What would happen if ... (end of life questions)

By Niles Ross

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In the race for patients, among the various local hospitals, most particularly the current competition for cancer care, one item is not discussed. What happens if ...

The Outpatient Surgery Center of Cedar Rapids http://www.surgerycentercr.com/ has, on its web page, a PDF file that can be downloaded by clicking on “Medicare Conditions for Coverage.” Well, it contains much more than simply Medicare conditions. The PDF file states, on its first page: “POLICY ON ADVANCED DIRECTIVES: Surgery Center Cedar Rapids does not recognize advanced directives and will use all measures possible to sustain life. If an emergency transfer did occur, all chart information would be copied and sent with the patient to the hospital. Because of this, if you have an advanced directive, please bring a copy of this to be placed within your medical record at SCCR.”

Oops.

What happens if ...

Mercy Medical Center Hospital, http://www.mercycare.org/, under Organizational Integrity http://www.mercycare.org/about/organizational-integrity. aspx has a PDF file called - Code of Conduct. Page 30 of 40 states: “The purpose of the Ethics Committee is to provide guidance in the conduct of business and the provision of care and services in accordance with the Ethical and Religious

Directives for Catholic Healthcare Services and to assure adherence to the mission and values of Mercy.”

The United States Council of Catholic Bishops, http://usccb.org/, states

http://www.usccb.org/prolife/tdocs/anhresponses.shtml

“Prepared by the Sacred Congregation for the Doctrine of the Faith.

“ First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a ‘vegetative state' morally obligatory except when they cannot be assimilated by the patient's body or cannot be administered to the patient without causing significant physical discomfort?

“Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life.

“It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.

“Second question: When nutrition and hydration are being supplied by artificial means to a patient in a ‘permanent vegetative state,' may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?

“Response: No. A patient in a ‘permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.”

There are no end-of-life care qualifying statements on the web pages for St. Luke's Hospital or the University of Iowa Hospitals.

Iowa law, and federal law, allow the patient to direct his own end-of-life care, subject to the specific provisions of the health institute.

Specific medical care at the various institutions may be equal, in terms of medical qualifications, but what happens if ...

Niles Ross of Cedar Rapids is a former pharmacist, retired pharmaceutical industry professional and local political activist. Comments: corr538nr@yahoo.co.uk