THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, December 10, 1995 TAG: 9512080024
SECTION: COMMENTARY PAGE: J4 EDITION: FINAL
TYPE: Letter
LENGTH: Medium: 54 lines
The report ``Why aren't dying patients' wishes the law?'' (front page, Nov. 22) is misleading. In it, Robert S. Boyd advances the notion that doctors ``try to prolong patients' lives rather than letting them die in peace.'' He bases this on a study done in five major medical centers over a 10-year period. The report implies that physicians have some vested interest in keeping patients in intensive-care units, ``in comas or attached to artificial breathing machines,'' and it implies that this sort of medical practice is the norm across the country. This is not true.
I have practiced internal medicine in a variety of hospitals in diverse locations, including three years managing an intensive-care unit. End-of-life issues are dealt with daily in these environments. It has been my experience that the scenario is almost invariably opposite the one described in the article.
If patients who are terminally ill are placed on life support, or treated aggressively in other ways, it is because the patient or family makes that request, not because physicians or other caregivers want to do it.
I have had numerous discussions with families describing the misery involved in such ``heroic'' measures, as well as the ultimate futility, in an effort to convince them to allow us to permit a patient to live his or her last days in peace.
Rarely is there disagreement among consultants, nurses, therapists or social workers on this point: We are all disturbed when asked to ``do everything'' for a patient for whom we do not feel the outcome will be measurably changed, but who will suffer regardless.
Furthermore, there is the unspoken but ever-present threat of litigation which, when we are in doubt, forces those of us at the bedside to choose the more aggressive course rather than the one we might feel is appropriate for the particular situation.
Again, the patient suffers.
Without a doubt, the most important factor in avoiding the frightening scenarios described in the article is effective communication between the caregivers and the patient or family members. If adequately informed of the options available and their ramifications, most people will choose reasonably. It is when communication fails that difficulties begin, and it is the responsibility of the caregiver to prevent such failure.
The aforementioned study cost $28 million to complete, according to your report. If the participants had spent more time in the real world of community medicine, rather than in the ivory tower of academic medicine, they might have reached a different conclusion.
JOSEPH L. KELLY, M.D.
Norfolk, Nov. 28, 1995 by CNB