Medical Ethics – by Nanny Ogg

There is a scene in a certain Prattchett book where Nanny Ogg is delivering a baby – she has to decide whether to save the life of the mother or the baby. The Junior witch asks if she should ask the father which to save – Nanny Ogg replies:

What’s he done to deserve that choice

She’s right though. No man deserves to have the responsibility to make that choice. And fortunately the days when obstetricians had to make the decision to save the mother or the baby are long gone.

But we still give people unacceptable responsibility. In the UK the decision when to stop treatment is a medical one. When it gets to the point where the suffering caused by the treatment – eg me trying 14 times to get a new cannula in – would probably outweigh the likely benefit, then it’s time to reconsider the treatment. Of course you ask the opinion of the patient – but they’re usually too ill. So you ask their family what their opinions would be likely to be. You take into account what sort of quality of life they have.

Do we consider the impact this discussion has on the family? I’ve meet lots of people who think that the decision ‘whether or not to resuscitate their relative’ was the hardest decision they ever had to make. Which is a tragedy because it wasn’t their decision at all.

There’s always the nagging doubt that if they had insisted that she should be resuscitated – then she would still be with us. They wouldn’t have understood how horrible a resuscitation attempt would have been, and that it would have inevitably failed.

No one deserves that sort of guilt.