Illinois Right to Life Committee
Connecting the Dots on End of Life Issues
Connecting the Dots on End of Life Issues The series of articles below brings together a number of dangers that must be addressed to protect your family and yourself from premature death: “Living will” becomes a license to kill The “Living Will”: Death Without Dignity Living wills are about death, not life Futile care “ethicists” push involuntary euthanasia Research on "brain dead" and "almost dead" patients declared "ethical" Using hospice care to hasten death declared "ethical" Hastening death with morphine overdoses and other means Culture
Of Death Taking Its Toll On Those Nearing Life's End
The “Living Will”: Death Without Dignity The “Living Will” - a document by which a person can give, in advance, a directive to have life-sustaining medical treatment withheld or discontinued at the time of future serious illness or injury - should be avoided by anyone who respects the sanctity of human life. Why? Because “Living Wills” were conceived and designed by “right-to-die” (pro-euthanasia) organizations and have more to do with dying than living. Signing a “Living Will” allows decisions about a patient's health care to be made by unknown medical personnel when the patient is not able to make these decisions. If these medical personnel believe the patient’s potential for recovery or "quality of life" is too low to warrent life saving measures, they may interpret the “Living Will” to mean whatever they consider appropriate to justify denial of treatments such as a ventilator or feeding tube. Indeed, according to Dr. Brian Clowes, author of The Facts of Life (HLI), there are several problems with “Living Wills,” as follows: 1) The person usually signs it long before he knows if or when he will be incapacitated, or what the circumstances of that incapacitation will be. This means that the person cannot specify the desired details of his treatment for future medical conditions. 2) Changes to or revocation of a “Living Will” depend upon an individual’s condition. If he should experience a change of heart after he is incapable of communicating, he is out of luck. 3) If a person would like to change or revoke his “Living Will,” he may find that it is very difficult to locate all original and duplicated copies of the document. [To revoke your “Living Will”, make sure that you destroy all the original copies, and as many duplicated copies as you can locate with relatives, medical personnel, and medical facilities.] 4) The wording of the original “Living Will” may remain the same, but the law governing its application may change. For example, Florida “Living Wills” now presume that patients refuse food and water unless otherwise specified - a fundamental change from the law’s original meaning (p. 115). The Patient Self-Protection Document (available from IRLC) is an important alternative to the pro-euthanasia “Living Will.” It is a durable power of attorney for health care that: counters the nationwide push to remove food and fluids from dying (and non-dying) patients; opposes euthanasia either by omission or commission; allows the appointment of a trusted agent to carry out one's Judeo-Christian beliefs regarding treatment/non-treatment if one is unable to do so. Is the Patient Self-Protection Document necessary? Yes, and for two reasons: 1) There is an Illinois law entitled the Health Care Surrogate Act (also known as Life Sustaining Decisions Act), which allows for the removal of food and water from a terminal or non-terminal patient by directive of a surrogate designated by law. 2) The 1990 federal law, the Patient Self-Determination Act, requires any medical institution accepting Medicare and Medicaid funding to ask entering patients if they have an advance directive. If the patient's answer is “no”, an option to complete an advance directive is offered, usually a “Living Will” in standardized format. The patient is not obligated to complete an advance directive, but may feel pressured under such circumstances. If the patient accepts the offer, the medical institution will record any advance directive signed by the patient. To obtain printed copies of the Patient Self-Protection Document, or for additional information on the dangers of the “Living Will”, please contact Illinois Right to Life Committee at 312-422-9300 or by email at illinoisrighttolife@ameritech.net.
