have wanted, we surrender trying to make a judgment on what is known as the principle of “substituted judgment” and proceed to the next (less desirable) level of “best interest”.
That’s where we are with Janet Rivera, and the problems abound once the speculation begins about how she might be suffering, or what it would be like for her to die when a decision to withhold or withdraw treatment is broached.
It is good ethics to thoroughly explore the facts about the burdens and benefits of her health status (prognosis), and the emotional social and financial costs of her care. The science of medicine is not 100% accurate, but it’s the best we've got; and yes, financial burdens are real, for her family and the state of California.
The reality of today’s healthcare forces us to recognize that we manage the dying process much in the same way we manage chronic disease; sometimes masterfully, sometimes competently, and often ineptly.
The best we can hope for is that good people keep Janet’s best interest at heart. That means keeping this story off the front page. Instead those most involved in Janet's care must be kept at the core of the tough decisions that have to be made on the remainder of her journey.
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Rivera cousin granted temporary conservatorship, Fresno Bee, July 29
A question of life support, McClatchy Newspapers, July 28