Resuscitation Efforts Death Ritual In Western Medicine

Resuscitation Efforts Death Ritual In Western Medicine

Posted on Wednesday, May 29th, 2013 at 11:19 am by Life Matters Media

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Although palliative care and hospice service have improved the death experience for many Americans, demands for non-beneficial resuscitation efforts are still frequent, said neonatologist Kelly Stuart at the Second Annual Conference on Religion and Medicine in Chicago Tuesday.

Medicalizing the death experience promotes dualism, Stuart said, separating both body and soul and death ritual and medicine. She said dualism does not attend to the needs of the whole person.

Dualism is more common in the Protestant traditions, because Protestants are largely without rituals. The rituals have been lost since the Reformation and the growth of organized medicine. Rituals become funeral services, usually without prayers for the dead.

“Race has been a disparity in the marketplace, so being black is a negative indicator for advance directives,” Stuart said. Due to a long history of receiving less care than whites, many blacks opt for more aggressive treatments at the end of life.

Blacks are almost twice as likely than others to choose aggressive end of life treatments and decline do-not-resuscitate orders, according to a recent study by the American Journal of Critical Care.

“Predominately Protestant, there is also comfort in redemptive suffering for the black community,” Stuart said.  Thus, many insist everything medically possible be done at the end of life- giving them they care they wanted all along. Resuscitation becomes a sort of death ritual for blacks and other Protestants, almost a Christ-like experience.

The adult children of terminally ill patients often spend months fighting with insurance companies and hospitals for their parents’ medical treatment. Once treatment begins, it can feel like giving up to elect hospice or palliative care.

Only 7.5 percent of hospice patients are black- that is less than half of their population representation in the United States, The Washington Post’s Rob Stein reported in a 2007 article.

Stuart urged reform, because aggressive treatments can lead to more painful deaths. “The American death experience lacks positive ritual, and non-beneficial resuscitation has substituted for death ritual,” she said. The medical community participates in the distortion. She urged families to remove the conversation about the subject from hospitals, and instead speak of it within the context of a family’s faith.

Stuart said she finds it helpful to speak with chaplains about suggestions for non-beneficial resuscitation. “One woman told me I wanted her son to die because he was black, it really offended me. It took me a long time to get over, but you have to come with open hands and build trust,” Stuart said.


POLST Form Presented At Northwestern Memorial

Posted on Thursday, May 2nd, 2013 at 3:12 pm by Life Matters Media

Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital

Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital

“The Illinois POLST form is a step in the right direction,” said Mary F. Mulcahy, a co-founder of Life Matters Media and practicing oncologist at Northwestern University, while lecturing physicians about the form Thursday at Northwestern Memorial Hospital.

In March, the Illinois POLST form was released to the public, an effort headed by the POLST Paradigm and the Chicago End-of-Life Care Coalition. This update to the Illinois DNR advance directive aims to improve the quality of life for patients at end of life.

POLSTs, Physicians Orders for Life Sustaining Treatment, are more detailed than conventional living wills and advance directives. These forms give patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across state care settings and direct doctors to provide or withhold lifesaving treatments.

Image: POLST form

Image: POLST form

The form should be adjusted over time to fit each patient’s prognosis. “This is not a one-time thing, as patients progress the form can change,” Mulcahy said. “There should be shared decision-making between physicians and patients.” To be valid, the form must be signed by the attending physician.

In the U.S., the average patient visits the hospital more than 30 times and meets nine different physicians during the last six months of life. These patients could benefit from having their medical wishes written down and on hand; the convenience helps cut through the chaos and confusion prevalent in care settings.

POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of such forms.

“Hopefully this form will change the culture and get people talking and preparing for the end of life,” Mulcahy said.

Palliative care expert Andrew Thurston, M.D., agreed. “I think this is great. My hope for the POLST form is that it will clarify patients’ wishes for their end of life care, and that it helps doctors more effectively communicate with their patients,” said Thurston. “We need more open discussion, and with easier language, this form helps.”


Death Denying Culture Unfortunate Result Of Medical Innovation

Posted on Wednesday, April 17th, 2013 at 9:51 am by Life Matters Media

Advances in medical therapies and technological innovation have led to a “death denying” culture pervading American health care, said Dr. Susie White, an emergency medicine physician at Provena St. Joseph Hospital, during a bioethics symposium at the University of Illinois-Chicago on National Health Care Decisions Day.

National Health Care Decisions Day aims to inspire and educate the public and medical providers about the importance of advance care planning.

