Medical ethicist Buyx: "Dealing with our mortality ain't nobody's favorite pastime"
"Humans Typically Avoid Contemplating Their Limitations"
For most, the name Alena Buyx brings up memories of her reign as chair of the German Ethics Council. Few can connect her field of expertise, medical ethics, to their daily lives. However, the questions it raises are crucial for everyone. Buyx has penned a book, "Life and Death", that dives deep into the topic while asking even more. Because any ethical question society needs to answer, each individual must address too.
ntv.de: What's the most pressing medical ethical question on people's minds today?
Alena Buyx: The two primary questions are: How do I want to live, and how do I want to die? The first falls under the private realm of lifestyle but also under medicine, illness, and health. The second is my bread and butter. 70 percent of people die in healthcare facilities and don't slip peacefully into their graves as they'd prefer. Eleven percent of Germans even die while on a respirator.
Many claim they want control over their own end, yet they shy away from advance directives and healthcare proxies. Why?
We aren't particularly fond of pondering our mortality. This fear carries over to organ donation, too. More than 90 percent say organ donation is fantastic and wish to donate, but not everyone has filled out a donor card. Vague fears play a role, with some fearing being just switched off.
Is that the case?
Studies indicate that clinical ethics consultations often lead to patients living longer. Field experience confirms this trend, where treatment continues beyond what's desired.
In what ways can self-knowledge help make good decisions?
Preparation brings peace and clarity for oneself. Knowing what a person wants for their final days makes decision-making on their behalf easier, as it often must be done. Some may wish to fight until the very end, taking every chance to rise again. In that case, a longer period on a respirator is necessary. Another might say: I don't want to be on a respirator anymore, I don't want to go to intensive care, I have cancer. I know it's life-shortening, and I don't want to experience that phase. Such stark contrast indicates different attitudes. When discussed and known in advance, with proper documentation, it eases many things.
Panorama: Five years of Corona in the "ntv Salon" Have we learned anything from the pandemic, Alena Buyx and Christian Drosten? What changes?
We're a bit better at navigating stressful and difficult situations due to the pandemic. This process can even be meaningful, especially if we go through it together. It doesn't always have to be terrible and scary.
It's probably different if you're young and have an accident or are at the end of a long, fulfilled life?
That's a significant difference. We must consider the specific life situation when making decisions.
Assuming I'm middle-aged but in great health, with a history of accidents, I've thought about my preferences. If I were paralyzed or on a respirator indefinitely, I'd still want to live on for my sons. In 30 or 40 years, things might be different. Then I wouldn't want it anymore. The question "How do I want to die?" always includes the question "How do I actually want to live?" What's essential to me, what am I not willing to give up? Or what state do I consider worth living?
Guide: Help, I'm getting old. These seven documents regulate legal precautions. What should one definitely regulate and what could one guide by?
Preemptive care planning is essential for anyone who's facing a chronic or life-threatening illness diagnosis. Specially trained professionals provide counseling options to start. It ranges from an emergency card to a patient's decree and the authorization of someone deciding on your behalf. Those less experienced might discuss their preferences with friends or seek advice from older or ill loved ones who've been through the process.
You've mentioned that few people die peacefully at home. How can it also go well in the hospital?
It helps to abandon a demanding stance and acknowledge that healthcare providers are dealing with a system in which fewer people must achieve more professionally. Most hospital staff means well with the people entrusted to them. Studies show, and I've seen it firsthand, that speaking openly about preferences helps. In that case, you might discuss what you'd like and work with the healthcare team to make it possible. Things usually go smoothly in most cases.
Panorama: Midwife and Funeral Director "Being born and dying connects us all". In an increasingly less religiously bound world, these medical-ethical questions are often very strongly religiously justified. What does that say about us that we fall back on something that's no longer that important to us at this point?
Religious value systems function as a cultural reservoir. In everyday life, we rarely interact with them. However, when it becomes existential, many people rediscover strong religious influences. This is why religious arguments remain potent in the debates. Our society was once relatively homogeneous, religious, not too long ago. Of course, that still affects us. And religion has intellectually permeated these questions. I view my book as an invitation to reflect on what principles like self-determination, care, avoiding harm, or justice mean to me? In a world that is very pluralistic in its value convictions, these principles are invaluable. While some convictions may be fed from non-religious sources, new challenges continue to emerge due to medical advancements.
To the offer at amazon.de:
Do new biotechnological possibilities change ethical assessments within society?
They challenge previous ethical assessments and require careful re-evaluation. New developments necessitate open ethical debates before legislation can be determined.
What do you see as the next medical ethical question we need to address?
The next question centers around how we'll handle new technologies in medicine. The AI regulation provides the first major guidelines. I believe this is a good start. These technologies are moving into an area where we are extremely vulnerable, dealing with health, illness, and highly personal decisions. However, we need to use them to manage the demographic change and skilled worker shortage, lest we'll be unable to care for our aging population. They're valuable tools, but only tools. Determining how much and what technology we can delegate, where people must retain control, is crucial.
Solveig Bach spoke with Alena Buyx
Topics: Medicine, Death, Hospital, Organ donation, Health, Healthcare system
- Vocational training for healthcare professionals in the field of mental health could be crucial for addressing the fear and ambiguity surrounding end-of-life decisions and organ donation, as many individuals shy away from advance directives and healthcare proxies.
- The integration of health-and-wellness programs focusing on self-knowledge, health, and mental-health management could aid individuals in making informed decisions about their final days, ensuring their preferences are met and easing the decision-making burden on loved ones.
- As we tackle the emerging medical ethical question of how to handle new technologies in medicine, it's important to explore the potential benefits and risks of CBD, a non-psychoactive compound found in cannabis, especially concerning its effects on health and managing medical-conditions such as cancer.
