ETHICS: by David PerrinNews Weekly
New safeguard for vulnerable patients
, April 28, 2007
How can patients admitted to hospitals best express their wishes about their future health-care needs, asks David Perrin.Many people today when going into hospital are faced with having to sign forms to outline their wishes if at some stage they are no longer able to instruct their health-care professionals.
These forms are called advanced medical directives or future health care plans, and their purpose is to predetermine what medical procedures should be carried out in the event of a patient's loss of consciousness or ability to communicate.
These plans aid health-care professionals by giving them clear instructions to follow when a patient is unconscious, in a coma or unable to express his or her wishes. They also allow the patient to appoint an agent to act on his or her behalf.Medical complications
There are of course a number of risks in anticipating medical complications in advance of their possible occurrence.
No one should be compelled to provide instructions about future medical care. Any guidance should avoid being too prescriptive.
Those in the process of dying should not expect to control their dying process fully.
If an agent has been appointed to look after a patient's interests, it is important to allow those appointed to be free to respond to the course of an illness as it unfolds.
Many people trust their families and their health-care professionals as they have traditionally done for hundreds of years.
One key factor is that a patient must have good and long-term trust in the health-care professionals that they use to help them.
Secular hospitals, aged-care professionals, courts and health-care professionals generally accept the world view that in making decisions about medical procedures what counts is the quality
of life of the patient.
Religious authorities, however, uphold the sanctity
of life as a key principle in making decisions about medical procedures.
Given the continuing debates over euthanasia, doctor-assisted suicide, patient rights and medical treatment, it is important for patients to state explicitly that they require life-sustaining treatment that is reasonable unless it becomes futile or overly burdensome.
To help patients in this situation, Catholic Health Australia has recently released a Model Statement For Future Health Care
suitable for use by a person of any religion or none.
The statement gives patients the opportunity, if they so wish, to specify their future health care needs. It allows the appointment of a patient's agent and the disclosure of any degenerative illness.
The statement's instructions specify:-
1. I wish to be given appropriate care to sustain my life, to cure disease, or to reduce deterioration in any physical or medical condition that I suffer.
2. I know that death need not be resisted by every possible means. I ask that I not be given any treatment that would not sustain me, or give me comfort, or relieve a condition that I have, or would be overly burdensome to me or to others.
3. I ask that I be given adequate palliative treatments to manage uncomfortable or distressing symptoms, while maintaining as much function as possible, especially lucidity, during the dying process. If the only way to manage my distress is with treatments that have the side effect of reducing lucidity or even shortening life, then I am prepared to accept these consequences.
4. I wish to be provided with food and fluid, and with other basic means of sustaining my life and making me comfortable, for as long as I need them. This may need to be done by tube, unless and until such methods of treatment and care are ineffective or are overly burdensome.
5. I do not want my life to be ended, or my death to be hastened, by any act or omission that is intended to cause my death.
6. When it is thought that I am in the final stages of terminal illness or injury, or that my death is imminent, I ask that all reasonable steps be taken to allow me to be with my family and to be reconciled to anyone from whom I have become estranged, and if it is impracticable, that I be allowed to die at home or at least in a home-like hospice or other institution.
7. In my medical care, I wish to follow the rites and teachings of my religion (to be stated). I ask that I be given pastoral care and the appropriate ministry, both early in the course of my illness and again when death approaches.
This new initiative, which can be used by any person of any religion or none, can be downloaded from www.cha.org.au
or by writing to Catholic Health Australia, PO Box 330, Deakin West, ACT, 2600.- David Perrin is national president of the Australian Family Association.