In Context: Dr. Daly Discusses End of Life Medical Decisions
July 10, 2009
Welcome to a new feature on the Saint Anselm blog. From time to time, we will ask faculty members and others to shed light on issues in the news, and post their answers either as text or short videos. Health care reform is making headlines these days, so we have started with a professor of medical ethics, Dr. Daniel Daly, assistant professor of theology.
President Obama raised the concerns and costs of end of life care this spring, when he discussed the treatment of his late grandmother, who received a hip replacement after being diagnosed with terminal cancer. "If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting,” Obama told The New York Times.
We asked Professor Daly to outline an ethical framework for making the often wrenching decisions about health care that can come in the final stages of life. He discusses the difference between ordinary and extraordinary care in the context of Catholic theology.
The Office of College Communications and Marketing welcomes suggestions for In Context interviews. If you would like to suggest a topic or have something you’d like to discuss, please contact Barbara LeBlanc or Doug Minor.
Dr. Daly:
This is fantastic and timely. I had just sent an email to the college suggesting that it I need a seminar raising controversial issues… to help me come up with practical solutions for front line patient care controversies. I called it "Doing the Right Thing"… so, what you are doing is exactly what I need. Especially if we can have a meaningful discussion surrounding real clinical scenarios.
For starters, just to see how this works, let me give you the specific example I used in my email. I will quote directly from my email. Remember, the context is based upon my request for a seminar… like the original "Interdisciplinary Seminar" I had the honor of attending as a senior biology student. Here are pieces of my email… and I quote pieces from two emails.
"I am also thinking I would like the help of the college to set up a program that would provide ongoing support for graduates… and community at large… in the arena of promoting ethical practices in science, medicine and business.
I am thinking out loud here… this is preliminary, but this could be as simple as virtual classroom… similar to the one that I had the honor of attending… starting? … what were they called… the multidisciplinary seminars… (or was it interdisciplinary?) there were only a few of us senior students and I don't remember who set it up, or ran it, but I do know these were the first seminars with the geniuses from the college… that grew into the integrated humanities curriculum that is now so much admired and copied.
In this virtual seminar that I picture, the college would assemble the smart guys, and people out in the community who need help with this stuff would apply. Applicants would send scenarios (and full registration information and money and formally register) and issues for discussion, and the smart guys from the college would respond with their opinions for discussion with the "students" who are registered. Later, there could be an "edited" blog that shares the opinions with the larger community (free?), or an electronic magazine? Blog/magazine would have to be edited by the seminar participants.
Let me give you an idea of the kinds of issues I am talking about from my point of view… from my work day. End of life issues: Specifically, I think some folks (docs) are a bit cavalier about their decisions to withdraw care from patients. Some appear to be unable to distinguish between medical killing, or active killing (AKA bad) and comfort care with no intention of killing (AKA good). I am forced to deal with these issues on a regular basis, and when I see others doing the wrong thing, I am stuck in the very difficult position of "what should I do?" So, this is the sort of dilemma that needs to be addressed… in my opinion… in this virtual seminar.
"The virtual seminar, let's call it "Doing the Right Thing," is very important to me personally, and I am sure it could be extremely valuable for graduates, friends, and the college long term.
…to help especially graduates and their families with the transition from campus to "real world". Thinking we need to work toward real world, practical application of fundamental principles acquired on the college campus… ongoing support… and help with real problems that might come up in any life… any field after graduation. I imagine this seminar, be it virtual, or real, or both, would address these issues as they arise in the absolutely real worlds of the participants. I will be the first participant for sure… I want to sign up right now.
As a Saint Anselm College graduate, I am certain that the fundamental principles learned on the campus have helped me through countless hazards over the years. The training has helped me understand with clarity what is the "right thing" to do in troubled times and in troubling circumstances. And, the training has helped me to understand and appreciate the value of doing the "right thing" and to push for proper behavior despite prevailing attitudes and behaviors. But, there is a cost that comes with the value… and there is a price of integrity. To stand alone in the face of the mainstream that is going against you… is extremely difficult… to say the least. We all know those who "sell" their integrity for "the right price" and there is always someone out there trying to "buy" the next guy's integrity.
Most of us who struggle to do the "right thing" when surrounded by (or pressured to do) the "wrong thing" need ongoing support and guidance. While there are a few who can do it alone … most of us will have at least an occasional issue that is extraordinary… and worthy of discussion and guidance that is derived from the long standing Benedictine tradition we have had the honor to share on the campus. We all need that opportunity for occasional ongoing support for and management of those special problems, and I want to help create that opportunity for myself and others."
I hope this is the start of something "good".
Looking forward to hearing a response from the experts.
Dr. Mike
Michael F. Mascia, MD, MPH
President, Infinity Health Solutions
&
Director Critical Care Anesthesiology
Associate Director SICU
West Virginia University School of Medicine
Department of Anesthesiology
Dr. Mike, thank you for your wonderful post. You confront daily, maybe many times a day, what most of us experience only once in our lives with our own parents and family members. I am not at all qualified to comment on the medical ethics debate, but know that it is a mark of a prudent person to seek out properly trained ethicists and practioners who can guide one through these moral hazards. Following one's conscience – yes, but a properly formed conscience enlightened by faith and in harmony with the teaching magisterium of the Church.
This may seem way off topic, but it is not: A book recommendation – "Peace" a short novel by Robert Bausch. It is a story set in Italy during WWII. The men are ordinary GIs confronted with the horror of war and its impact on their humanity. It is a brief, elegant story of the importance of conscience and the peace one obtains when acting in accordance with it. As John Henry Neuman wrote and I paraphrase – "our conscience is the voice of Christ speaking to us deep within our hearts"
Best regards, Stephen Ortiz, Class of 83.
Thanks so much for your insightful comments on the benefits and burdens in making end of life decisions. At Group Health Cooperative of Puget Sound, I'm involved in a program for patients and families to discuss end of life issues before the crisis occurs. This includes clarifying values, understanding the benefits and burdens of medical procedures, and how to communicate one's wishes to loved ones. After 32 years in Pulmonary/Critical Care medicine, I frequently had these deliberations with families when the patient, in crisis, could no longer communicate. My own theology is Swedenborgian but I find no differences from your Catholic theology in this area. Thanks and God Bless.
Jim deMaine, MD
Clinical Professor of Medicine
University of Washington School of Medicine
PS: I've just started my own blog on my experiences:
http://www.endoflife.com