Living wills are about death, not life We knew the push for living wills based on the Terri Schiavo case would be dangerous to people who took the bait. Recently, some cases are coming to light that confirm our fears about the dangers of living wills. A living will has nothing to do with living, but everything to do with dying. A living will is claimed to be a mechanism for preventing unwanted
medical treatment, so-called heroic medical measures or resuscitation in the event of a
healthcare catastrophe. No one wants to
consider that their perspective might change after they experience a healthcare
catastrophe. The will to live is strong,
regardless of what someone else perceives our quality of life to be. The organization Not Dead Yet understands this
fact. They are fighting to maintain respect
for the rights of disabled people and recognize the threat to these rights from a
“quality of life” mindset that decides to deny medical services based on the futile care
theory. Another case out of Florida should establish the serious risk that
living wills and futile care theory have on disabled
patients. Late in 2004, Hanford Pinette was
admitted through emergency to a hospital in Orlando, Florida after suffering congestive
heart failure. He was placed on a ventilator
and a dialysis machine. Doctors informed his
wife Alice that his condition was “not likely to improve”. Then, they informed her that they intended to
“follow his living will” and remove the provisions of ventilation and dialysis. Mrs. Pinette objected because
‘Hank’ was alert and oriented, there was no prognosis tendered that could
determine his death was eminent, he spoke (sporadically, but he managed), and he responded
physically to her directions and touch. He
was fighting for his life. By her accounts,
he simply wasn’t ready to die. The hospital actually petitioned the circuit
courts for the authority to remove Hanford Pinette’s provisions of ventilation and
dialysis, over the objections of his named surrogate (his wife Alice) and as a means of
“enforcing his living will”. They
won, and those medically necessary treatments were taken away from him. After two hours of struggling for air, Hanford
Pinette – a nondying, cognizant and alert man - succumbed and was pronounced dead. The hospital’s deadly application of his
living will overcame even Hank’s stated intention to have his own wife make his
medical decisions. Supporters of the living will claim that modern technology has allowed the artificial extension of life in violation of human dignity. Is the artificial extension of life through modern technology really the issue? Then why is it that the issue is almost always feeding tubes and ventilators? Why are organ transplants and cancer treatments never the focus of these debates? Judgments are made about when it is appropriate to use modern technology such as organ transplants, apparently with very limited controversy. Removal of feeding tubes and ventilators is the agenda of the “right to die” movement. Their claims of oppressive technology do not stand up to scrutiny. Action Points: Medical institutions are required by Federal law to ask patients if they have completed an advance directive. "Advance directive" is a generic term that covers both Living Wills and Durable Power of Attorney for Health Care documents. If you sign a Living Will, or a poorly-worded Durable Power of Attorney for Health Care that states you do not want “life-sustaining treatment”, you may be signing your death warrant.If you have not signed a Living Will, don't! If you have signed a Living Will, Illinois Right to Life Committee IIRLC) urges you revoke it by locating the copies and destroying them. [The same advice applies to a poorly-worded Durable Power of Attorney for Health Care.] As an advance directive, IRLC urges you to sign only a life-affirming version of the Durable Power of Attorney for Health Care. The IRLC Patient Self-Protection Document provides such a life-affirming Durable Power of Attorney for Health Care. Obtain it by calling Illinois Right to Life at 312-422-9300. Protect yourself now from those who see death as the solution for difficult health care decisions.
Futile care “ethicists” push involuntary euthanasia You are preparing to take or have already enacted a life-affirming advance directive such as Illinois Right to Life Committee's Patient Self-Protection Document. Now you are fully protected, right? Unfortunately, in some cases even this step may not be sufficient to protect your life in all cases. The following circumstances occurred in Texas, but some hospitals around the nation are forming ethics committees. These committees are making decisions about denial of patient care that in some cases override a patient's advance directive, with or even without support of a state law. The only way to reduce the chances of encountering these circumstances is to verify that you are working with Pro-Life doctors and medical facilities. What a change a few days can make! No, I am not talking about the weather. I am referring to the case of Andrea Clark,
a patient at St. Luke's Episcopal Hospital in Houston, Texas. On April 19, 2006 the hospital ethics committee
there decided that Andrea’s life was futile so she should be removed from a
respirator, and all medical treatments should be stopped. Even though Andrea is mentally alert, communicates by moving her lips and blinking her eyes, wants to live, and has the full support of her family, the hospital ethics committee decided further care was futile. Andrea, 54, developed bleeding on her brain after open-heart surgery and needs the respirator to breath. Although she suffered damage to her motor functions, her mental capacity was not affected. On May 2nd Andrea received a new doctor who is
not planning to give up on her medical care and treatment, reported her sister Melanie
Childers. “Not only is my sister not
going to be put to death by St. Luke's Episcopal Hospital, but it also looks like she is
recovering from her heart surgery, finally,” Melanie said. She also mentioned that Dr. Matthew Lentz has told
the family that Andrea will be able to get off of blood pressure raising drugs she has
been on for months, and he is cutting in half the amount of pain medications she is on.
