Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, October 10, 1993 TAG: 9310070011
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: CODY LOWE
DATELINE: LENGTH: Long
It's not an original thought, I'll grant you. Millions have expressed the same thing, and for years doctors were willing to help us do that.
Two decades ago, as my father lay in a hospital bed no longer able to recognize me because a virulent melanoma had invaded his brain, the cancer specialists who were caring for him sat down for one of their periodic talks with my mother.
The point had come, they said, when they had exhausted their capacity to treat his illness. From now on, they could only try to make the end more comfortable.
Dad would need medication to fend off dangerous convulsions. He would be eventually be unable to feed himself, but they could feed him intravenously. If he quit breathing, they could attach him to a respirator that would keep his body alive for some indefinite period.
Though they didn't suggest it directly, the doctors' honesty with my mother helped her make the decision to go ahead and take Dad home.
He would be in familiar surroundings, even if he didn't seem to recognize many family members. He would not risk the indignity of being attached to machinery that might have kept his body alive while his brain died.
The doctors would prescribe powerful anti-convulsants, offer advice on how to get him to eat a little, talk about how to avoid bedsores.
So, Mom drove Dad home in his own car and got him into bed, knowing that the doctors' best guess was that he would live only a couple of weeks.
Once home, our family doctor of two decades came by the house every day or so to check on Dad - and Mom.
He gave us more advice - how to help clear Dad's colon when his bowels weren't moving. How to mix his medicine with a little honey and feed him baby spoonfuls at a time.
And he gave us a little warning just one week later when he thought Dad had only a matter of hours to live.
Painful as it is to recall his death, my mother, brother and I have always been comforted knowing that Dad died with dignity, in the arms of his family, in the home he had built and loved.
For that I've always been grateful - in particular, to a now-retired general practitioner named Ted Hairfield who was always more than just a professional consultant to our family. He was a friend who knew us, whom we trusted to give us his honest best - in treatment and advice.
I couldn't help but recall that trust as I listened to the speakers who addressed a Roanoke conference on the ethical problem of "futile" treatments of dying patients.
A few weeks ago, medical professionals, clergy, hospice workers and others packed a Roanoke Memorial Hospital conference room to hear six speakers confront the apparently growing problem of how to decide when to stop medical treatments.
In just a few years, the debate has shifted from the question of whether or not a patient has a right - now established by the courts - to refuse life-sustaining treatment, to whether patients have a right to demand treatments even if they have little or no prospect of being effective.
It is a complicated subject, worthy of serious discussion and debate.
How much are we willing to spend to extend the life of a patient one week? Six months? A year?
How do we decide who gets to use the limited beds in the intensive-care unit? Do you move out the 62-year-old in the last stages of lung disease to make room for the 6-year-old accident victim whose only chance of recovery is through intensive care?
Should doctors and hospitals be compelled to provide cardiopulmonary resuscitation for an 80-year-old woman whose congestive heart disease will never allow her to leave the hospital? Is it ethical to continue to provide dialysis - at significant public expense - to a patient in a persistent vegetative state?
Speaker after speaker described the tough calls, the irrational family members who insist that "everything be done" - even procedures with little or no prospect of curing or prolonging the life of a loved one. They talked about the medical establishment's recent historical fixation on using every means available to thwart death.
What was remarkable was that despite the complexities, most of the difficulties could be solved if doctors and patients simply trusted each other and communicated better.
Of course, it's easy to say a good talk will fix most any problem, but it seems particularly true in this case.
Dr. Christine K. Cassel, the first and perhaps most articulate of the conference speakers, described a real case she had overheard at her own University of Chicago hospital.
The doctors didn't go to the family and say "We've done all we can do, now we're going to make your mother comfortable for the rest of her life." The family was essentially asked, "Do you want your mother to live or die?"
As Cassel pointed out, the latter is a "false choice" guaranteed to instill an unnecessary guilt in the family.
Of course the children want their mother to live, even though they - and probably she - may have a pathological fear of vegetating while attached to mechanical life-prolonging equipment.
The "terrible things" Dr. Jack Kevorkian is doing in Michigan, including helping nonterminal patients commit suicide, have widespread popular support because of those fears of intensive care or abandonment, Cassel said.
Physicians and hospitals have to do a better job of caring for the dying and their families, Cassel said.
Then, "death, when it comes, can be seen again as a natural part of life - not as a medical failure."
There inevitably will be conflicts occasionally between the judgment of physicians and the desires and beliefs of some patients. Those will have to be resolved individually, sometimes with the help of ethics committees and public policy makers.
As Cassel pointed out, however, most of the us only want to be assured - to have faith or trust - that when reasonable treatments have been exhausted, we and our families will be comforted, we will not suffer pain, we won't be abandoned.
We want to be assured that, if at all possible, we can die in our own beds.
Cody Lowe reports on issues of religion and ethics for this newspaper.
***CORRECTION***
Published correction ran on October 10, 1993.
A few lines are missing from Cody Lowe's column, "The Back Pew," in today's preprinted Extra section. The final paragraph before the story continues on another page should read:
A few weeks ago, medical professionals, clergy, hospice workers and others packed a Roanoke Memorial Hospital conference room to hear six speakers confront the apparently growing problem of how to decide when to stop medical treatments.
by CNB