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Posts Tagged ‘medical ethics’

On Monday I talked about my visit to the Medical campus at The University of Colorado Heath Sciences Center’s monthly ethics discussion. This month they discussed Physician Assisted Death (PAD). The first thing that caught my attention was the shift from Physician Assisted Suicide to Physician Assisted Death. What caused the shift in terminology? Is it a way to make the legislatures in our country look upon these actions differently? Does it take away the stigma of suicide? Does it differentiate between suicide as we traditionally think of it and as a choice in dying?

The speaker presented some very interesting statistics that has been collected since 1997 about those who choose Physician Assisted Death. The most startling was that of all the prescriptions written with the intention of PAD only 64% actually follow through on taking the medications to end their life. Here are some other interesting statistics:

*74% were over 65 years of age

*54% had a college degree or higher

*85% were enrolled in hospice

*94% were insured

*65% had a cancer diagnosis

*94% were Caucasian

*62% were men

I share these statistics because we need to understand the outcomes when we institute societal, cultural, and legal shifts related to end-of-life care.

I’ve spent over twenty years sharing the journey of those facing chronic and life-threatening illnesses. I’ve always had a copy of Derek Humphry’s book Final Exit on my bookshelf. I’ve had numerous clients ask to borrow the book as they think about end-of-life care. In each of the cases I have always found that having the book available didn’t encourage taking one’s own life, but it did take the taboo out of the topic. It opened up many dialogues about suffering, pain, depression, assumptions about life, and a host of other topics.

When we de-stigmatize PAD we can begin to have open and honest conversations concerning advanced directives. These directives are important not only between the patient and the medical provider, but for the person who is your Durable Power of Attorney for Healthcare. Everyone needs to be on the same page. There are only four states that have PAD in the United States. I know that many more states are going to begin these conversations and that’s an important step, allowing us all to have options in our end-of-life care!!

Are you and your family facing a diagnosis of a chronic or life-threatening illness?  Looking for education, support, and inspiration?  Visit http://www.survivingstrong.com

Looking to explore your views about end-of-life care through art?  Visit http://www.timetolivecreatively.com

Follow me on Twitter: @GregKatz2

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I’m fortunate to live near the University of Colorado Health Sciences Center. The school has a medical school, nursing school, dental school, and pharmacy school. Having these four disciplines on one campus affords them the opportunity to create programming that cuts across all four professions. They recently started a monthly ethics discussion raising issues the staff and students may/will come across in their careers.

Yesterday’s talk was about Physician Assisted Death, a topic that not only cuts across cultural and religious arenas, it is also being debated in many state legislatures. The presentation focused on two cases, both women, a twenty year old with end stage ovarian cancer and a forty-eight year old with leukemia. The cases were both interesting, but what I found particularly interesting were the responses by some of the students about the ethics involved.

I’ve been a mental health practioner for over twenty-five years. I’ve spent most of my career working with those diagnosed with chronic and life-threatening illness and I can tell you, you never know what how you’re going to react until you’re in the situation. Training is good because it gives you a basis for your decisions, but it’s the things not in text books that float around you like a cloud waiting to rain down at any given moment.

One of the things that caught me off guard was one student who was quite vocal. He was responding to a question from the moderator, but his sense of surety was a bit unsettling. I believe in having conviction but when it shuts off the possibility of anything contrary entering one’s consciousness I get concerned. My hope is that when these students enter clinical work and throughout their careers they will have the awareness that nothing in ethics is black or white. If you’re not comfortable with the “gray” zone, then perhaps medicine is not the right field for them.

What can I tell you after participating in yesterday’s dialogue? Create operational definitions with your physician about what you mean when you use words like suffering, distress, and control to describe your health. Have as many things written down in your medical chart about your wishes about care, especially end-of-life care. Don’t’ leave it up to the medical staff to assume, guess, or translate your wishes, make it know and do so with conviction.

The less you leave up for interpretation. Give yourself the peace of mind you need and deserve by having the hard dialogues with your medical providers. It will save you a lot of trouble and will reduce the risk that your wishes won’t be honored!

Facing a chronic or life-threatening illness?  Looking for education, support, and inspiration?  Visit http://www.survivingstrong.com

Want to express yourself through art?  Visit http://www.timetolivecreatively.com

Follow me on Twitter: @GregKatz2

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Welcome to Caregiver Friday!!

Just when you think being a decision maker in the role of caregiver/wellness partner a new study lays an extra burden of responsibility on your shoulders.  The findings are in reference to a study done on patients who had been labeled in a permanent vegetative state.  In many cases the family is asked if they want to continue the person on life support or have other extreme measures performed.  That decision can be easier if you know that the person is truly in a permanent vegetative state.  But what if you’re not sure.

The Wall Street Journal (WSJ) reported on the study that was published in the New England Journal of Medicine.  The study examined 23 patients who had been diagnosed as being in a permanent vegetative state.  Four of the patients showed signs of consciousness…can you believe it 4 of 23.

Using MRI scans the patients were asked questions and their brains were monitored.  Certain responses would light-up certain parts of the brain.  The WSJ article stated “Four of the 23 vegetative patients responded to the commands and exhibited brain activity in the same areas as healthy control subjects”.

When trying to make potentially life and death decisions as a caregiver (hopefully you were mindful to have a Durable Power of Attorney for Healthcare) you are now burdened with the quandary, “Is the person I’m caring for really in a permanent vegetative state or is he/she one like in the studies that can still responds to questions?’ 

I believe the medical ethicists are all gathering to take up this matter on a big-picture discussion.  How would you handle this situation as a caregiver?  If the decision is your, how will you know whether the person you’re caring for has some level of consciousness?  

Dr. Allan H. Ropper said, “the line between consciousness and unconsciousness will be blurred” as scientific understanding of the vegetative state depends.  This is not the most comforting statement for those of you caring for someone who is facing end of life issues or has been in an accident, but for now it’s the reality.

Who do you have that you can discuss these issues with such as a medical ethicist or spiritual director?  Did you have thorough conversations with the person you’re caring for about end-of-life issues?  There are those who even though they may have brain activity, on whatever level, wouldn’t want to live the rest of the days unable to speak, move, or communicate.  Even if the brain might register some activity is this a life?  You know this will wind up in the courts at some point, but for now the onus of responsibility is on you.

I know there is more to come; this is truly the tip of the iceberg.  Please have conversations with your loved ones about end-of-life care.  Decision-making for caregivers is tough enough without the burden of deciding one’s level of consciousness.

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