That will allow Andrea to better interact with her family. Jerri Ward, the attorney for Andrea's family,
stated, “St. Luke's is doing the right thing in this case now. The physician team met with the new attending
[physician] and it went well. The team is on
board and the medical futility procedure has been stopped.” This change in direction was certainly vital for
Andrea! It is most fortunate that her family
was fighting for her right to life and found a physician who was willing to make another
assessment of her case. But why should patients’ lives be threatened by a medical facility that is supposed to provide them a means for recovery? Unfortunately, a Texas law gives hospitals the power to decide if a patient’s life is “worth” maintaining so officials at St. Luke’s Hospital are legally able to remove Andrea’s respirator against the expressed wishes of herself and her family. If the hospital ethics committee decides to withdraw care, the family has just 10 days to find another treatment center. How many patients have already died through lack of support from family members or no opportunity to get the opinion of another physician? Bob Kafka, a disability rights activist with Not Dead Yet, observed “I have come to the conclusion that the essence of any futility law embraces involuntary euthanasia. The ability of a doctor to overrule both the patient and their surrogate in withdrawing life-sustaining treatment is in violation of the principle of patient autonomy.” Kafka says the Texas law can't be improved but should be thrown out entirely. How far are the peddlers of death, labeling themselves the “right to die” movement, willing to go? Here is some evidence that the so-called right to die will really be deemed a duty to die. This intent was made visible in a 1997 article by philosopher John Hardwig that appeared in the Hastings Center Report, a prestigious bioethics journal. Hardwig argued that there is not only a right, but also a duty to die, including this scary statement: “A duty to die becomes greater as you grow older. As we age, we will be giving up less by giving up our lives . . . To have reached the age of say, seventy-five or eighty years without being ready to die is itself a moral failing, the sign of a life out of touch with life's basic realities.” Here we go again -- more bait and switch, with semantics that promise one thing and deliver something else. [Ed. note: Unfortunately, Andrea contracted a sepsis infection that caused her death on May 7, 2006. At least she was given a chance to live rather than prematurely euthanized. The ethics committee that Andrea's family had to overcome was empowered by a Texas state law, but ethics committees are being formed at many hospitals, and then taking similar actions to deny "futile care" even without any state laws to give them cover.]
Research on "brain dead" and "almost dead" patients declared "ethical" Life is precious, and it is certainly fragile for those who are burdened with serious diseases or injuries. In today's health care arena the certainty of care seems to evaporate when the patient's "quality of life" is deemed too low. This can lead to a battle with the hospital ethics committee on whether patient care should be continued [see the previous article in this series]. Ultimately, for some patients, recovery will not be possible even with the best efforts of relatives to protect the patient's right to care and the best efforts of the medical staff to provide that care. The right answers on reducing or ending treatment are often difficult and are rarely made with complete confidence. When hope of recovery is gone, new threats to a natural end to this earthly life now present themselves. If the patient is declared "brain dead", is he/she really dead? Should the patient's organs be donated? If the organs are not usable, should the patient be allowed to have medical research conducted either after declaration of "brain death", or even while unconscious but not yet declared "brain dead"? Relatives are getting asked to make such decisions. Be especially concerned if your relative is diagnosed as “brain dead”. “Brain death” is not a definitive means to establish that a person is dead. For this reason, IRLC has already been recommending not to choose organ donation because it could lead to your premature death. IRLC has presented informed concerns from medical doctors about the tentative nature of this diagnosis. For example, see Ethical Dilemmas Defining Death and "Brain Death" is Not Death!. For patients who are declared "brain dead", medical personnel might push for approval of organ donations. If the patient’s organs are not considered usable, you may now encounter requests to allow medical research on your dying relative. Some medical researchers have decided that it is ethical to perform research on “brain dead” patients. A very outrageous article on this new abuse of disabled patients appeared in the January 3, 2006 Chicago Sun-Times. Researchers can use these brain dead patients to try new drugs for effectiveness in stabilizing irregular heartbeats, test new alternatives to respirators, etc. Of course, as soon as this new utilitarian perspective is put into action, further abuses immediately begin to occur. The Sun-Times article discussed one patient at M.D. Anderson Cancer Center in Texas who was alive but unconscious, and so sick with complications of cancer that his family was about to take him off life support. [Translated, that means they were going to allow removal of his respirator so he would die even though he was not declared “brain dead”.] Instead, they were convinced to leave him on the respirator so medical research could be performed using his body before he died. According to the Sun-Times article, M.D. Anderson researcher Dr. Wadih Arap said that in research projects, the soon-to-be-dead can ethically be treated the same way as the recently dead. Arap used this unconscious patient in a study on targeting drugs to