“The Pushy New Vogue for ‘Dying Well’”
October 14, 2007, 2:15 pm
Posted by Joseph A. Komonchak
Today’sWashington Post has an op-ed piece by Charlotte Allen on living wills. The inside-link has the headline I chose for this thread. She recounts her being urged to sign a living will. She makes some good points, I think, and the solution she proposes, urged by a Hastings Center Report, is that instead one “execute a durable power of attorney, a simple document that entrusts decisions about end-of-life care to a relative or friend who shares the signer’s moral beliefs about death and dying.”
Allen didn’t mention that as a condition of receiving federal funds under the Medicare and Medicaid Acts, hospitals and nursing homes are required to present patients with the opportunity to sign an advance directive. (Patient Self Determination Act of 1991). My guess is that the legal requirement to provide patients with this opportunity was listed on one or another of the forms she received.
All hospitals aren’t salivating to pull the plug. There are other reasons to want patients to make advance plans. A hospital’s worst nightmare is to have a fight among family members about what to do with an unconscious patient. Even then, a living will and a durable power of attorney won’t avoid a big fight in some cases. If Terri Schiavo had clearly stated that she wanted her husband to make all health care decisions, I doubt that would have stopped her parents from fighting the decision.
Most secular ethicists as well as religious ethicists think the durable power of attorney route is preferable to the living will route. Allen wouldn’t get much argument there.
All in all, I think this was not a very well-informed piece.
As one who does not enjoy the rights, benefits and priviliges of a traditional marriage, my partner and I executed and have periodically updated a DPA for both healthcare and financial matters years ago. We were assured by our attorney that the DPA-H would more than adequately meet the requirements of a Living Will, even here in litigious California.
Ooh–spoke too fast. she did mention the law (but not by name) in the middle of the op-ed. If I remember correctly, Bush was president when the law was passed.
What bothers me most about this is that this isn’t an argument, it’s a series of insinuation. We move from her experience at the hospital to the insinuation that they’re trying to get her to die followed by a quick denial (but they’re just doing their jobs) followed by more insinuation; we move to Schiavo to the Netherlands to create the impression that we’re swamped by yet one more conspiracy of the culture of death. I think it’s sensationalist. I also think the surest way to bring legalized euthanasia to this country is to undermine legitimate decisions to withdraw treatment.
There are good reasons for hospitals to suggest patients to have advance directives –avoiding family fights about who decides under difficult circumstances. There are good reasons for Catholics to talk with family members /deciders about what they believe would constitute an ordinary or an extraordinary means of medical treatment.
Here is directive no. 55 of the Ethical and rEligious Directives for Catholic Hospitals:
“Catholic health care institutions offering care to persons in danger of death from illness, accident, advanced age, or similar condition should provide them with appropriate opportunities to prepare for death. Persons in danger of death should be provided with whatever information is necessary to help them understand their condition and have the opportunity to discuss their condition with their family members and care providers. They should also be offered the appropriate medical information that would make it possible to address the morally legitimate choices available to them. They should be provided the spiritual support as well as the opportunity to receive the sacraments in order to prepare well for death.”
Holy Moly, Fr. K, tell me what “good points” were you able to pull out of Charlotte Allen’s rant.
As far as I can see, she’s still ticked off about Terry Shiavo’s death, understandably upset over her own diagnosis, and is incoherently equating the opportunity to make a living will with being nudged into Netherlands style euthanasia, and implying that “morphine drip” is code for Death In An IV Bag because a disembodied voice on the phone told her so.
Somebody running around half-cocked like that simply spreads misinformation that will dissuade families and doctors from providing adequate medication to the dying.
In her bok, “A Field Guide to Good Decisions,: John Gibson relates the problems hospitals face -she was the ethicist called in to handle the dispute beteen a family wishing to ‘pull the plug” and a reluctant physician. It took some time and strain to resolve the issue.
Seniors here are urged to make advance decsions.
For myself, i wonder what’ happened to the morality of “dying with dignity?”
“Dying well” sounds like a difficult semantic.
I suppose I liked it because I remember my time in the hospital after surgery for colon cancer–that element of confronting a rather pointed (metaphor deliberately chosen) Memento mori. On the larger issues (Schiavo et al.), I confess I’m more torn than many who have entered that debate–just another one of those practical conflicts on which I am always amazed that people–on both sides– can be so confident, even so dogmatic. Aquinas said that the more concrete a moral question is, the less certain we can be about it, and that’s where I find myself, uncertain.
