The goal of medical care is not simply to preserve or prolong life but to restore the patient, as much as possible, to physical and mental health. The best care in the world cannot bring back exuberant physical health any more than it can bring back joie de vivre.
Being suicidal is not the same as being mentally incompetent; sometimes it is a sane and rational choice. The question for ethics is whether or not the person who wants to die is choosing to die due to physical and mental pain and if, should these other conditions be improved, the patient would then choose to go forward and live.
It is not, currently, a choice, in public, to die. An attempt to take one’s own life will be met by aggressive and even punitive measures to prevent the attempt but, if your life is not your own to make choices about, then whose is it? Do we all automatically surrender autonomy simply because we live within a society? Does our society have authority, without our express consent but through some unwritten, undisclosed, ill defined, “social contract”, to make decisions against our will even in the absence of committing a crime against others?
In this instance the physicians could offer only palliative care and could promise that the patient would, at best, improve to around the clock care in a nursing facility for the rest of her life. Given the woman’s life history it is questionable whether she had ever been truly sane but she had been accorded that status through the legal process when she granted durable power of attorney to her sister.
Given that there was no further hope for her mental or physical recovery and that she had, perhaps in anticipation of this event, granted the authority to make decisions for her to her sister it is reasonable to believe that she though she might wind up in a place where her life would end. Ordinarily this decision would be hers but authority in this society has decided that a person is automatically insane if they choose death over life. Suicidal people usually choose to die alone to prevent any attempts to prevent their choice. It is difficult, in this instance, to know whether she would want to die but it is not difficult to know whether she wanted that ultimate question to be left in her hands or in the hands of strangers who are charged with preserving life without regard to the restoration of quality. She made a rational decision to leave that choice in the possession of someone who she knew would act from personal knowledge and love and whose integrity she trusted.
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