Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, November 26, 1995                   TAG: 9511250019
SECTION: EDITORIAL                    PAGE: F-2   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

TREATING DYING

It is frustrating and frightening to read that in a two-year test, even patients assigned a nurse-advocate to encourage clear communication with family and physician ended their days hopelessly hooked to artificial respirators in the cold, clinical surroundings of hospital intensive-care units. Before they are critically ill, most people express a horror of dying this way.

Doctors, of course, are in the business of healing, not ushering people gently to premature death. And patients, of course, want their doctors to be able and diligent enough to save their lives when possible. There is a difference, though, between saving a life, and extending it artificially to no other purpose than continued dependence on artificial supports.

Yet, even among doctors who readily agree, making life-and-death decisions is more difficult than discussing abstract ethics, especially in high-pressure situations where outcomes are not entirely predictable. No rule book ever will cover every contingency, take into account every variable, apply in every case to every individual.

The sound judgment and caring but clear-eyed assessment of a competent professional are critical not just in saving lives, but in dealing compassionately with the dying.

Rather than mistaking themselves for God, as doctors are sometimes accused of doing, perhaps the greater problem is that their acute awareness that they are not God makes them unwilling to allow death when they have within their power the ability to extend a life, even one filled with pain and without hope of recovery.

Yet patients and, more often, their families must rely on the knowledge, experience and good judgment of doctors to guide them when they face decisions about whether to pursue aggressive treatment, or permit a peaceful, painless death. Doctors working in such situations often are lost in a labyrinth of legal considerations and hospital policies.

The American Medical Association's decision to assign a task force to study appropriate care and identify futile treatments in cases when death is likely is welcome - and overdue. Its findings cannot be expected to resolve difficult questions of life and death, but they should help doctors and patients use more effectively the tools they have - from advance directives to hospices - to allow more of us to die with dignity.