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Hawaii Healthcare System Develops a Manual For End-of-Life Care
"Keep her alive," the senior resident physician barked. "We mustn't lose her. Her family and attending physician want everything necessary done."
The intern approached the bed and looked at the patient, an elderly woman who was unconscious and paralyzed from a stroke three weeks before. Afflicted with the failure of multiple organs, the woman already had many tubes attached to her body. Now one of her lungs had collapsed, and she would need a chest tube inserted to help her breathe.
The intern knew the woman would die without the chest tube. But even with it the prognosis was grim. At best, he knew, she had no more than six weeks to live.
During a previous hospital stay the woman had apparently told a nurse that she wanted no "heroic measures" performed for her. But she had left no advance directive.
Why the intern wondered, do we insist on keeping her alive?
In 1996, the leaders of St. Francis Healthcare System (SFHS), Honolulu, convened a brainstorming session for people concerned about end-of-life care issues. The leaders called the meeting because they knew that Americans were finding such issues increasingly worrisome. A recent study had shown that at least half of terminally ill patients suffered significant pain, their wishes concerning their care either unsolicited or ignored by caregivers.' A recent poll had indicated that 60 percent of the population feared pain, indignity, and loss of control in the final days of life.2
About 25 people-including physicians, nurses, managers, administrators, and parish and community representatives-attended SFHS's meeting. They identified 10 issues as, though poorly understood, essential to the care of the dying:
Decision making
Pain management and comfort care
Pastoral and spiritual care
Psychosocial care
Hospice and home care
Cardiopulmonary resuscitation
Futility
Withholding and withdrawing treatment Artificial nutrition and hydration Physician-assisted suicide and euthanasia The meeting's participants decided to write an end-of-life care manual that would be a resource for staff throughout SFHS. The Ethical and Religious Directives for Catholic Health Care Services would serve as the manual's ethical foundation, the participants determined. Noting the directives' commitment to holistic healing"Since a Catholic health care institution is a community of healing and compassion, the care offered is...
