November 13, 2014
Second of a two-part series [go to part 1]
End of Life Issues II -- Palliative Care
By Mike McManus
Some readers of last week’s column on assisted
suicide were critical of my comparison of two women with inoperable brain
tumors. One moved to Oregon where she got drugs to kill herself. The other was
an 18-year-old whose dream was to play college basketball. She played part of
one game, winning a standing ovation, and continues to show up for a 5:30 am
practice, though she can do few of the drills now.
I praised the second woman for facing her crisis with inspirational courage. And
I quoted the American Medical Association on why it opposed assisted suicide as
being “incompatible with the physician’s role as healer.”
An Iowa reader disagreed with the AMA, saying “a mentally competent person
should have the freedom to make the decision about ending his or her own life.”
He noted we kill pets with terminal illness. “Should we not treat human beings
with the same sensitivity?”
Another critic said he could not imagine “living on life sustaining equipment in
That is not what I am proposing. What ought to be given to patients who are
nearing life’s end is “palliative care,” in which medication is used to ease the
pain and symptoms of disease – without attempting to needlessly prolong life
The current issue of Consumer Reports tells the story of Paul, a retired
dentist, who told his daughters and wife a decade ago: “No ventilators, no major
surgeries except to alleviate pain.” Cancer re-appeared in his lung at age 84.
Doctors told him he had 6-12 months to live but chemotherapy might buy him a
little more time. Paul refused, realizing how debilitating chemo can be.
However, he had entered a hospice program, which he said was “one of the best
things that’s happened to me.” Hospice workers, including a physician, came to
his home – all paid for by Medicare. This was a great relief for his wife of 62
years who suffered from multiple sclerosis. “The hospice workers walked into our
home and became part of our family,” Paul commented.
Patients in hospice forgo all therapies aimed at combatting the disease itself.
Palliative care “incorporates regular medical care for symptoms or conditions
that don’t arise from the terminal illness itself, such as insomnia, high blood
pressure and anxiety,” stated Consumer Reports.
This is important information about palliative care that three-fifths of
Americans have never heard of. Yet half of Americans – if facing death – would
prefer pain management and comfort care over other medical treatment. And fully
86% would want to spend their final days at home.
If this is your desire about your final days, you must take several steps to be
sure that your end-of-life wishes are respected:
First, regardless of your age, write an advanced directive or a living will that
states your desires in writing. Second, appoint a person who will be your health
care proxy or agent charged with the responsibility of making decisions for you,
if you are unable to do so yourself. Usually, that person is one’s spouse or
You may want to include a Do Not Resuscitate order, or DNR, instructing health
care providers that they are not to perform cardiopulmonary resuscitation (CPR)
if breathing stops or if the heart stops beating.
You do not need an attorney to write a living will and appoint your health care
agent. Get specific forms at caringinfo.org. Make several copies of your living
will with original signatures. Give them to family members and your doctors for
your medical records.
In addition, you should talk to everyone in your family about your wishes, not
just your health care agent.
Find a hospice well in advance of any need for one. Go to the National Hospice
and Palliative Care Organization (nhpco.org). However, Consumer Reports warns
that more than half of hospices are for-profit, and “several recent news reports
have highlighted problems at some of these programs.”
Therefore, be sure that your hospice is not-for-profit, and has been in business
for 20 years, that it has hospice-certified nurses and doctors on staff 24 hours
a day plus palliative care consultants who can begin care if your are not yet
ready for hospice. Also be certain that it is Medicare-approved and has an
inpatient unit if symptoms can’t be managed at home.
Finally, prepare yourself spiritually for your last days. I suggest reading
Scripture like Psalm 20: “May the words of my mouth and the meditation of my
heart be pleasing in your sight, O Lord, my Rock and my Redeemer.”
Copyright © 2014 Michael J. McManus, President of Marriage Savers and a
Mike McManus is President of Marriage Savers
and a syndicated columnist, writing Ethics & Religion weekly
9311 Harrington Dr.
Potomac, MD 20854
30+ Years / 1700+ Columns
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