Thursday, November 10, 2011

DOCTORS, DOCTRINE & DYING WISHES


How effective are advance directives in ensuring a dying patient’s wishes are heard? Not effective enough, according to Compassion & Choices.
Current cases in Kentucky and California both cast a light on the limits, potential and real, of advance directives, and the challenges inherent in trying to enforce them.
In California, a Physician Order for Life-Sustaining Treatment, or POLST, not only was ignored by a physician, according to a lawsuit, but the hospital’s culture encouraged that it be ignored. 
And in Kentucky, fear of such an order being ignored is driving opposition to the merger of three hospitals into a system beholden to Catholic doctrinal decision-making, especially as relates to reproductive issues and honoring of advance directives.
In an editorial, the Courier-Journal of Louisville wrote: “The issue is whether a public hospital, operated by a public university and charged with care of the indigent population of this region (funded by tens of millions of public dollars) should have legal medical policies restricted by the rules of any religious group.”
A notable presence in both cases is Compassion & Choices, which has a mission of increasing the legal range of end-of-life care and choices. The national organization, formerly the Hemlock Society, is opposing similar church/hospital merger scenarios in the state of Washington. (In Massachusetts, Death With Dignity, not to be confused with Compassion & Choices, is at odds with the Archdiocese of Boston over the possible 2012 ballot measure on legalizing physician-assisted suicide.)
On its blog, Compassion & Choices vowed to “urge all parties to fully review the proposed merger and approve it only if the parties involved will preserve continued access to vital healthcare services, including care at the end of life.”
In California, the family of Emily DeArmond seeks monetary damages and an order forcing policy changes at Kaiser Permanente to ensure respect for patients’ treatment instructions.
DeArmond died at age 18 after a battle with cancer that began when she was four. In her final days, her parents completed a POLST, which California law requires a physician to follow pending review. (See the full complaint and POLST at http://thaddeuspope.com/images/DeArmond_OCSC_11-03-11_complaint_.pdf)
I’m curious to know the ER physician’s reasoning for intubating Emily against the family’s  wishes as stated on the POLST; what can ensure that advance directives follow a patient through the care system; and why the parents rushed her to an ER, given her condition and their wishes. Isn’t that a mixed message from family to doctor?
And, I wonder, if advance directives can be ignored, for doctrinal or other reasons, are they even useful? The Rev. Leith Anderson, president of the National Association of Evangelicals, answers this convincingly and eloquently.
“For the family, that there are processes in place is wonderfully helpful,” Rev. Anderson says in a Oct. 21 segment on PBS’ Religion & Ethics Newsweekly, “because often children and spouses, they’re frightened, they don’t want to make a mistake, they don’t want to give up too soon, they don’t want to hold on too long, and if it’s been discussed, and especially if it’s been documented in writing, that is really a gift to family.”
The full PBS story, and interview with Rev. Anderson, is available here: http://to.pbs.org/sPHF4Y

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