ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, August 19, 1996 TAG: 9608190137
SECTION: EDITORIAL PAGE: A-6 EDITION: METRO
DR. JACK Kevorkian continues his sensational crusade for assisted suicide. However disturbing, his actions have forced a needed debate about medical ethics, individual rights of self-determination, and the influence of economic considerations on both in an era of diminishing resources.
But a question likely to affect far more people than whether a doctor should be able to ease a patient into an early death is whether a doctor should take aggressive measures to bring a patient back to life against his or her known wishes.
The largest clinical study to date of seriously ill and dying patients underscores the point: This issue is far from settled. The study, which tracked more than 10,000 patients at five medical centers from 1986 through 1994, found that doctors often ignored patients' wishes about end-of-life care.
Do-not-resuscitate orders "were infrequent and late" even for patients who said they didn't want cardiopulmonary resuscitation - especially among those under 75. That, the lead author concluded, did not indicate that older people had died prematurely but that younger people, with no greater hope of recovery, had died more prolonged deaths.
Doctors' reluctance to let younger patients go is understandable. It is also, however, indicative of the gulf in communication that must be bridged between medical professionals and patients.
With so many medical options available, how can doctors make good decisions without a real understanding of - and respect for - what patients would want?
And how can patients know what they would want without the knowledge and advice of physicians who can discuss life-and-death issues in a frank and reassuring way - before their patients are, literally, at death's door?
If patients have made their wishes known, are doctors right at times to disregard them? If so, under what circumstances? Can doctors reasonably ignore patients' preferences on the premise they don't have the expertise to contribute to medical judgments? Or that their wishes are being driven by financial considerations?
Would doctors even know whether patients were making decisions based on money problems? This study indicates they often do.
Such questions cannot be debated within the medical profession alone. Patients, who have the greatest interest in their own medical care, should be assured that their wishes are known - and taken seriously.
Life-support machines are among the wonders of modern medicine, able to keep critically ill people from death while their bodies have a chance to recover, often completely. Many people, though, talk with families and friends about their horror of dying lingering deaths while hooked up to machines that are merely extending a physical life that is all but over.
Technology has put greater powers of life or death within humankind's reach. How can humankind use those powers humanely? Doctors and patients need to explore, together and at length, the difficult choices of life and death posed by this technology, and discuss it well before critical decisions must be made.
LENGTH: Medium: 58 linesby CNB