Sunday, March 27, 2005

Make end-of-life decisions for yourself, while you can

If any good comes of this Schiavo mess, perhaps it will be that more people make their wishes known to more of their loved ones.

An end to it all
The issues raised by the Terri Schiavo case linger and are as complicated as life itself
Make decision for yourself--now

By Hesham A. Hassaballa
a Chicago doctor and freelance writer
Published March 27, 2005

There are countless Terri Schiavos across the nation, and the same difficult issues are being grappled with every single day.

I have witnessed many of these heart-wrenching situations as a pulmonary/critical care physician, and it has profoundly affected my thinking about end-of-life issues.

As a physician in the 21st Century, I have witnessed medical technology advance to such a degree that diseases that once killed can now be cured with little effort or at least treated successfully.

HIV is one. When I was a young lad in medical school, I would rarely see a patient with HIV over 30, and frequently they came into the hospital deathly ill. Now, however, I am routinely consulted on patients with HIV well into their 50s who have more "routine" medical illnesses.

Yet for all the advancement in medical technology, I have also seen a person be stricken with a disease that simply does not respond to treatment. Sometimes, in fact, the treatments administered can do much more harm than good. Mind you, this is not malpractice--it's just reality.

The most difficult cases for me, however, are the patients who, while surviving the disease's initial onslaught, are left with permanent organ damage, the most serious of which is the brain and nervous system.

Frequently, they are left neither fully alive nor fully dead.

This is where the difficult questions arise: Do we continue to "do everything," or do we "let nature take its course"?

The answers are not easy.

Continuing to "do everything" may come at a high price and with pain when subjecting the patient to complications of medical procedures and side effects of medications. Allowing "nature to take its course," on the other hand, can be an equally heart-wrenching decision, with feelings of guilt and remorse for relatives who perceive that they have "given up" on their loved one.

Yet these very difficult questions must be answered by every single one of us--here and now--when we are of sound mind, if not body. I cannot tell you how horrible a situation it is when a doctor approaches frightened and terrified family members--watching their loved one be in extremis--and ask them, "Should we do everything?"

Quite often, the family says, "do everything, doctor."

Yet that either may not be the most medically appropriate choice, such as in a patient with a terminal condition, or may not be what the patient truly wanted for himself or herself.

I have made my decision already: If there is no hope for my meaningful recovery, then I do not want my life sustained; please, let me die in peace and dignity and return to my Creator.

But that is not a decision I should be making for my patients. Rather, it is a decision for every free-willed human being and--most important--one that should be clearly delineated to our doctors and loved ones.

When I bring up end-of-life issues with my patients, they frequently fidget uncomfortably. It is such an important issue to discuss, however, that a brief moment of uncomfortable silence in a doctor's office is well worth it.

Whatever the decision, it has to be made, and it should be made between oneself, one's god, and one's family.

Governors mansions, state legislatures, houses of Congress and Oval Offices should never have to get involved.

Copyright © 2005, Chicago Tribune

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