Some Ethical Concerns About End of Life: A Paradigm Shift From Ars Moriendi to Medicalized Death
Authors: AVCİ Ercan 
Published: April 2023

Medicine has several goals, including preventing and curing diseases, relieving pain and suffering, and promoting and maintaining the mental and physical health of the person from birth to death. Thanks to medical and technological developments in the last century, medicine has started to provide the opportunity to live longer. However, whether a longer life leads to a better life is debatable. Before these developments, death was regarded as a natural and inevitable end and mostly handled with religious approaches, such as Ars moriendi. However, these medical and technological advances have caused a misleading perception that medicine has the power to achieve every desired outcome. Under the influence and pressure of this misleading situation, people began to demand aggressive treatments, like resuscitation, mechanical ventilation, artificial nutrition and hydration, and chemotherapy. Of course, these medical interventions can be lifesaving for some patients. However, in the case of incurable conditions, such as metastatic cancers, Alzheimer's disease, or advanced organ failure, aggressive treatment methods often fail to produce promising results; on the contrary, they place a variety of burdens on patients, families, and society, as significantly reducing patients' quality of life, causing unrealistic hopes, and exhausting limited health resources. In this context, the article aims to briefly examine the change in people's perception of death and the dying process and to evaluate its de facto and ethical impacts. This study shows that medical and technological breakthroughs have significantly changed people's comprehension, acceptance, and perception of death, which made death no longer a natural end, but a medical failure. In other words, a medical interventions-based death, called medicalized death, has replaced a religion-based death. As a result of this change, the social, spiritual, and emotional aspects of death and the dying process are ignored for the sake of excessive and ineffective medical interventions. This situation brings about a critical shift in where, how, and when to die, and produces various ethical problems regarding the principles of respect for autonomy, non-maleficence, and justice. The present article demonstrates that most people want to die at home and spend their last days with their families. However, due to medical interventions, many die in healthcare facilities while on medical treatments and machines. In this context, this study recommends home-based palliative care services encompassing social, emotional, and spiritual support instead of aggressive medical interventions at end-of-life. Home-based palliative care will enable individuals to spend the last days of their lives at home with their loved ones, receive emotional and spiritual support, and prevent themselves, their families, and society from unnecessary and futile medical expenses. In conclusion, in light of the principles of respect for autonomy, non-maleficence, and justice, in end-of-life issues, medicine should focus on improving patients' quality of life, providing patients with social, emotional, and spiritual support, and ensuring that patients have the opportunity to spend their last days of life with their family members, which can most suitable be achieved through home-based palliative care.