Palliative care can offer comfort in futile situations

The death of a child is always painful. It takes immense courage and fortitude for any parent to forgo life support for a child, even in the face of futility.

Dr Chong Poh Heng's comment that letting go is extremely difficult "because so much future is at stake" resonates deeply with most people (Life support: To switch off or not?; June 3).

In the cases of 23-month-old Alfie Evans and 11-month-old Charlie Gard, who both suffered profound and irreversible brain damage, the court allowed the withdrawal of mechanical ventilation against their parents' expressed wishes.

Expert witnesses testified that the two British children would never be capable of recovering meaningful brain function. Continuing mechanical ventilation would not confer clinical improvement but only delay the process of dying, inflict unnecessary suffering, compromise dignity and perpetuate false hope.

The two cases invoked intense public debate, with advocacy groups accusing doctors of practising euthanasia.

Providing, what some would consider, clearly non-beneficial and harmful treatment goes against the person's best interest, and the withdrawal of such treatment does not constitute euthanasia.

The difference lies in intentionality and causality.

Euthanasia is the deliberate termination of life by a physician, where death is the primary goal.

On the other hand, when a physician forgoes what he sees as medically futile treatment, he has the patient's well-being and comfort uppermost in his mind.

He omitstreatment that would otherwise bring more pain and suffering. Death is foreseen, but not contrived, and is allowed to progress naturally from the illness.

Dying patients and their families needn't suffer alone.

An important approach in the transition from curative treatment to supportive care is good palliative care. It is committed to the alleviation of distressing symptoms, preservation of human dignity and the promotion of meaningful conversations to help patients and families weigh the benefit and burden of therapeutic options, elicit their values and preferences, and jointly formulate a care plan that is in the patient's best interest.

Such conversations, if initiated early, allow time for careful reflection, unrushed judgments and rational decisions to be made.

Revised goals of care can keep real hope alive even in seemingly futile situations.

While certain treatments may be futile in curing or prolonging life, compassionate care can and must never be so.

Neo Han Yee (Dr)

James Low (Associate Professor)

Ethics Advisory Committee

Singapore Hospice Council

A version of this article appeared in the print edition of The Straits Times on June 12, 2018, with the headline 'Palliative care can offer comfort in futile situations'. Print Edition | Subscribe