Earlier this week Paula Span wrote in the New York Times about the increasing number of lawsuits being filed on behalf of patients being kept alive. Counterintuitive? Not when you consider they were kept alive only to endure more pain and suffering – against their known wishes.
If you’ve ever read or heard about a court case involving whether, how, why or why not an individual’s advance directive was carried out as intended by the patient, then you are no doubt familiar with the myriad circumstances and events that can lead to great confusion at the time of death. It’s an area of healthcare painted with a thousand shades of grey.
Unfortunately, an advance directive often gets twisted and manipulated nine ways to Sunday in the hands of numerous stakeholders standing bedside, whilst the person in the bed is most often unable to advocate for their own interests. This is when doctors begin envying lawyers because lawyers don’t have to practice medicine.
I have yet to meet the physician who wants to cause his or her patient harm. They even swear an oath not to. There are other areas of the Hippocratic Oath wherein its fulfillment brings into question – absent an informed directive – to just what lengths are necessary and appropriate to save the life of a dying soul in the knowledge that such actions may cause increased suffering.
Allowing for the presumption of innocence, however, doesn’t change the very real consequences suffered in those cases shared in the article. I suspect attributing the failures to a breakdown in communication is a safe bet in most of those cases since that is a phenomenon, which continues to plague our healthcare delivery system despite the investment of billions into information technology.
Of course, the broader discussion this story touches upon is addressing life and death in the context of quality of life – and who determines the subjective nature of “quality.” To that point, we have much to benefit from the continued awareness and education of the role palliative care can play in treating severe and terminal illnesses.
In this country we are culturally adamant about resisting and ignoring the realities of death. One needs look no further than the hysterical idiocy that surrounded death panels. Perhaps these cases will help advance the broader conversation we need to have on how we can best protect individual patient rights while providing them the best possible life while still on earth.