Mercy explains policies on terminal patients

By Dr. Mark Valliere

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A Dec. 26 guest column by Niles Ross did not put Mercy Medical Center's position regarding advance directives in proper context. Mr. Ross's review of the website was accurate, but the assertion that undesired care would be forced on a patient with a terminal condition, or when the patient or family feel the burden exceeds the benefit, is incorrect.

Mercy is a Catholic hospital and as such does adhere to the Ethical and Religious Directives. The ERD's maintain that all life is sacred from conception to natural death and is worthy of being maintained. This would include the use of artificial hydration and nutrition when indicated.

What was not discussed in the Ross column is that the ERD's go on to describe conditions under which it is considered permissible to withhold or withdraw medically assisted nutrition and hydration: “Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be excessively burdensome for the patient or would cause significant physical discomfort, for example resulting from complications in the use of the means employed.” (ERD No. 58) This applies to all patients, including those in a vegetative state.

A decision is made after discussions among the patients, their families and their health care providers. A patient's own advance directive is taken into consideration when the patient cannot personally participate in the discussion. T

The role of the Mercy Ethics Committee is to facilitate these discussions, be a resource and help the parties reach a decision. As Mr. Ross stated, the committee “provides guidance” - it does not direct care. Sometimes the decision is to not provide artificial nutrition and hydration. This is quite common in terminal conditions when the provision of hydration or nutrition will not alter the outcome of the disease process. In such cases, Mercy offers options for end-of-life care, such as our Palliative Care Team, Home Hospice program and the Dennis and Donna Oldorf Hospice House of Mercy, to maximize the quality of life and comfort of the patient.

It is common in most surgery centers, including at Mercy, to suspend advance directives at the time of a surgery. Surgeons and anesthesiologists cannot appropriately advise patients on the risks and benefits of a surgery if they cannot use the full complement of resources available to them. If there are extenuating circumstances, such as a surgery done only to provide comfort to a terminally ill patient, this should be specifically discussed with the surgical team so the advance directive can be kept in place.

The goal of the staff at Mercy is to provide high-quality, compassionate care to all people. In order to help your health care provider recommend the type of care you want to receive, I would strongly encourage anyone who does not have an advance directive to prepare one. We at Mercy are happy to discuss concerns on end-of-life decisions with any of our patients, families, providers and community members.

Dr. Mark E. Valliere is Senior Vice President for Medical Affairs/Chief Medical Officer, Mercy Medical Center, Cedar Rapids. Comments: mvalliere@mercycare.org