IHM: Spring 2008 Quarterly Feature

Publications

Spring 2008 Feature

At the intersection of medical ethics and aging
by Holly Knight, Director of Communications and Marketing

Life expectancy is climbing. And Baby Boomers are refusing to relinquish their youth under the banner that '60-is-the-new-40.

While we may live longer than any generation in human history, some think it may be at a cost.

In his book, The Brave New World of Health Care, author Richard D. Lamm credits modern medicine with saving people from deadly infectious diseases, but, he claims, the trade off is leaving us with a battery of disabilities and diseases -- such as diabetes, heart disease, arthritis and Alzheimer's -- to fight for the rest of our lives.

Lamm poses a key question: Are the miracles of medical technology really giving us a longer life or a longer and more expensive death?

"It is no longer acceptable to blindly forestall death by every means possible," Lamm says. "The price of our individual overconsumption in modern medicine is paid for by others in our plan or by society not getting their adequate share."

Lamm's point reflects some of the dilemmas at the meeting of medical ethics and our growing aging population.

The IHM Sisters, like many religious communities at the forefront of conversations on aging, are exploring ethical questions like these. This past year the congregation established a Medical Ethics Committee, which serves as a community resource, educates its members on the importance of creating their own holistic life plans and knowing their rights when it comes to medical treatments and critical decision-making.

Sister Janet Ryan, IHM According to Sister Janet Ryan, who chairs the committee, 80 percent of health care dollars are spent on the last 18 months of life.

But costs aren't the only ethical issue. Joanne Lynn, M.D, ethicist, hospice physician and author, advocates for an entirely new approach to long-term health care -- for alternatives that are person-centered, less institutional and that empower patients to plan the kind of care they want.

Person-centered planning includes the right to make your own decisions, to prepare an individual health plan, to be included on your planning team and have your own hopes, dreams and goals at the center of your plan.

Lynn, along with co-author Joan Harrold, M.D., wrote the book Handbook for Mortals.

The authors ask us to face tough questions.

Have you thought about the care you want during severe illness?

Have you talked with your family about plans to ensure you will get the care you want?

What would you do if you became so ill you couldn't ask for what you want done?

Do you want every treatment possible? Even if it means you'd be hooked up to mechanical support for body functions -- and the treatment likely won't work?

Does your doctor know how you feel?

And Catholics want their medical care to be consistent with the way they live as Catholics.

The 2001 Ethical and Religious Directives for Catholic Health Care Service, a document published by the United States Conference of Catholic Bishops, reaffirms the ethical standards of behavior in health care that flow from the Church's teaching about the dignity of the human person and provides guidance on certain moral issues that face Catholic health care today.

Many moral issues revolve around Lamm's point about people's tendency to forestall death by every means possible. And many of the "means" that confuse Catholics fall into the four life-sustaining measures most frequently considered:

1. Cardiopulmonary resuscitation (CPR)

This procedure involves applying pressure on the chest to start the heart pumping again. This procedure, usually performed in the event of a cardiac or respiratory arrest, has saved many lives.

2. Mechanical breathing (respirator, ventilator)

This procedure allows a machine to breathe for a patient when the person is not

able to breathe without assistance. After some surgeries, a respirator or ventilator

is a standard temporary procedure.

3. Artificial methods of nutrition or hydration

Intravenous tubes (IV tubes) are used to provide fluids. Two methods used to feed a patient who cannot take in food orally are: a) a small tube placed through the nose to the stomach (NG tube); b) a tube placed directly in the stomach through the abdomen.

4. Antibiotics

Antibiotics are medications used to treat or prevent infections. In all cases, it is wise to ask about the side effects of any antibiotics.

The IHM Sisters remind their members such life-sustaining procedures are beneficial in many situations. However, when a person is terminally ill, these same procedures may prolong the dying process and reduce the quality of life for a patient.

Author and bioethics professor John J. Hardt concurs in his article, "Church Teaching and My Father's Choice," in the January 21-28, 2008 issue of America, "Procedures that are medically ordinary, in the sense that they are readily available, technically feasible and of biological benefit to the patient, are not always morally required."

For all patients, including patients in a permanent vegetative state, the Catholic tradition advises us to determine what benefits an intervention would provide and whether the burdens of intervention are proportionate or disproportionate to the expected benefits.

In a Sept. 15, 2007 document, Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration, the Congregation for the Doctrine of the Faith identifies four exceptions to the general rule that artificial nutrition and hydration for a patient in a persistent vegetative state constitutes ordinary care.

The exceptions cited by the CDF include 1) when remote geography and/or extreme poverty make the administration of artificial nutrition and hydration impossible; 2) when emerging complications prohibit the assimilation of artificial nutrition and hydration; 3) when in some rare cases, it may be excessively burdensome; and 4) when in some rare cases it may cause significant physical discomfort.

Thomas A. Shannon, in his article, "At the End of Life," published in the February 18, 2008 issue of America, writes, "In some instances -- and these are not rare cases, as the congregation's document suggests -- such interventions can harm the patient, given side effects such as infections at the insertion point of the tube, nausea, vomiting and the possibility of the vomitus choking the patient. Such maintenance violates the dignity of the person because it defines and reduces their personhood solely to terms of biological functioning."

The keys to maximizing our heath care as we age are being informed, planning and communication. It's up to each of us to be informed regarding our rights and alternative options, to prepare a holistic life health plan and to communicate our wishes to family members, durable power of attorneys and doctors.