THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, April 21, 1995 TAG: 9504210500
SECTION: LOCAL PAGE: B3 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
DATELINE: NORFOLK LENGTH: Medium: 84 lines
It didn't take long for a conference about living wills to turn to the issue of assisted suicide. It came, in fact, with the very first question.
What is the difference, one man asked during Thursday's seminar on ``The Right to Live, the Right to Die,'' between disconnecting a dying person's ventilator or feeding tube and giving that person an injection to help him or her die?
The difference, answered Dr. Thomas Pellegrino, a medical ethicist and neurologist from Eastern Virginia Medical School, is that one is legal and one is not.
But he swiftly sidestepped a more involved discussion on the morality of assisted suicide, steering the conversation and questions back to the issue that more than 100 people, most in their 60s or older, had come to Sentara Leigh Hospital to hear: How could they ensure that, when their time comes, they can die the death they want?
``This is long overdue,'' said Bernice Van-Aalten, 77, a retired registered nurse from Norfolk. ``You don't need your children, who are acting on their own feelings - usually guilt - keeping you alive forever.''
And yet, Van-Aalten hasn't told her two daughters of her wishes. Nor has she updated the living will she had prepared when she lived in New York.
And that may mean her wishes won't be known, medical ethicists warned Thursday. And that the end of her life won't be choreographed the way she'd want it.
``Many of the folks that end up having to have these kinds of decisions made haven't ever told anybody what they might like, what would be an acceptable quality of life for them,'' Pellegrino said. ``So it's great to say this is (someone's) choice, but if he never told us about it, how are we going to do what's best for him?''
Even writing a living will, or advance medical directive, doesn't provide all the answers, he said.
For instance, advanced medical directives talk about ``terminal conditions.'' But, Pellegrino asked, what does ``terminal'' mean?
``We're all terminal. How close does it have to be before we're terminal within a living will? How do we decide when you're in a terminal phase of a terminal disease?
``This is a judgment call a doctor has to make, and yet there are no good guidelines for doing that.''
The end of life makes for some complex moral issues. For instance, a patient may refuse life-support care but still receive comfort care. And it's ethically appropriate even if that comfort care - such as narcotics for pain, which can suppress breathing - results in death.
The issues become stickier once treatment has begun, noted Dr. John Parker, a cardiologist and co-chair of Sentara Leigh's ethics committee. That's because then it's not only the patient's wishes that must be considered, but the medical staff's as well.
If a dying patient develops pneumonia, for instance, it's up to the patient - or the patient's family - to decide whether antibiotics should be given. But once the patient is started on the antibiotics and someone asks that they be stopped, the decision becomes more complex.
Which is why it's so important to communicate with your physician, family and friends about how you want to die, the doctors said.
It's especially important if someone has to act as your surrogate, making medical decisions on your behalf because you're unable, Parker said.
``If you're a surrogate, you're not making life or death decisions. All you're doing is conveying what the patient would have said if he or she had been able to decide.''
For instance, Parker said, a man may tell his wife, ``Honey, if I'm on a ventilator for more than three days and it doesn't look very good, I want to be taken off.'' And then something happens, he's on the ventilator and it's not looking good, and the wife says, ``I don't want to take him off; I just can't make that life-and-death decision.''
``Your wife does not have the right to do that,'' Parker said. ``Her job is to protect your interest, to say that you didn't want to be on a ventilator for more than three days. . . . The intent is not to put spouses, family members, in the position of making life-and-death decisions.'' ILLUSTRATION: Photo
CHRISTOPHER REDDICK/Staff
Bernice Van-Aalten, 77, of Norfolk, attended ``The Right to Live,
the Right to Die'' seminar Thursday. A registered nurse, Van-Aalten,
77, said she doesn't want her children to keep her alive forever.
But she has not conveyed this wish to her two daughters.
by CNB