Taking On The Ethical Questions Of Healthcare

By Jan Howard

Members of Ashlar of Newtown’s Ethics Committee discussed the legal and medical ramifications of a hypothetical case history during a Lunch and Learn program, “Ethics in Today’s Healthcare Environment,” February 15 at Ashlar.

About 40 persons listened as the committee discussed the need for a person to make decisions about advance medical directives, such as a living will and a Do Not Resuscitate order, and to appoint a health care agent. The health care agent would make decisions regarding care if a person was unable to do so on his/her own behalf. The committee also discussed the need to advise family members about health care and organ donation wishes.

The attendees also had the opportunity to talk about the issues and to ask questions of the panel during analysis of the case history.

Ashlar’s Ethics Committee was formed more than ten years ago. It is comprised of the following members: Tom Gutner, president of Ashlar of Newtown; Ann Battzell, chaplain; Lynn Mora, social services; Brenda Fegley, resource assessment coordinator; Carol Carlson, assistant director of nursing; Angela DiLillo, director of nursing; Carl Anderson, recreation manager; and Doris Yocum and Ray Cooley, community representatives. The committee meets once every two months.

Mr Gutner said changes in the nation’s demographics would occur when the first baby boomers reach 65 ten years from now. By 2010 the nation will have 39 million people over 65.

“America is aging,” he said. “We’ve known that for some time.” He said with the baby boomer age wave, end of life issues will be brought even more into focus.

“The focus will be on quality of life issues,” he said, and concern for the right behavior, or ethics.

He said Ashlar’s Ethics Committee confronts a wide range of decisions of an ethical nature. The committee consults, advises and educates but does not make policy, though committee deliberations and the consensus reached by its members may influence new policy or change existing policy.

“When we reach a consensus, we don’t tell a physician or the nursing staff what to do. They are the professionals,” he said. “We don’t get personal. We focus on issues perceived to be ethical, rather than the individuals.”

Ms Mora discussed the need to draw up advance medical directives, such as a living will, to describe what kind of medical care the person desires in case of terminal illness or permanent unconsciousness. The living will can be revoked at any time.

In Connecticut there are three types of advance directives: the living will, appointment of a health care agent and appointment of an attorney-in-fact for health care decisions, which is also called a durable power of attorney.

The health care agent is a person authorized in writing to convey a person’s wishes concerning the withholding or withdrawing of life support systems.

  The attorney-in-fact for health care decisions is a person named in writing to make medical decisions other than withdrawal of life support if a person is unable to make or communicate such decisions. The same person can be named to be the health care agent as attorney-in-fact for health care decisions.

A Do Not Resuscitate Order, meaning no CPR is used, is accepted by physicians and hospitals in all states, Ms Mora said. It can be revoked at any time.

In the case of organ donations, a person may select who receives the gift through a will, in writing and on a driver’s license.

Decision on advance directives is a personal and individual decision, Ms Mora said. “Consideration should be made for the future,” she said.

Ms Battzell outlined the basic principles of ethical decision-making. They are:

Autonomy – The nursing home resident’s right to make her/his own decisions about care. The resident should have the final say as long as he/she is competent to make the decisions.

Beneficence – Emphasizing what is best for the resident, and “first do no harm.”

Quality of Life – Is the resident able to participate in life in some meaningful way? “This is a very individual thing,” she said. “How basic can that get and at what point?”

Individual rights versus rights of others – How do you weigh both needs and rights in a fair way?

Justice – Allocation of scarce medical and financial resources. “How do we balance a patient’s needs against other people’s needs?” she said, especially when the financial resources for a patient are the financial obligations of others.

The hypothetical ethics case discussion centered around a well-dressed man in his 60s who is found unconscious by a passer-by on the sidewalk. He has no identification. He is rushed to the hospital, where he is admitted and tests are performed, which determine he has a cardiac problem that requires surgery. His chance of recovery is 50 percent with the surgery.

After a search, family members are located, but his three children have had no contact with their father for many years. A daughter flies in, identifies her father, but is unaware of any health problems he has had.

The hospital is seeking permission to put him on life support and to perform the operation.

Questions discussed included: Is anyone a health care agent for him? Does he have a Do Not Resuscitate order? Has he discussed his health care wishes with anyone? Does the daughter have the right to make the decision about the operation? Can he be taken off life support?

The program is part of a series of free seminars for mature adults about living and aging well. The March 21 program, which will be a Breakfast Lunch and Learn at 8:30 am at Ashlar, will feature Rep Julia Wasserman, who will present an update on the Connecticut legislative session.

 To register or learn more about other upcoming programs, contact Hilda DeLucia at 203/364-3127.