THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Wednesday, November 22, 1995 TAG: 9511220546
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY ROBERT S. BOYD, KNIGHT-RIDDER NEWS SERVICE
DATELINE: WASHINGTON LENGTH: Long : 108 lines
Millions of dying patients suffer needless pain, alone and hooked to machines, because medical professionals keep trying to prolong their lives rather than letting them die in peace, researchers reported Tuesday.
``There is a tragic mismatch between the health care many seriously ill and dying people want and what they get,'' said Dr. William Knaus, a specialist in critical care at the University of Virginia Medical School.
Despite the attention paid in recent years to the idea of death with dignity, a 10-year study of nearly 10,000 critically sick persons at five major hospitals found a woeful failure of communication among doctors, patients and their families.
The $28 million study was financed by the Robert Wood Johnson Foundation of Princeton, N.J. The results were published in this week's Journal of the American Medical Association.
``The problem is that the system doesn't know when or how to stop,'' said Knaus, director of the study, the largest ever attempted for patients in the final months of life.
``We're very good at fighting disease,'' added Dr. Alfred Connors, a physician-researcher at Cleveland's MetroHealth Medical Center. ``We're not good at treating patients at the time of death. People don't need to die in pain.''
At a press conference in Washington Tuesday, authors of the study said they were ``surprised and disappointed'' that an elaborate two-year test of ways to improve doctor-patient communication made no difference in the way critically sick people were treated.
In the test, 2,534 patients were assigned a nurse-advocate specially trained to encourage patients and their families to make their wishes clear to doctors, and to encourage doctors to make dying a more humane experience.
Detailed written instructions were provided about pain control and ``do not resuscitate'' orders. Computer-generated reports estimated each patient's chances of survival.
Despite these efforts, these patients continued to spend their final days in comas or attached to artificial breathing machines. Complaints of pain actually increased, and the staggering costs of intensive care in a hospital were not reduced.
``The results shocked me,'' Knaus said. ``The tools that experts thought would work didn't make a bit of difference.''
In response to the study, the AMA announced Tuesday that it was forming a ``Task Force on Quality Care at the End of Life'' to identify futile treatments and decide what kind of care is appropriate when death is likely. The group was not at the press conference.
But the AMA continues to reject euthanasia or assisted suicide, such as practiced by Dr. Jack Kevorkian in Michigan.
``Such practices are ethically prohibited; they are fundamentally inconsistent with the physician's role as healer,'' said Dr. Thomas Reardon, AMA secretary-treasurer. ``They pose a serious risk of abuse that is virtually uncontrollable.''
Dr. Joanne Lynn, director of the Center to Improve Care of the Dying at George Washington University here, said at the press conference that terminally ill patients should be allowed to die comfortably and painlessly at home or in a hospice, rather than in a hospital's intensive care unit.
``We know how to alleviate most pain,'' said Lynn, a co-author of the study. ``It's very troubling that we are not regularly delivering that.''
In addition to making patients suffer unnecessarily in a futile attempt to prolong their lives, intensive care leaves families ``not only emotionally but financially devastated,'' Knaus said. ``This is not the way I - or a majority of Americans - want to spend our final days.''
Medical ethicists not connected with the study said it revealed flaws in the health care system.
George Annas, director of the Law, Medicine and Ethics Program at Boston University, said it proves that doctors pay little attention to the wishes and feelings of patients.
``Physicians simply have never taken the rights of hospitalized patients seriously,'' Annas said. ``There is no excuse to this indifference to human suffering, which amounts to systematic patient abuse.''
Daniel Callahan, president of the Hastings Center in New York, blamed ``the culture of medicine,'' which he said ``pushes in the direction of aggressive treatment (and) of deafness to patient wishes.''
The study authors said doctors were not solely to blame for providing care that turns out to be in vain.
``Physicians are taught to save lives - that death is a failure,'' Lynn said. ``Patients and families have come to expect miracles in every case. It's easier for everyone to follow the usual path of aggressive treatment, even when it's clear that it's leading nowhere.
``We need to change the way we pay for care,'' she said. ``We should make it easier to get supportive care, and more difficult to get surgery.''
The study covered 9,105 persons, average age 65, who had a 50 percent probability of dying within six months from cancer, heart failure or seven other life-threatening diseases. The patients were treated at the MetroHealth Medical Center in Cleveland; Beth Israel Hospital in Boston; Duke University Hospital in Durham, N.C.; St. Joseph's Hospital in Marshfield, Wis.; and the University of California Hospital in Los Angeles.
Half the patients reported moderate to severe pain, and half of them were dead within six months after entering the hospital. MEMO: On Oct. 1, the AMA, the American Association of Retired Persons (AARP)
and the American Bar Association issued a patient's guidebook entitled:
``Shape Your Health Care Future with Health Care Advance Directives.''
Free copies are available from local AARP offices.
ILLUSTRATION: Graphic
KEYWORDS: DEATH WITH DIGNITY LIVING WILL by CNB