End-of-Life Care Issues Can’t Be Avoided

We in the hospital community were disappointed by the recent ruling of a New Jersey appeals court in which a panel of judges decided not to rule on a case that centered on some very difficult issues regarding end-of-life care for hospitalized patients. It was a 26-page opinion that essentially said “the case is moot.” (As a lawyer I can appreciate why it sometimes takes 26 pages to explain a non-decision.)

Why are we disappointed? The medical community, along with patients and family members, need reasonable, responsible and compassionate procedures for the care of patients in their final days when further medical intervention would provide no relief or benefit. This lawsuit was filed against a hospital by a family member pushing for continued medical interventions for a dying patient. I sympathize with them, having seen similar circumstances in my own experiences. The hospital, however, thought it best to end those medical interventions because they didn’t meet medical protocols and were in essence doing little more than drawing out the patient’s death. These are difficult ethical issues that society must face as our population ages and technological advances can greatly prolong the dying process. In the end, the appeals court ruled that it didn’t have enough information to provide this much-needed guidance and encouraged the Legislature to take up this important issue.

Our goal as healthcare professionals is to provide the highest level of care that is medically necessary and appropriate, care that protects our patients from unnecessary pain and preserves their human dignity. These difficult issues will continue to confront physicians, patients and their loved ones until we honestly and sensitively address the conflict between the marvels of medical science and the natural limits of the human body and spirit.

This case has generated some spirited discussion on Web sites and news blogs. Some people have accused hospitals of wanting to deny care because of the cost to the facility. There is no doubt that medical care is costly. However, that is not what is at the core of this matter. This is a human issue, not a financial one. And the undeniable human reality is that sometimes more care is not better care. Sometimes, more care does not add to an improved quality of life. Sometimes, providing care is medically futile. It is a difficult issue for anyone to confront, and certainly a tough conversation to have with family members and loved ones. I know – I’ve been in the midst of such conversations with doctors, nurses and my own family members. It is never easy to hear, and it is never easy to have to be the one to decide. Difficult as it is, this conversation will have to continue in the public arena. In the meantime, make sure your loved ones know what you want – and what you don’t want – should you find yourself in such a situation. Make an Advanced Directive so your wishes are clear to your loved ones and your medical team.

Written by Betsy Ryan at 16:35

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Steve Kelly said...
Thank you for the thoughtful comments . After the discussion about " death panels " in the recent public forum , I certainly appreciate your comments on this difficult issue. There are no easy answers and everyone faces this issue within their family at some point.
The August 2 issue of the New Yorker has an excellent aricle by Atul Gawande titled " Letting Go " . I would recommend it highly and you can access it by going to the New Yorker website and searching Gawande / Letting Go .
August 23, 2010 08:32
Agreed on the New Yorker article. Here's the link http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=1
BTW, Ryan's frank and sensitive approach is most welcome.
August 24, 2010 12:07
Wonderful article, NJHA. As a senior health care facility in Jersey City, Hamilton Park, http://www.hamiltonpark.com , works with compassionate care for not only the patients, but also, the families. Families and patients are extremely vulnerable when entering a nursing home facility, which is why it is very important to have your final wishes clear and complete prior to any serious downturn in health occurs. Couldn't agree more with your article!
September 29, 2010 01:34