White speaking to a room of medical providers, caregivers at symposium on NHCD Day

White speaking to a room of medical providers, caregivers at symposium on NHCD Day

“Many older patients find themselves in a position they never thought they would find themselves in,” White said. “We have gained 30 years in our life expectancy.” Prior to antibiotics and modern therapies, most people died quickly- from infections, malnutrition or fevers.

Now, only 10 percent of Americans die sudden, unexpected deaths, and the sick and dying receive care in hospitals.

These shifts have fueled a “death denying” culture, one in which many wish to suppress or avoid any sign of aging or illness, White said. Families may grow angry at doctors- or even the patient- when treatments fail.

White maintains that palliative care can help patients and their families, and that the relatively recent medical specialty has the potential to reverse this culture of denial. “What we want to do is form a team of doctors, nurses, chaplains, anyone who might be helpful in an individual’s case and help anyone who has a life- limiting disease,” she said. “We want everyone in the family on the same page and smooth transitions.”

Most patients should not begin palliative care during the process of active dying, but rather, much earlier- even at the onset of illness, White said. “Palliative care is not hospice, but is an extra layer of support, that can go along with aggressive treatments,” she said.

The Integritas Institute for Ethics, a program of the John Paul II Newman Center, arranged the symposium, which explored the ethical challenges that arise at the end of life.


Five Wishes: One Of America’s Most Popular Advance Directives

Posted on Sunday, March 10th, 2013 at 6:41 am by Life Matters Media

Launched in 2011 by the nonprofit Aging with Dignity, Five Wishes Online has become one of America’s most popular living wills.

For a $5.00 fee, the Web site lets adults choose who they want to make medical decisions on their behalf if unable to do so, preferences for medical treatments, comfort care and social interaction.

Written with help from the American Bar Association’s Commission on Law and Aging, the form meets legal requirements in 42 states and can be used in all 50. It can be printed immediately or emailed to physicians.

With help from the United Health Foundation, the form is available in 26 languages, including Spanish, Hebrew and traditional Chinese. The less computer savvy can print out the form and fill it in by hand. There are even video tutorials and easy to navigate prompts.

First introduced in physical form in 1997, more than 18 million copies are now in circulation. It boasts easy to read language and simple explanations for those unfamiliar with medical and legal terminology.

“Aging with Dignity believes we have responsibility in our society, local communities and families to care for the most vulnerable among us – those who are sick, aged, weak, disabled, poor and isolated,” an online statement reads.

Massachusetts’ lawyers, doctors, hospices and faith communities have been providing the form because it has proven successful, the North Andover Patch reports.

Five Wishes Online is just one of a growing group of Web sites offering advice and resources for those making end of life decisions. LMM previously reported on the popularity of Prepare and The Conversation Project.


Life Matters Media Featured In The DePaulia

Posted on Monday, January 14th, 2013 at 5:59 pm by Life Matters Media

Life Matters Media’s Daniel Gaitan shared his thoughts on the Oscar-nominated “Amour” and the importance of advance care planning in The DePaulia.

Amour

Amour

‘Amour’: Discussing death and dying

How do you care for a suffering loved one? “Amour,” the sublime French-language nominee for best picture directed by Michael Haneke, encourages discussion surrounding the end-of-life by highlighting the pain one aged couple faces navigating caregiving, medical treatments and death.

Amour’s first scene takes place in an elegant Parisian apartment. Firefighters bash in the doors and cover their noses from the smell of human decay. They proceed to the bedroom, only to find a woman’s corpse wreathed in carefully arranged flowers. The rest of the film is flashback.

The apartment belongs to Georges and Anne, a posh couple in their eighties who care deeply for each other. They have been married for decades and are finally enjoying the rewards of having lived successful music careers. However one morning, Anne (Emmanuelle Riva) goes into a catatonic state during breakfast. This state triggers a flurry of health problems, including paralysis. Georges (Jean-Louis Trintignant) dutifully does the best he can to care for her. He promised he would not put her in a nursing home or let her die in a hospital. The film suggests they do not have advance care directivesa living will or power of attorney. If they did, the film would have ended much differently.

Planning for the end of life

Advance care planning involves learning about the types of decisions that need to be made in case of a medical crisis and aims to ensure an individual’s desires are carried out.

One common form of planning is a living will, a written document that tells doctors how a patient wants to be treated if incapable of making decisions about emergency treatment, according to the National Institute on Aging. A power of attorney is a legal document that names a healthcare proxy, someone to make medical decisions on behalf of a patient unable to do so.

Read the rest at The DePaulia