Decision to End Life Support a Common One
Posted by Patti on March 29th, 2005 / Print This Post
Decision to End Life Support a Common One
By DAVID B. CARUSO, Associated Press WriterPHILADELPHIA - Hospitals and nursing homes don’t track how many Americans die each year after some level of life support is withdrawn, but the number is likely to be at least in the tens of thousands, doctors said Friday.
“I make at least one of these decisions daily,” said Dr. Sean Morrison, a palliative care physician and professor at the Mount Sinai School of Medicine in New York City.
“For a majority of people who die in this country, a decision is made at some point to either withhold or withdraw a medical treatment,” he said. “We ask the family what their goals are for the care, and we ask them to consider whether they believe that there is a fate worse than death. If the treatments meet the family’s goals, we continue it. If not, we don’t.”
Such end-of-life decisions are usually made quietly, without anything close to the turmoil or controversy that has marked the case involving Terri Schiavo.
The Florida woman has been in what some doctors describe as a persistent vegetative state for 15 years as her husband and parents have battled in court over whether to remove the feeding tube keeping her alive.
Doctors said her medical situation and the decision to withdraw life support is far from unusual.
Every day at hospitals and nursing homes, relatives of patients who have been rendered unresponsive by a stroke or Alzheimer’s disease (news - web sites) instruct doctors to detach their loved one from a ventilator or remove a feeding tube.
People with failed kidneys are taken off dialysis machines. Other patients stop getting chemotherapy or antibiotics, even though it will hasten their death.
“It’s so common, many hospitals don’t require these kinds of decisions to be brought before an ethics panel anymore,” said Laurie Zoloth, a professor of medical ethics Northwestern University.
American Medical Association guidelines bar doctors from performing euthanasia or participating in assisted suicide, but also require physicians to respect a patient’s wishes to forgo care, even if it is life sustaining.
In cases where the patient is unable to communicate, the association recommends a spouse or closest relative be given the power to decide whether to withdraw life support. The guidelines allow physicians to discontinue treatment, even if the patient is not terminally ill or permanently unconscious.
Family disputes do happen, said Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania. Almost none winds up in court.
Most find a way to agree on whether their loved one would have wanted to be kept alive artificially.
“If there is one single lesson to take out of this, it is to fill out a living will, and discuss it with your family,” he said, referring to a document that specifies a person’s end-of-life wishes.