Rutland joins national end-of-life discussion
By GORDON DRITSCHILO Herald Staff
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Published: April 21, 2005
A terminal patient under the care of Dr. William Lamers once turned to him and said "I'm going to lick this."
Twenty minutes later, the patient was dead.
While some patients with terminal conditions fight for their lives to the very end, others reach a point where they prefer what some might call an honorable surrender. In the wake of the Terri Schiavo case, people around the country are talking about the legal and moral issues that come to the fore at the end of a person's life.
About 30 people at the Rutland Regional Medical Center joined that national discussion Wednesday by participating in "Ethical Dilemmas at the End of Life," a teleconference put on by the Hospice Foundation of America.
Rutland was one of 125 sites around the country participating in the conference.
Lamers, a doctor in California and Calgary who founded one of the first hospice programs in the U.S. and is HFA's medical consultant, was one of nine experts brought together for the discussion.
"Our job is not to take away help," he said of hospice programs. "Our job is to be there for them."
One of the central topics were advanced care directives, also known as living wills. William Colby, a lawyer and a fellow at the Center for Practical Bioethics in Kansas City, said that a living will is no guarantee that one's wishes will be carried out.
"There are no rules for overriding an advanced directive, but there are all kinds of ways they don't work," Colby said. "There's one copy and it's in a bank vault and the only person who has access is in a coma."
Richard Fife, chairman of the Corporate Ethics Committee for VITAS, a major national hospice provider, said that some living wills are very old and some are very vague.
"We had a case in which a woman had a piece of paper signed by her mother," he said. "She said it said the opposite of what her mother wanted. When you looked at it, you could see how that happened."
The key, Colby said, is communication.
"People are always amazed by the limited reach of the law," he said. "The piece of paper helps, but what you've also got to do is have that talk with the person you're empowering and everyone else in your family."
Lamers said that early communication is also an important goal for providers.
"Somebody has to begin to explain to the family what to anticipate," he said, "not what's going to happen way out there, but what's going to happen next week, next month."
Several members of the panel said the biggest problem is miscommunication and misinformation. They said many people who say they have religious objections to a given procedure or course of action find no conflict with their beliefs once things are clearly explained.
"One of the biggest problems we have is people from outside of a situation who don't know the facts presume to think they can comment," said Charles Corr, a board member of the Hospice Institute of the Florida Suncoast.
Colby said many of the questions around end-of-life issues are new, having only been raised in the past 30 years or so. The questions often have to do with the implications of specific technologies, such as feeding tubes.
"I've got four kids," he said. "I force-feed them sometimes. Is that the same thing I do with my kids, or is it providing an FDA-regulated nutrient with an FDA-regulated pumping device under medical supervision?"
Dr. Kenneth Doka, a professor of gerontology at the College of New Rochelle in New York, said in many cases, physicians push for aggressive treatments when they are not necessarily what is best for a terminal patient because doctors are trained to think in terms of cures.
"We have a technology and sometimes we become convinced we should use this technology," he said. "We never ask the larger question - what are we trying to accomplish? Is our goal to sustain a person until they can eat again or is the goal palliative?"
At present, the panel said, the system manages. Colby said battles such as the one over the fate of Terri Shiavo are the exceptions.
"Every day in Florida, 500 people die, often in institutions where there's been some decisions about medical treatment," he said. "Medical care providers together with a family spokesperson make the best decision they can for that person."
Contact Gordon Dritschilo at gordon.dritschilo@rutlandherald.com.
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