specific sites in the body. Arap injected genetically modified viruses that had identification tags and moved through the body like drugs. Family members allowed this research after receiving assurances the patient would feel no pain. Would you trust such assurances? You should not, given that these assurances may be as inaccurate as the claims made that no pain is felt during starvation and dehydration after feeding tube removal, or that unborn babies feel no pain during abortions. Pain or no pain, however, allowing medical research on unconscious patients continues expanding the use of morally unacceptable "quality of life" criteria in making decisions that can deny care to patients and ultimately justify euthanasia. Don't allow the dignity of your dying relative to be violated by agreeing to medical research that may cause pain on even hasten the death of your still living relative. Apparently, hospital ethics committees will allow the continued use of the respirator for patients on whom research will be performed, but have no problem removing the respirator from non-research patients deemed to have a low "quality of life", even when relatives consider that step premature. Early in 2006 I was informed that a doctor at a hospital in California, contrary to the expressed request of family members, removed a respirator from a heart attach victim, who then died. The doctor took this action when no family members were present, even though they indicated that they would be back shortly. The Chicago connection to this tragedy is the victim’s son, who lives in Chicago. He happened to mention his family distress to a Chicago policeman he knows. The policeman said that removing respirators happens at hospitals in Chicago all the time. A call placed by a family member to a supervisor at St. Mary of Nazareth Hospital in Chicago asked about their policy in such cases. The caller was informed that the hospital would remove the respirator in similar cases. The supervisor emphasized the point by adding that they are not concerned about lawsuits from family members because the hospital always wins in court. If you have a relative placed on a respirator, be aware that someone must remain with the patient constantly to protect them from overzealous medical personnel who find their quality of life too low even to give them a fair chance to recover.
Using hospice care to hasten death declared "ethical" As was noted in the previous article, the right answers on reducing or ending treatment are often difficult and are rarely made with complete confidence. When respect for life has been maintained, but a patient's prognosis is ultimately unfavorable, care requirements for the struggling patient may overwhelm family members. Hospice has been designed to provide relief to help patients live their last days as best as they are able without putting undue stress on family members. As presented on the Hospice Foundation of America web site (http://www.hospicefoundation.org/hospiceInfo/), the principles of hospice state that "hospice care neither prolongs life nor hastens death," and that "the goal of hospice care is to improve the quality of a patient's last days by offering comfort and dignity." In practice, is hospice true to these principles? Is Hospice Foundation of America consistent with its stated principle not to hasten death? Have at least some hospices ignored the principle against hastening death and instead embraced such actions as "compassionate" and "ethical"? IRLC has received a number of reports of concern about hospice care beginning in late 2004. Two nurses reported specifically that they witnessed how hospice care is used to quickly terminate the lives of patients through morphine overdoses. In April 2005, one of our board members attended a conference called “Ethical Dilemmas at the End of Life” sponsored by Hospice Foundation of America (HFA). The materials obtained from this conference express principles that seem inconsistent with the principles mentioned above that are visibly proclaimed on the HFA web site. Some examples from conference materials include:
The implications of these principles suggest that in practice hospices have no problem with taking steps that hasten death. Under their definition of the term, medical treatments to sustain life include tube feeding, insulin for diabetics, kidney dialysis, and many more. Removal of these medical treatments will certainly hasten death. Regarding tube feeding, an article from HFA on nutrition and hydration states “There comes a time in some cases where even nutrition and hydration are considered extraordinary means of prolonging life, and such ordinary nutrients are discontinued. The decision to withhold food and/or fluids is made only when it is apparent to the caregivers and family that further prolongation of life would only extend discomfort.” These statements apply to many more cases than those where the body begins to shut down and becomes increasingly unable to process nutrients. True medical justification for removal of nutrition only occurs when body systems are shutting down as death becomes truly imminent. Using a criterion “that further prolongation of life would only extend discomfort” is much broader in scope than circumstances where body systems are shutting down. This expansive willingness to deny nutrition and hydration is further confirmed when the article suggests “bio-ethical support for withholding nutrition in those persons with advanced illness whose greatly impaired quality of life would not be improved, but only prolonged.” “Greatly impaired quality of life” is a subjective criterion that can easily be abused in arbitrarily deciding to deny food and water to patients who are not dying. Any hospice that follows the principles set forth by the Hospice Foundation of America is certainly willing to cooperate with or even encourage actions that hasten death through denial of food and water. They have clearly stated a standard of care that hastens death in their own literature. HFA's push to hasten death gets worse. Among conference materials was
