End-of-Life Choice, Palliative Care and Counseling

Posts Taggedend-of-life choice

Hard Decisions in the I.C.U.

by Paula Span
The New York Times
October 24, 2012

Your relative has spent five days in a hospital intensive care unit, unable to breathe without a ventilator and incapable of making her own medical decisions. Because she appointed you her health care proxy, or simply because you’re her closest relative, the choices about treatments — trying them or stopping them — fall to you.

It’s not a hypothetical situation: One-fourth of elderly people die in an I.C.U. A patient in intensive care on a ventilator probably requires a feeding tube, a catheter, various IV lines. Perhaps her doctors are suggesting dialysis or recommending surgery. There are many choices to be made.

To act as her surrogate is a daunting proposition. “It’s incredibly intense to not only be confronted with loved ones at death’s door, but to have to make treatment decisions you hope are in their best interests — and sometimes you’re not sure,” said Douglas White, a bioethicist at the University of Pittsburgh Medical Center who has studied end-of-life decision-making for years.

Discussions about the end of life, when they happen at all, often focus on what would happen if someone becomes irreversibly comatose or faces a terminal disease. But the victim of a severe stroke, for instance, may remain extremely impaired, physically and mentally, and institutionalized for the rest of her life — yet still be semiconscious.

“Is this a state in which a person would want to be kept alive?” Dr. White said. “It’s a tough question to answer.” More

The Facts on End-of-Life Care Programs

by Terri Schmidt
Milwaukee Journal Sentinel
October 23, 2012

In 2001, my frail 94-year-old grandmother – a lifelong Wisconsinite – died in a way consistent with her wishes. But it wasn’t easy. It required relentless advocacy by her daughter, who signed “Do Not Resuscitate” paperwork three separate times in one week after my grandmother fell and was taken to the hospital with a serious brain injury.

My grandmother’s loving Brookfield foster home wanted her back with hospice care. Her daughter needed to sign paperwork to confirm her desire to avoid hospitalization and die at home – first at the hospital, then just for the ambulance ride home and again for the hospice admission.

All of this could have been avoided if a system had been in place that made it possible for health professionals to follow a seriously ill patient’s wishes when transferred from one facility to another. With a system in place, patients with advanced illness might have thoughtful conversations with doctors and family about treatments they do or do not want, complete advance directives and appoint trusted loved ones as their health care decision-makers when they cannot speak for themselves. More

What Can We Learn From Eleanor Roosevelt’s Death?

by Barron H. Lerner
Huffington Post
October 23, 2012

Fifty years ago this November, when Eleanor Roosevelt’s doctor told her that her very debilitating disease was tuberculosis, and potentially curable, he expected her to be thrilled. But she instead uttered “I want to die” three times.

As the Affordable Health Care Act goes into effect, much attention is being paid to end-of-life care, and with good reason. Expenditures during patients’ last year of life are enormous — totaling roughly 25 percent of all Medicare costs – and often not very effective. Yet patients, health care providers and even insurers have a hard time saying no to such interventions.

Mrs. Roosevelt’s case vividly demonstrates how crucial it is for physicians to have frank end-of-life discussions about goals of care with patients and families — something that is still too often avoided. By challenging her physicians on this topic, she was, as usual, ahead of her time. More

When Prolonging Death Seems Worse Than Death

NPR
October 9, 2012

Many of us think of death as the worst possible outcome for a terminally ill patient, but Judith Schwarz disagrees.

Schwarz, a patient supporter at the nonprofit Compassion & Choices, says prolonging death can be a far worse fate. For many patients, good palliative or hospice care can alleviate suffering, yet “a small but significant proportion of dying patients suffer intolerably,” Schwarz says.

Based in the New York area, Compassion & Choices is an organization that helps terminally ill patients and their families make informed and thoughtful end-of-life decisions to hasten a patient’s death. These decisions are not made impulsively, Schwarz tells Fresh Air‘s Terry Gross. “Nobody makes this choice unless the burdens of living have so consistently, day after day, outweighed all benefit.” More

Sane Discussion on Right to Die, Freedom Needed Now

by Bob Ingle
The Daily Journal
October 8, 2012

Mention “assisted suicide” and images of Dr. Jack Kevorkian come to mind; he’s the pathologist said to have helped at least 130 people commit suicide in the 1990s, saying “death is not a crime,” although he served eight years in prison for second-degree murder. Credit him with starting a national conversation about end-of-life issues and patient rights that continues.

It has to come to New Jersey in a direct way. Assemblyman John Burzichelli, D-3, has introduced the New Jersey Death with Dignity Act (A-3328) that would grant physicians the right to prescribe lethal doses of drugs to willing patients with less than six months to live.

The Garden State would not be the first. In Oregon and Washington, it is legal for doctors to help the terminally ill in deciding when to die. Montana allows it through a court order. The issue will be decided by voters next month in Massachusetts. California, Maine and Michigan rejected similar laws.

Offshore, Switzerland allows assisted suicide, Belgium permits “euthanasia” and in the Netherlands physician-assisted suicide has been legal since 2002. A medical journal study of the Netherlands practice indicated little has changed in the decade since the Dutch law was enacted. Euthanasia and assisted suicide are roughly as common in the Netherlands as they were before the law went into effect.

One of the concerns people have about such laws is that someone might make a rash decision in a moment of pain or depression. The New Jersey bill would start with a verbal request for a prescription followed in 15 days by another verbal request and one in writing signed by two witnesses. The doctor has to give the patient a chance to rescind the request and a second doctor would have to certify the original doctor’s request and certify the patient is acting voluntarily and is capable of such a decision.

Even with safeguards to assure the patient is capable of making the decision to end life and has ample opportunity to undo it, the discussion is a difficult and emotional one because of long-held deeply-felt convictions about the sanctity of life. For many religions, the taking of one’s life is a sin.

The other side of the argument is a person’s life and body is his and he should be able to make decisions about it without government interference. Who is the government or religious institutions to tell us we have to continue to suffer when the end is inevitable? We take freedom very seriously in this country.

It is expected that some of the strongest opposition would come from organized religion. That is its right. We have a proud tradition of separation of church and state in this country, and our First Amendment right of freedom of religion also means freedom from religion for those who want it. More