Dr. John Brofman loves his job, but he doesn`t always love the dilemmas it creates.
As the associate medical director of the ventilator support center at Suburban Hospital in Hinsdale, Brofman has intervened in the dying process countless times, when prolonging life through artificial means seemed senseless.
”I remember every time I`ve withdrawn support because they have affected me quite profoundly,” Brofman said. ”I even write letters to these families who have made the decision to take their loved ones off ventilators because I think they have a hard time dealing with it. They need to know what they`re feeling is okay.”
Recently Brofman had two lengthy discussions with the sister of a 75-year-old stroke victim, who was comatose and was being kept alive on a ventilator. Although the woman had not seen her brother for years, she was his closest relative, and the decision to continue treatment rested on her shoulders.
Brofman said the woman was torn with anguish, and he offered medical information and compassion to her.
”She felt guilty. She felt alone. And she really needed support,”
Brofman said. ”I explained to her that it was important to do what her brother would have wanted. I asked her, `Would he elect to continue like this or have support withdrawn?` ”
Eventually the woman decided to release her brother from the ventilator. Shortly after the machine`s humming ceased, the man died.
As advances in medical technology make their way into suburban facilities, scenes like this are being played out with increasing frequency at hospitals throughout Du Page 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.
”In many cases technology is simply interrupting the process of death. And when we`re prolonging death and not adding to the quality of life, then decisions must be made,” Brofman said. ”Many people still believe where there`s life there`s hope, but everyone dies and sometimes we have to accept that we don`t have control over everything. I think that technology that prolongs death is worse than dying, and we need to change our focus from life at all costs to quality of life.
”When people are robbed of all the qualities we associate with human beings, one can argue that life is meaningless. Prolonging life for life`s sake should not be our goal.”
According to Brofman, some doctors have had difficulty maintaining pace ethically with the explosive technological surge of late. While physicians are inching along, technology has progressed in leaps and bounds. But criticizing science is not the answer, nor is placing the blame on physicians.
”Technology is neutral. How we apply it is good or bad,” said Chaplain Dan Sullivan, director of pastoral care at Copley Memorial Hospital in Aurora. ”Unfortunately a lot of times we expect perfection and sometimes expectations on physicians are unreasonable. Doctors are human, too. They don`t have crystal balls.”
Sullivan said because physicians are often unable to predict the long-term outcome of the patients they place on ventilators, treatment is begun with the hope that the patient`s condition will improve. But as the prognosis dims, doctors and families find themselves asking some painful questions.
”Patients and physicians are beginning to weigh the down side of technology and they are asking, `Should we really do this?` ” Sullivan said. ”Family members fear making their loved ones suffer, and doctors are beginning to wonder, `Just because we have this equipment is it always right to use it?` ”
Although the physician`s inability to pinpoint long-term outcomes still exists, their ability to diagnose and treat illness has improved greatly in recent years.
According to Dr. Julius S. Newman, vice president for medical affairs at Copley, the progress is simply amazing, and what doctors are able to do today would stun their medical forefathers.
”We now have better medication, better diagnostic tools and doctors are trained better in school. We`re seeing more aggressive use of ventilators, transplants and renal dialysis,” said Newman, who has been practicing medicine 41 years. ”We are able to do incredible things and for the most part we believe if there is an opportunity for improving quality of life we should do what we can.”
But Newman added that progress has its negative side as well. He said that sometimes the aggressive care simply prolongs the patient`s death, and many doctors who place patients on ventilators are reluctant to remove them.
Additionally, because treatment is available now to people who just a few years ago would have died at home in the arms of loved ones, 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 is 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. And behind each story stands a doctor who may be providing costly, aggressive treatment for fear of litigation.
”A lot of people will say, `Cut back on technology, cut back on surgery, but if it`s my family, do everything,` ” said Dr. Victor Zuckerman, a pediatrician at Central Du Page Hospital, Winfield, with expertise in critical care. ”The patients demand the highest technology. Patients want that. They expect it. And you can be sure if you don`t offer them every available test and something goes wrong, their lawyer is going to be asking you about that.
”So a lot of what we do is for the patient. A lot of what we do is for the advancement of medicine. And a lot of what we do protects us from getting sued.
”But we have to come to grips as a society, as a nation, as a culture, with the fact that somewhere you have to draw the line,” Zuckerman said.
”Doctors see death as losing. Patients see death as losing. But death is a process, and sometimes dying may not be the worst of all scenarios.”
According to Father William Grogan, an ethicist and consultant to numerous hospitals including Hinsdale Hospital and an attorney with Hinshaw and Culbertson, what is as bad as death is not being able to make sense out of what is going on. He said one of the patient`s greatest fears is suffering and no longer being in control of his life. Grogan said this is where doctors need to step in, to ease fears and offer support.
”It`s difficult for us to come to grips with the reality that we are limited human beings, and equally difficult to make sense of the suffering,” Grogan said. ”The real challenge of health-care professionals is to be able to enter into that suffering with the patient. But it requires a tremendous amount of moral depth, and not all doctors are able to provide that.
”Doctors can`t always make their patients better, but they can say, `I will be with you in your suffering.` And they can help them realize that one way to be in control is to let go.”