a 350-page book published by Hospice Foundation of America, entitled Living With
Grief: Ethical Dilemmas at the End of Life. Actions called ethical in this book
are anything but ethical. Buried in the middle of the book, in a chapter extolling
the ethics of assisted suicide (Chapter 10), are statements that reveal the intent and
means used by hospice to hasten death. This quote appears in a chapter that encourages the use of physician-assisted suicide and praises Oregon for having a law to allow it. The chapter expresses the ethics of assisted suicide. The twisted thinking reflected in these so-called ethics is reflected in the following logic on why the physician is not responsible in any way for the death of the patient: “Assisting suicide does not involve killing others or taking steps that cause or hasten their deaths. Suicides kill themselves. Assistance involves such things as giving would-be suicides information about how to kill themselves, enabling them to secure the means of doing so, giving them realistic options, interacting with them as they choose among their options, assuring them that their choice will be respected, supporting them emotionally once they have decided, and protecting them from unwanted intervention. The would-be suicides themselves are entirely responsible for exercising the option and completing the act of killing themselves.” If valid ethics have reached such a state, we need to inform the criminal courts that they can no longer prosecute the person who drove the bank robber to and from the bank that was robbed. The driver had nothing to do with the bank robbery. Clearly this example shows that what is being called ethical behavior to encourage patients to kill themselves does not pass the test of logic. Hospice Foundation of America puts its name squarely behind faulty logic to justify behavior that is not ethical at all. Their reference to these means to hasten death as “contemporary terminal care” warns us that these practices are also being used outside of hospice care. We might be in danger in hospitals and nursing homes as well, but HFA is willing to document such practices as ethical end-of-life care. This is certainly not death with dignity! The author even uses the same false concepts of “choice” that we have heard for years to justify abortion. If you do not accept these actions as ethical, do not commit suicide yourself or assist someone else, but do not try to prevent others from exercising their “right to die.” They have the right to choose to end their life. The author even goes so far as to claim that not referring patients to others who would be willing to assist them would be unethical. That is what always happens when something truly unethical gets labeled as a right. Wrong becomes right and right becomes wrong! Beyond HFA among hospice associations, the National Hospice and Palliative Care Organization (NHPCO) accepts the use of “terminal sedation” for some patients.1 "Terminal sedation is deliberately inducing and maintaining deep sleep but not deliberately causing death in very specific circumstances." Terminal sedation (also called total or palliative sedation) is a protocol actively promulgated by NHPCO. Howard M. Ducharme, chair of the philosophy department at the University of Akron, expresses serious concerns about the use of terminal sedation. He writes (copied from http://www.cbhd.org/resources/endoflife/kingsbury-ducharme_2002-01-24.htm):Terminal sedation (TS) is not
limited to patients who are suffering from overwhelming physical pain from their terminal
illness. TS is deemed appropriate for intractable or refractory suffering due to
"overwhelming physical, emotional, or spiritual distress that is poorly relieved by
other means."2 NHPCO advises, "There
are many cases in which patients experience refractory spiritual or emotional pain, often
referred to as existential suffering."3 TS
is deemed appropriate treatment for existential distress "that is not relieved by
counseling from social workers and chaplains, psychotropic medications, and other
interdisciplinary interventions."4 Thus, the criteria for
rendering a patient totally unconscious can come down to the individual's own report of
the existential distress he or she feels. Those suffering from chronic depression or
severe depression (e.g., parents who have lost their only child in a car accident) would
qualify for TS. When patients are put in an unconscious state through terminal sedation, they will not be given food and water by hospices that practice this protocol. Whether a feeding tube is removed or total sedation is used, the patients will die from starvation and dehydration. In what way is this approach not hastening death? In summary, there is clear evidence that the hospice principle to avoid hastening death is seriously threatened. Whether the method used is a high dosage of painkillers such as morphine (justified as pain control), terminal sedation, denial of food and water, or a combination of these methods, the arguments to justify these actions are well established as "ethical" in the view of some medical ethicists. Next time, we will review some examples of how hospice care has failed to "improve the quality of a patient's last days by offering comfort and dignity." --------------------------- 1 Perry G. Fine, "Total Sedation: Management Issues," Total Sedation: Ethical Foundations and Pharmacotherapy Review, National Hospice and Palliative Care Organization, Telephone Seminar (June 14, 2001), p. 1. The NHPCO total sedation policy draft being available at this time (November 2001) is evaluated as the NHPCO TS policy in this article.2 Ibid. 3 Jamie Goldstein-Shirley and Perry Fine, "Ethics of Total Sedation," Total Sedation Educational Resources Draft, Prepared by a Task Force of the NHPCO Ethics Committee (Session 8A, March 25, 2001), p. 3. 4 Ibid., p. 9.
