NEW ORLEANS — With major portions of the Affordable Care Act, also known as “Obamacare,” taking effect earlier this month, issues of medical ethics and care continue to garner headlines across the United States.
Recognizing that intensifying national debate, the Louisiana Right to Life Federation, along with the Institute for Faith and the Public Square and the Baptist Center for Theology and Ministry at New Orleans Baptist Seminary, hosted a panel discussion Sept. 17 focused on end-of-life health care issues.
The event, titled “Who Lives, Who Dies, Who Decides,” was held in the seminary’s Leavell Center. Experts featured on the panel included Burke Balch from the National Right to Life Committee; Dr. Jeff White, a cardiologist and chair of a medical ethics committee for a health system in North Louisiana; Father Jose Lavastida, pastor of Blessed Francis Xavier Seelos Parish and executive director of the department of Christian formation for the Archdiocese of New Orleans; Marie Wirfs, nurse practitioner and nursing education professor at Southern University; and Steve Lemke, provost and ethics professor at New Orleans Seminary, who also has served as a chaplain in a hospital setting and on bioethics committees for hospitals.
Ryan Verret, assistant director of the Louisiana Right to Life Federation, emceed the panel discussion and guided panelists through three case studies.
The first case involved a woman who experienced severe complications during childbirth. She suffered quadriplegia, developed hypertension and diabetes, and eventually required regular dialysis. About a year later, she suffered cardiac arrest, was resuscitated, but remained comatose.
The treating physician felt that continuing treatment presented only a 1 to 5 percent chance of the woman regaining consciousness and recommended stopping life-sustaining care. The family refused. The physician then appealed to a morals and ethics board at the hospital, which had a policy for discontinuing care if the chance of recovery was minute. The board ruled in favor of the physician, who despite family opposition, stopped treatment. The woman died the same day the ventilator was removed.
Lemke said that, while he considered this a rare case, it does present a word of warning for physicians.
“In my experience, this is a rare phenomenon which could be called ‘physician paternalism,’ that is the physician knows best and it really doesn’t matter what anybody else thinks,” he said. “I think it’s very rare because usually the physician would want the consent of either the patient or their surrogate decision maker.”
He added that, while the family has every right to desire full and intensive treatment, cost is an issue that must be dealt with.
“It’s just a realistic decision that has to be made,” he said. “We don’t want to quantify life and say it’s worth X number of dollars, but I think you do have to have some idea of who’s going to pay for it.”
Wirfs wondered where the other medical professionals were during the process of terminating treatment.
“Where is the person in charge of the units where this person resides? Where is the chaplain? Where is the attorney?” she asked.
Wirfs added that this case exemplifies the importance of every person having a living will and an advance directive for medical care.
“Did she think this was going to happen to her when she went in to have a baby? No,” Wirfs said. “But how many of us in this room have advance directives at home that a family member can pull out and say, ‘This is what mama said she wanted if these circumstances presented themselves?’”
The second case involved a 58-year-old British man who suffered a massive stroke that left him with limited motion, the ability to only eat soft foods, and no prospect of improvement. He was identified as severely depressed and later sought the legal right to end his life, with assistance. His request was denied, but he died six days after a court ruled against his motion.
Lavastida identified one type of treatment the case didn’t mention the man receiving – treatment for his depression.
“When those symptoms are dealt with, there’s a very different scenario that develops. I think the worst thing you could do in a case like this is to abandon this 58-year-old man to the misery he feels and not address the underlying issues that may have to do with psychology and depression,” Lavastida said. “Even though we can understand his cry, the solution is not to let him go but to address what he’s really dealing with.”
Balch pointed to statistics that seem to indicate that, if a person is counseled away from his or her desire to commit suicide and treated for underlying issues, the chance of that person attempting suicide again drops significantly.
“What we know, for example, is, if someone attempts suicide and is stopped, five years later less than 4 percent have gone on to kill themselves,” he said. “And 50 years later, less than 10 percent have gone on to kill themselves.
“This suggests there’s a great deal of changeability and ambiguity in what appears to be a clear desire or decision to commit suicide,” Balch continued. “We have other statistics that show 94 to 95 percent of all the people who commit suicide can be shown to have been suffering from some kind of judgment impairing, diagnosable mental disease of some sort.”
The third case involved a college student who was hit by a car while riding his bicycle, left comatose in a vegetative state, but was not brain dead. With little hope of the student’s recovery, his family requested that he be able to donate nonessential organs even though he was not on record as an organ donor.
Wirfs pointed out that the viability of donated organs is crucial to successful transplants. The longer the person’s illness and decline in health, the less healthy his or her organs will be at the time of transplant, she said.
“I see viable organs here that could do a world of good for a lot of people,” she said.
Balch, though, cautioned against being too quick to harvest organs from someone who is still alive.
“The question is – and we’ve heard this point raised – if we’re going to maintain the notion that we’re not going to become utilitarian, that we’re going to recognize the inherent dignity of each individual human being … then we really have to be careful about not breeching that wall,” he said.
Lemke reiterated the point that the case should prompt people to consider their desires for end of life care and organ donation – and to put those in writing.
“It also is a reminder to everyone in this room that you need to make your own decisions, to have a living will and advanced directives. Make a decision and put it on your driver’s license about organ donation,” he said.
Following the event, Lloyd Harsch, director of the Institute for Faith and the Public Square, said the huge attendance demonstrated the timeliness of the topic.
“The packed room for the panel discussion is ample evidence that medical ethics issues are on the forefront of many people’s minds,” he said. “Ministers of all kinds will be confronted with these issues, most often in unexpected ways. It is important to have thought through the issues and the consequences of certain action before the crisis arrives.”
Adam Harwood, director of the Baptist Center for Theology and Ministry, concurred: “In the pastorate, our students will face these medical ethical issues on a regular basis. Families will come to them for counsel about how to answer complex questions regarding issues such as the use of do-not-resuscitate orders or life support. Pastors need to be able to address these difficult questions from a biblical perspective.”
Lemke echoed that call for ministers to be prepared to guide families through end-of-life decisions from a Christian point of view.
“As families are facing pressure to make hard decisions about the health care of family members, they and their ministers need guidance about how to deal with these challenging choices from a Christian perspective,” he said.
For more information on the Louisiana Right to Life Federation, the Institute for Faith and the Public Square or the Baptist Center for Theology and Ministry, follow the links below.