FRIDAY JUNE 11, 2010
(This special edition of Healthcare Matters was co-authored by Betsy Ryan and Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey.) Modern medicine is amazing. We live in an age where life-saving organs can be transplanted, where intricate surgeries can be performed through an incision the size of a pinprick, where an implanted manmade device can do the body’s work. In short, we live in an age where medical marvels can and do occur.
But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our healthcare system?
That’s a dilemma that is playing out in a New Jersey appellate court, where judges are being asked to determine whether physicians should be compelled to artificially sustain a dying person’s life. The legal drama stems from a case at Trinitas Regional Medical Center in Elizabeth where a team of physicians spent more than a year treating an unresponsive patient who was in a permanent vegetative state with multiple organ failure. The patient could not breathe on his own, eat on his own or respond to outside stimuli. He was being kept alive purely through science. Five different physicians agreed that there was no hope for his condition to improve and that the requested treatment – kidney dialysis – would not change that outcome. But the patient had not stated his end-of-life preferences ahead of time, and his family ordered the life-sustaining treatments to continue indefinitely.
It’s a gut-wrenching case, and our hearts go out to the family in this case and all families that endure the difficult process of a loved one’s death. The unsettling questions this case raises will only continue as our population ages and medical science advances. That’s why our organizations – the Catholic HealthCare Partnership of New Jersey and the New Jersey Hospital Association – have joined this case. Representing a faith-based organization and a secular healthcare association, we respect both the sanctity of life and the healthcare mission of healing and caring. The question our society must confront is: Should healthcare professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?
New Jersey has a distinguished history in such legal debates. The landmark case involving Karen Quinlan, for example, set a precedent for the right of patients and their family members to stop life-sustaining treatments. That case involved a patient’s right to receive or refuse treatment within the medical standard of care. What sets this current case apart from prior situations is the fact that it is asking the legal system to compel doctors, nurses and hospitals to act in ways that go against the medical standard of care and continue treatment where it can do no good. It is uncharted territory and, quite frankly, it makes us uneasy.
Our organizations have been very involved with our state’s physicians and hospitals to address these very difficult issues in end-of-life care. Our goal 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. In striving for the proper balance, we must ask ourselves some key questions: How much care is the right amount of care? When do healthcare interventions – in the form of machinery and technology – become inhumane rather than heroic? What, in fact, is a death with dignity?
These questions are deeply personal, and that’s why we will continue to urge all individuals to state their end-of-life wishes through an advance directive or a healthcare proxy. But these very personal decisions are now becoming a societal issue as well – one that will confront physicians and families again and again in the years to come. New Jersey once again is in a position to be a leader in setting legal precedent that clearly and compassionately establishes a process that respects the dignity of dying patients. It is a process that must include the input of patients and their loved ones. We urge the Court to accept this opportunity to set forth reasonable, responsible and compassionate procedures to be followed by physicians and hospitals when artificial healthcare interventions overrun the natural capacity of the human body and spirit.