Virtues and dying patient virtues and good deaths /

by 1972- Kabasenche, William Paul

I argue that for most patients a good death involves more than contemporary medicine can or should be expected to provide and that virtues can secure goods not provided by medicine. Currently, medical care at the end of life focuses on addressing pain and suffering, supporting independent functioning and autonomy, providing aggressive care near death when desired, and preserving overall quality of life, among other aims. When bioethicists have discussed a good death, they have argued primarily for the provision of such services and for respect of patients’ autonomy. However, I argue that such circumstances are not sufficient by themselves to ensure a good death and a patient’s use of autonomy will be “guided” by her conception of a good death. In many cases, a good death requires—as a necessary if not sufficient condition—virtues as well. At least four different conceptions of a good death, I argue, exist within American society. These conceptions imply goods that go beyond what proper medical care currently does or should provide. Next, I discuss the challenges that dying patients face in our contemporary medical and social context. What types of challenges—and how one faces them—will be determined partly by one’s conception of a good death, though certain challenges seem more universal. I argue that the challenges associated with the loss of independence and increasing dependence on others and the nature of pain and suffering at the end of life are among our most prominent concerns. After discussing virtues in general and the place of emotions within them, I use this account to show how virtues can enable a person to die well, given a particular patient’s conception of a good death. Embodying virtues such as patience, gratitude, generosity, and practical wisdom can help patients become the kinds of people who can meet some of the challenges of dying. I conclude by giving a fuller depiction of one conception of a good death rooted in the Christian moral tradition. iv