Ministers urged to help in life-support decisions

November 19, 1992|By Kerry O'Rourke | Kerry O'Rourke,Staff Writer

Edith decided to put her 67-year-old husband on a ventilator after he suffered a heart attack last year. Two days later, she decided to take him off the artificial life support.

He died five days after the ventilator was removed.

"It's a terrible decision to have to make. I feel for anyone who has to do it," she said during a panel discussion yesterday at Carroll County General Hospital.

The woman, a Carroll resident, asked that her real name not be used.

"Ventilators are powerful machines and are able to maintain life when there is not life," said the Rev. Cliff Webner, pastor at Taylorsville and Salem United Methodist Church.

The machines are so powerful, he said, that they're sometimes seen as monsters.

About 25 clergy members attended the panel discussion, which was part of a seminar at the hospital on helping families decide whether to place relatives near death on artificial life support systems.

Even though her husband died about 18 months ago, Edith said she remembers her decisions every day.

"I just prayed every day for God to take him," she said. "I'll never get over it.

"I hope and pray my son doesn't have to make the decision for me. It hurts."

Pam Shafer, a registered nurse and assistant vice president for quality assurance and risk management at Carroll General, said that a living will -- in which the patient has left specific instructions about whether he or she would want artificial life support -- helps families make decisions.

In certain situations, without such directives, the state has the power to weight decisions toward sustaining life, she said.

"The point is to remember we want to keep the lawyers and courts out of it," Ms. Shafer said.

Hospital chaplain Mary Shimo said that pastors can help families and sometimes can say what relatives may be thinking but are afraid to say.

Families who have been through traumatic experiences have remarked that their pastors were there but didn't say much, she said.

She suggested that pastors can use humor to ease tense situations.

"It's OK to help them laugh," Chaplain Shimo said.

Pastors also can help families by encouraging them to talk about a relative who is hospitalized, thus helping them remember the good times, she said.

Pastors can also help family members understand what doctors tell them about their relative's condition, Sharon Gomes, a registered nurse, said.

"You're important," she told the ministers.

Carroll County General has an ethics committee that is sometimes consulted when families must make decisions about life support. The committee of about 15 members includes clergy, doctors, nurses, administrators, a social worker and Chaplain Shimo.

Ms. Shafer said that most life support decisions are made by doctors and family members, and that it's rare to take a case to court.

Dr. Natvarlal Rajpara, a respiratory specialist and chairman of the hospital's critical care committee, said that patients' families sometimes want to continue medical treatment even after doctors have determined it would be futile.

"Families tell us to do everything," he said.

Doctors must do what is in the best interest of the patient, but it's hard to go against a family's wishes, he said.

"The first principle we have in medicine is, do no harm," Dr. Rajpara said.

One seminar participant asked whether insurance companies have a say in decisions on how long to keep a patient on a ventilator.

Ms. Shafer said she has not heard of a case in which an insurance company said it would no longer pay for a patient's critical care, which can cost $1,000 a day.

But Connie Miller, pastor at Grace Lutheran Church in Westminster, said that could change. The issue of "ethical decisions vs. dollars" probably will be fought out in the courts, she said.

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