Joe, I think Aquinas was right. But you have to make decisions, and a hospital and a society have to have procedures that outline them. And I think American law has, overall, a very sensible way of dealing with all of this uncertainty
1. A competent person cannot be given medical treatment without his or her consent–it’s unconsented touching or battery. So a competent person can refuse all medical treatment, even life-saving medical treatment.
2. You’re no doubt familiar with the distinction in the manuals between ordinary and extraordinary medical treatment-what’s ordinary for one person might be extraordinary for another. We need to give competent individuals the right to say what should happen to them–not presuming their refusal of treatment is suicidal.
If they’re mentally ill and suicidal, by definition they’re not competent–if they’re not mentally ill and suicidal, then we need to ask what means we can impose on people to stop them from making morally incorrect decisions–you’re talking about strapping a person down and forcing treatment. that requires separate justification apart from the moral wrong of the patient’s suicidal act.
3. How do we deal with incompetent patients?
First order of dealing–the durable powers of attorney and living wills for which Charlotte Allen has so much scorn. Living wills aren’t perfect–but remember that they came into vogue with the public repulsion of being kept alive artificially (on a ventilator, then ANH indefinitely) Second order of dealing–a default list of decision makers; spouses, children parents, etc. with a judicial appeal procedure.
3. How do we deal with artificial nutrition and hydration? Different states do it differently–Florida, Schiavo’s state, had a higher burden of proof for withdrawal here. This seems to me to be a sensible resolution in a pluralistic society.
On Schiavo–well, if you want an overview, read the report of the last guardian ad litem. It’s not too long, and it’s an interesting overview of the case by someone who is sympathetic to both sides.
news.findlaw.com/hdocs/docs/schiavo/1203galrpt.pdf
I take it Charlotte Allen hasn’t been in a hospital in a long time. I was given advance directive information as a maternity patient more than 15 years ago. The nurse was embarassed but I told her I knew all about the law that made it a requirement. It’s an ineffective law for a myriad of reasons, but it’s not new and I really doubt if anyone was pushing Ms. Allen. If so, she might want to consider the benefits of being attended by someone with so much extra time that they had the leisure to actually debate the issue with her.
Re: the Schiavo guardian ad litem report. It’s very affecting. If you have an interest in this issue you also might want to read the current New Yorker article regarding physicians who are trying to improve diagnostic criteria for various “twilight” states — not really for extreme cases such as Schiavo’s, but in order to find those who can benefit from additional rehabilitation and justify the cost of it to payers (including state Medicaid programs). Among other tidbits, it noted that cases in which the patient is deprived of oxygen are the least likely to be amenable to therapy, and those that result from other types of head injury or trauma are much more likely to show gains from rehabilitation. Just a really interesting article.
Barbara,
Just a thought here. My cousin’s older son had relatively simple emergency surgery about 25 years ago. During the procedure, a kink developed in the oxygen tube. As a result, he became paralyzed from the chest down.
Family got a large settlement from the parties involved. The son received physical therapy several times a week at home for over 20 years until he suffocated to death (apparently, he had turned over in his sleep during the night, and his mother found her dead son when she went to his room for a regular check during the night).
While the New Yorker article (haven’t read) has noted that oxygen-deprived patients are least likely to be amenable to therapy, did it suggest such therapy be withdrawn from such patients?
Thanks.
The article was aimed at explaining how difficult it was to make a diagnosis of miminimal consciousness versus PVS. What it noted was that rehabilitation is almost non-existent for patients with either condition, and the effort is to try to figure out who might get better with further treatments, and what those treatments might consist of. It wasn’t endorsing ending treatment for anybody. It talked in passing about how patients who have been diagnosed as minimally conscious or PVS patients as a result of O2 deprivation tend not to have the rebound effects that they’ve been able to bring about with patients whose state is the result of a different kind of injury. I’m not a doctor, but I suspect the reason for that is O2 deprivation injures the entire brain and results in widescale tissue death, which makes regeneration of function less likely. If only one part of the brain is injured, however, there is a greater possiblity that another part will take over. What a sad story.