Susan Warmouth-Oleson loves her job, but she doesn`t always love the dilemmas it creates.
As patient care director of critical care at Victory Memorial Hospital in Waukegan, Warmouth-Oleson has watched nature take its course in the dying process on countless occasions. But recently, she has seen that process slowed.
”We have technology which helps us prolong the dying process, but the problem is that most people who say, `I want everything done for my mom,`
don`t realize that everything is only prolonging death, it`s not delivering quality of life.”
Warmouth-Oleson recalled a case that exemplified her point. She said that an elderly man with end-stage cancer allowed himself to be kept alive because his wife could not bear to lose her lifelong partner. Although nothing could be done to cure his cancer, surgery was performed to make him more
comfortable. Following surgery he was placed on a ventilator while the hospital staff waited for his wife to let him die.
”We gave him another month of life because his wife simply wasn`t ready to give up,” Warmouth-Oleson said. ”He allowed us to do this because he knew she couldn`t let go. He committed himself to our technology and in doing so he suffered so much more than he had to.
”Years ago the family doctor would have said, `There`s no more we can do.` But now we have technology which helps us prolong the dying process, so we use it. But you don`t have to be a nurse very long to realize that dying is not the worst thing that can happen to you.”
Eventually the man`s wife decided to release her husband from the ventilator that had been holding him hostage. Forty-eight hours after the machine`s humming ceased, the man died. ”We waited for her to be at peace with the decision,” Warmouth-Oleson recalled. ”They were so much in love.” As advances in medical technology make their way into suburban facilities, scenes like this are being played out with increasing frequency at hospitals throughout Lake County. And while health-care professionals agree that the benefits of medical technology far outweigh the disadvantages, they are quick to add that ethical dilemmas are the outgrowth of this wave of ingenuity.
”The problem I see with advanced technology is that ethical development has not kept up,” said Sister Christine Bowman, chairwoman of the ethics committee at St. Therese Medical Center in Waukegan and chairwoman of the corporate ethics committee for the Franciscan Sisters Health Care Corp.
Bowman, who has worked in health care since 1964, said the definition of heroic treatment has changed dramatically during the last 30 years. ”At one time extraordinary care was IV therapy,” Bowman noted. ”Now that`s pretty common and doctors are able to do other incredible things.”
Experts say these incredible leaps forward are due primarily to advances in medication, equipment and diagnostic techniques. According to Warmouth-Oleson, the progress is amazing, and it`s keeping sicker people alive longer.
”Those on the floor (in regular rooms) today would have been in ICU five years ago,” Warmouth-Oleson said. ”Those in ICU today would have been dead five years ago. They would have been non-salvageable.”
But Warmouth-Oleson added that the progress is not all necessarily beneficial. Treatment is available now to people who just a few years ago would have died in the arms of loved ones, so the price tag is high financially as well as emotionally. And it`s not just elderly people who, some would argue, are not being allowed to leave this world with dignity. It`s also premature infants with imperfect lungs and young adults, who are more likely to be involved in automobile accidents and sustain head injuries, who lie motionless in hospital beds across the country.
These examples describe helpless patients whose loved ones are also trapped in limbo, unable to accept the inevitable.
”Many patients may be (connected to ventilators) longer than medically appropriate, but so often family members are fearful and they have a very difficult time letting go,” said Rev. George Franke, director of pastoral care at Victory Memorial Hospital in Waukegan. ”We have to respect the families` wishes as much as we can. And it`s important to care for the family as well as the patient.”
Franke said that when family members need support they sometimes turn to the hospital`s ethics committee, which he chairs. The committee provides consultation to those faced with moral and ethical dilemmas.
Ethics committees are forming at hospitals across the country with increasing frequency. Lutheran General Hospital in Park Ridge has gone a step further by establishing the Center for Clinical Ethics, which occassionally offers services to physicians at other hospitals. Dr. John La Puma, director of the center, has served as a consultant on right-to-die cases. According to La Puma, the ethicists at the center are hearing increasing numbers of questions about care near the end of life.
”The drive for survival is probably our strongest and I think it`s probably undervalued,” La Puma said. ”For a long time medicine was just focused on survival, but patients are telling us that quality matters just as much, and in some cases more. That`s a new facet for medicine to focus on: how to improve quality of life and not just survival.”
La Puma`s colleague, Deerfield resident Dr. Robert Moss, agreed. ”We may be adding to the number of years we live to the exclusion of quality,” said Moss, co-director of geriatric medicine at Lutheran General Hospital and senior associate at the Center for Clinical Ethics. ”As the prognosis dims, it`s helpful for families to talk about the goal of treatment. Restoring someone to health may be impossible. For someone who is suffering, prolonging life may not be the answer, providing comfort may be the answer. It should be based on an individual`s needs and wants.
”Sometimes it`s okay to let go. Sometimes the treatments are more burdensome than the disease.”
