Nightmare on Main Street

Did you get spooked for Halloween? Did anyone play scary tricks on you? If not, then here is something very scary to think about.

Imagine that you or a loved one has a terminal illness. You have appointed a health care proxy and signed a DNR (do not resuscitate form). Just when it seems the end is near, a hospice worker shows up discovers this death was a suicide and calls 911. Even though the Proxy is displaying the DNR and saying these are the patient’s wishes, the ambulance arrives and transports him/her to a hospital for the next 4 days while the proxy battles with the doctors over what to do. What a nightmare! What went wrong?

Well this is what really happened to someone in my area a few months ago. I was horrified when I read the story in my local paper*. In my own family, there have been two deaths recently. One had battled cancer for over a decade; the other died less than a year after his diagnosis. Both had living wills, proxies and DNR orders. One died in a hospice facility which provided great comfort to him as well as to the family members. The other died peacefully at home under the care of a visiting hospice worker. Knowing we were following each of their end of life wishes made us feel more at ease. We had enough time to say our good byes and did not have to see them suffering.

But what if something had backfired, like in the case above? I understand the moral dilemma these health care professionals must face in order to watch a patient die. In order to relieve employees of this burden, the health organizations must create clear guidelines for them to follow in these situations. There must be a clear picture of what their role is and what measures they can and can not use to aid the patient.

Even though there seem to be more and more miracle treatments these days, we need to remember that in the end we are all mortal beings. We need to distinguish between passively allowing someone to die by withholding treatment (per their wishes) and actively killing someone. Euthanasia is a whole different issue. However, that brings us back to the above case where the patient tried to end her illness sooner by overdosing on Valium.

Apparently she had never been counselled about palliative care or been told she could get a POLST (Physician Orders for Life Sustaining Treatment). The latter started in Oregon in 1991 and is now valid in 11 states including NY. This is a standard form with very clear guidelines expressing the patient’s treatment (or non-treatment) plans. Compassion and Choices is an organization that offers counselling on end of life treatment, but not enough people know about them or are referred to them by their doctors**. If more people knew the options that they had to ease their discomfort while they are in the process of dying, maybe there wouldn’t be cases like this where she felt she had to take life into her own hands.

As our average population age goes up and the use of miraculous life-extending treatments and devices increases it is extremely important that we figure out where to draw the line between our individual freedoms and the moral or religious beliefs of others. We need to make it clear that a person’s life belongs to him and as long as he has been informed of his health care choices and has signed the proper forms, the health care providers are clear of any moral or ethical obligation to provide unwanted medical assistance.

I know dying is a difficult issue, but if we don’t talk about it now it could become even more complicated in the future. Do you know there are now people living with artificial hearts? How will we be able to determine if their time has come if they are still powered by a generator? Politicians try to frighten people about Death Squads and being refused live-saving healthcare; but in reality the more frightening thing is when you have a terminal illness and are not allowed to die peacefully according to your wishes.

*Life interrupts an attempt to die at home by Cathleen Crowley   Times Union 9/25/11 .

**If you find this as shocking as I did, I recommend looking up the right to die laws in your state. Go to compassionandchoices.org for more information.

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4 Comments (+add yours?)

  1. stmarco7
    Nov 01, 2011 @ 14:02:47

    Tough issue and you balance well a few facts with the personal side. A good reminder that all adults, regardless of age, should decide how they want their end to be managed. I also like how you touch on the point that these issues are only going to be trickier with continued medical advances.

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  2. themiddlegeneration
    Nov 01, 2011 @ 15:35:54

    This was a hard topic to write about but I really needed to get this one off my chest. Ever since reading that article, I just felt I had to bring this to more people’s attention. If only one person who reads this puts their end of life plans into writing, I will be happy I took the time to post this.

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  3. suzicate
    Nov 03, 2011 @ 12:56:00

    I hadn’t heard about this. Wow, really makes one rethink what they already have in place.

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  4. themiddlegeneration
    Nov 03, 2011 @ 17:58:20

    You think you have it figured out, and something throws a wrench in the process. I am definitely reviewing my living will and making sure my objectives are clear. With luck, it won’t be needed for a long time.

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