Hastening death with morphine overdoses and other means Hospice has developed a good reputation for
providing compassionate care for dying patients. A
key principle is that hospice care neither artificially prolongs life nor hastens death. Unfortunately, this principle is no longer
consistently followed in hospice care (as discussed in the previous article in this
series). This lack of consistency requires a
“buyer beware” attitude when evaluating which hospice might be appropriate to
provide truly compassionate end-of-life care. Now that we have established that at least some hospices deviate from the original mission of hospice, some real life examples will clarify how hospices can act to hasten death, while justifying such actions as compassionate and caring. These examples show how hospice care can fail to "improve the quality of a patient's last days by offering comfort and dignity." Suggestions on the means to evaluate whether a hospice will truly care for, or likely kill, a patient are also provided below. Bruce called me on September 29, 2005. He heard the IRLC message about the Patient Self-Protection Document on WIND radio 560AM. He called because he thought he should obtain a copy for his mother. The background that led him to that conclusion is most disturbing. He witnessed his father being killed by a hospice nurse using an overdose of morphine. The nurse who came to his father’s house to provide hospice care actually tried to get Bruce’s mother to give the morphine, but she refused. So the nurse gave the overdose of morphine herself. Bruce said his father was not even in pain. Having pain would have been the justification for giving some morphine so there was no justification for any morphine at all.That experience seems like more than enough for Bruce to decide that his mother needs to complete a Patient Self-Protection Document. But there is even more that Bruce is concerned about. It turns out that Bruce’s sister is a hospice nurse. She actually thinks that she is doing the compassionate thing when she overdoses hospice patients on morphine. She even told her mother about providing morphine to the children of a 93-year-old man so they could relieve his suffering whenever that might be necessary. For now, he still drives and gets along just fine. He happens to be a friend of Bruce’s mother. How might she let him know that his own children are armed with morphine and dangerous if he develops medical problems? Bruce’s mother has told his sister that she should leave her job as a hospice nurse “because she is killing people.” How does she face the knowledge that her daughter is ready to end her life if she gets too inconvenient? She is legally blind and deaf, but she is still able to take care of most her needs. Her daughter suggested she should consider hospice, and she replied that a nursing home would do just fine. This hospice nurse was working at a hospice in the Elgin, IL area. It would seem that such a hospice may already be using euthanasia as a standard part of their hospice care with Bruce's sister as one of their willing agents to perform the deed. Bruce made an observation based on his experience with his sister. He said she never came home at breaks during college, but if someone had an ailing animal to be put to sleep, she would come right home to take care of it. Now she apparently thinks human beings should get the same treatment. Bruce thinks she is quite happy with her job, even though she is dealing with death, and people near death, all the time. He observed that hospice work could easily attract people who think like his sister. I have received additional calls from people who witnessed occurrences of this practice with other hospices. Fortunately, in one case the result was better, as expresssed in an email I received from Angie. When her husband needed hospice care, Angie was already knowledgeable about morphine dosages because her husband had needed it for pain control for two years. When hospice got involved nine days before her husband died, Angie was given a schedule for morphine every 2-4 hours, but Angie only gave her husband morphine once per day until the last two days when she gave two and then three doses, but never anything even approaching 6-12 doses per day. Angie wrote, “He was never uncomfortable, was coherent to his last breath, and telling his family he loved God and wanted to be with Jesus.” Her family never allowed him to be left alone with a hospice nurse. Other families are not as fortunate. In many cases the family members are innocently giving the morphine per the hospice schedule that hastens death without even realizing what is happening until it is too late, or never knowing the truth. Unfortunately, some relatives are not caring in the way that Angie treated her husband. In one case the wife made a decision to get hospice involved in her husband’s care during his recovery from both surgery and another medical procedure to remove a brain tumor. Even though the brain tumor was declared to be in total remission by the surgeon and the patient was not in pain, pain medications were forced on the patient. This was the initial stage of the process that too often leads to an eventual overdose on morphine. I was asked for advice by the patient’s niece who witnessed the mistreatment of her uncle that was occurring. The niece was eventually denied access to her uncle because she was trying to help him rather than trying to hasten his death. In another case, a mother was on a feeding tube and being cared for at home by one of
the younger sons among her eight children. The
oldest daughter, who was the designated agent on her mother's Durable Power of
Attorney for Health Care, arrived one day to take their mother to hospice
“because she would not want to live this way.”
