Honor and Respect in Healthcare

Rabbi Richard Address

We are in the midst of a longevity revolution and that’s presenting challenges for us all.

Rabbi Richard Address is the director of the Department of Jewish Family Concerns for the Union for Reform Judaism based in New York City. He was in Kansas City recently for presentations on honor and respect in healthcare. Lorell LaBoube visited with him about those issues on this edition of the Bioethics Channel.

Link to podcast here.

Good Facts = Good Ethics. Right?

Rosemary Flanigan

February 10, 2010

When all our ethical analysis models stress, “Be sure of the facts,” we all know how twisted the meaning of “fact” can get.

Think of the distortions made by presuppositions, beliefs, years of bias. What if a beloved daughter brings home a grubby, tattooed, slouchy fellow and announces they’re engaged? Who IS this new son-in-law-to-be?

At the end of a patient’s life, the very meaning of “life” can be different for patient and family than it is for clinicians—one sees living; the other may see dying. And it helps to try to suspend all interpretations of the two words in order to try to agree on what “living” and what “dying” really mean in themselves.

A Dying Man and Sophie's Choices

John Carney
February 2, 2010

I want to express my sympathies to Alicia on the death of her father. I’d also like to extend my apologies to her and posthumously to him – for making them responsible for decisions that should have never been theirs to make.

Dying is hard enough work for patients and families without our making it harder by throwing every mechanical obstruction we can in its path. That is not the art of medicine, it is technological abandonment. He died tethered to machines, she supposes, because he chose to.

Is that really true? We in health care conspired to allow his dying a death unimaginable a few decades ago. It was not only a “mistake” as she suggests, but it was preventable, for it is not a dying man’s job to make Sophie’s choices.

We are not allowed to torture a beleaguered soul out of a false notion of patient self determination. When a medical intervention cannot serve the purpose it was designed for, cannot approximate an acceptable standard or achieve a goal of care we should not impose it.

We have no obligation to offer, recommend or even suggest care that patients cannot benefit from, and we should avoid putting patients on “mechanical paths to death.”

At some point, supporting this daughter and her father requires that we face the inevitability of his dying with them, compassionately, honestly and ethically. Yes, it would have been wrong of her to tell us that he didn’t want to be intubated when he did, but that decision should not have dictated all others.

It was her job to tell the truth when asked about her father’s treatment preference - especially given that particular intervention’s success previously. But it is our job to ensure that we honor preferences in meaningful and reasonable ways.

We are obliged to offer patient centered care, not patient directed care. Prolonging his dying six months served whom? Autonomy run amok is as disrespectful of the patient as is paternalism.

Yes, Alicia, your role was to support your father, and our role was to support you. You may have upheld your part of the bargain, but unfortunately we let you both down by allowing our “support” to create unforeseen burdens while misusing valuable resources in the name of acceptable.

Link: An Ill Father, a Life-or-Death Decision, Alicia von Stamwitz, New York Times
January 25, 2010