MGordon_MD
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Oct 20, 2010, 1:17 PM
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By Dr. Michael Gordon
It was 1968 and I was a medical resident at the Royal Victoria Hospital in Montreal. The head nurse called me because one family was about to light a candle in their mother’s room.
The nurse said: “He says it’s part of the ritual of waiting for her to die, and the family is prepared to gather, to say prayers, sit a vigil and light a candle. I explained that he can’t but he says, I cannot stop him. I am afraid of a violent outburst.”
I responded to the call. I sat with the eldest son and his siblings and explained that if a candle were lit, the fire department would be called and they would come and extinguish and disrupt the important part of the dying process – the vigil. We together agreed to use an electric Jewish Sabbath candle as a symbolic replacement for the real candle. The woman died peacefully and the family could carry out their ritual.
An article in the Feb. 11 issue of the New England Journal of Medicine questioned whether it might be ethically acceptable to perform “futile” CPR on a child as a way to deal with the parents’ need to be certain “everything possible was done” and to help them deal with of their loss. The article ends with the following, “In a small number of cases, providing non-beneficial CPR can be an act of sincere caring and compassion. Futile CPR has a limited but legitimate place in the practice of medicine.”
Many clinicians and ethicists might find such a suggestion anathema to ethical decision-making, as one might ask, “Why stop at CPR? What if the family wants other non-beneficial procedures undertaken and why stop at children – why not adults and elders?”
The core question seems to be: why is there a need to use modern medical technology as a means of satisfying the emotional needs of parents, siblings or children facing the imminent death of a loved one?
In the field of aging, it is increasingly common for elders to die in hospital settings connected to electronic monitoring devices and to receive interventions such as intravenous or subcutaneous fluids or antibiotics, or receive CPR, even when it’s abundantly clear the benefit from the interventions will not change the comfort level or prognosis in a substantial way.
As a clinician-ethicist, I am often asked to discuss the reasons to forgo end-of-life CPR when a family member cries out to staff members, “I can’t just let my mother die without doing everything possible to save her or bring her back to life.” I have heard similar comments when artificial nutrition and hydration is explained. “I can’t let my father starve to death,” a family member may say. This is even when it’s clear that the underlying illness isn’t going to change its course by the provision of tube feeding.
I get a strong sense that the reason these interventions are asked for is that they are the modern substitute for the traditional rites and rituals that previously surrounded the dying process. Death rarely occurs at home, and the modern institutional setting is replete with technologies that appear to have no limits of perceived benefit – even when, in fact, they do not.
Prayers, chants, incense, candles and vigils have unfortunately been replaced by non-beneficial CPR, tube feeding, intravenous fluids and end-of-life antibiotics as the means we use to demonstrate our devotion to those we love who are leaving us forever.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on Oct 20, 2010, 1:35 PM)
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