Most of the siblings, who opposed this move to hospice, needed to get an attorney
involved even to get the opportunity to learn where their mother was taken so they could
visit her. They learned that their mother was
no longer being given food through her feeding tube.
Even though she had not been taking pain medication at home, she was now being
given morphine under hospice care. Tragically, she died within two weeks. Might one conclude that morphine overdoses are being used by every hospice? No. I have talked to a number of people who have friends or relatives who have recently been under hospice care and have continued to live for a number of months. Those hospices did not use these procedures to hasten death (because when hospices do use these practices, patients are often dead in 3 to 5 days after entering hospice care). Some hospices have a policy that no patient can remain on a feeding tube upon entering hospice care. Such a policy is a clear sign the hospice is willing to hasten death. If a feeding tube is effectively doing the job of providing the patient with food and water, then removing it will result in a hastened death from starvation and/or dehydration. Such action will certainly not "improve the quality of a patient's last days." Rather, it is an immoral attack on human life. Of course, if there are medical indications that the patient's body can no longer process the nutrients provided through the feeding tube, then removal is justified, but such individual cases cannot justify a blanket policy to end tube feeding upon entering hospice care. How many hospices hasten death versus how many do not? It's very difficult to know, but hospice leadership organizations including Hospice Foundation of America, National Hospice and Palliative Care Organization, and probably others are pushing hospices in that direction. The efforts of these organizations mean that even if a certain hospice was faithful to the original mission of hospice in the past, policies could change so understanding current hospice policies is always very important before choosing that hospice for a new patient. Whether death is hastened by denial of food and water or suppression of breathing using overdoses of morphine, this is certainly not death with dignity! Illinois Right to Life offers a Hospice Checklist to help evaluate the underlying philosophy of care practiced by any specific hospice. Seeking answers to the questions on this checklist should be helpful in that evaluation. The tragic situations described above where the patients' relatives actually wanted
hospice care to hasten death reinforce the need to be very cautious in what type of
advance directive you complete and who you designate as you agent to make health care
decisions for you if you cannot make them yourself. Even using a life-affirming
Durable Power of Attorney for Health Care such as IRLC's Patient Self-Protection Document
will be no match if your designated agent does not respect your life and has access to
hospice care that has no problem with taking steps that hasten death. To protect
your life you need to identify both relatives and health care professionals that respect
life and reject the "Right to Die" movement's philosophy that ending life
prematurely is "compassionate" and "dignified" when the patient is
deemed to have a "low quality of life."
Thanks to Daniel Zanoza for suggesting this series of articles and publishing them at www.rffm.org as follows: The Myth Of Living Wills: You Are Actually Signing Your Life Away How a Living Will can bring about your premature death: Precautions and Alternatives Futile Care--What Is It? Knowing May Save Your Life Or The Life Of A Loved One Research on "brain dead" and "almost dead" patients declared "ethical" Choose Hospice Care Provider Carefully: Using Hospice Care To Hasten Death Declared "Ethical" Do Some Hospice Care Providers Hasten Death Through The Use Of Morphine Overdoses And Other Means? Culture Of Death Taking Its Toll On Those Nearing Life's End "Living Will" Becomes a License to Kill: The Horror Goes On In 2008
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