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New electronic registries quickly allow emergency personnel to learn whether an elderly or ill person desires to receive medical care. But one thinker in bioethics suggests the registries could inadvertently force medical personnel to be complicit in the suicides of troubled patients.
In the state of Oregon about 42,000 people have registered for an electronic database containing physician orders for life-sustaining treatment, known as Polst forms. These forms convey whether a patient wants a feeding tube or wants to be taken to the hospital at all.
The Polst forms typically concern end-of-life care. They differ from a living will because they are medical orders signed by a physician and are meant to be used by patients who are elderly or ill.
Oregon’s electronic registry is housed at Oregon Health and Science University.
Susan Tolle, director of the university’s Center for Ethics in Health Care, said that the registry can never contribute to getting a patient less treatment than he or she wants.
Some critics of end-of-life care directives have argued that elderly or sick patients could be persuaded to choose less care in order to save money, even if that isn’t their wish.
Databases similar to Oregon’s are under development in New York and West Virginia.
Bioethics writer Wesley J. Smith, a consultant for the pro-life International Task Force on Euthanasia and Assisted Suicide, told EWTN News in a Dec. 22 interview that such registries have their place.
“There are times when a person is in hospice and does not want resuscitation if they have cardiac arrest, for instance,” he explained. Hospice is often provided at home, he explained, and quite often when a person is dying family members panic and call 911. This requires the emergency responders to try to resuscitate the person.
He thought it acceptable in such cases to have a registry for hospital and emergency personnel to confirm a patient’s wishes.
But he also saw “some real problems,” especially regarding states like Oregon which have legalized assisted suicide.
If a person has registered his wishes not to be treated in a situation and that person is still able to be saved, Smith wondered, “are we going to require the emergency response team to complete the suicide by not saving that person’s life?”
He cited a “terrible case” in the U.K. where a suicidal woman named Kerrie Wooltorton swallowed antifreeze and called 911 afterward. Because she had a note pinned to her blouse saying she did not want medical treatment, the doctors refused to save her.
“At the coroner’s inquest, the doctors said nobody wants to watch a young woman die, but that’s exactly what they did.”
To preclude abuses of end-of-life registries, Smith recommended the explicit exclusion of cases of suicide, both illegal and legal, from orders not to treat a patient.
In an emergency response situation, any personnel who reasonably believe a patient is trying to end his or her life “should try to save that life.” The laws should not put people “into the position of completing a suicide,” he said, warning that such rules potentially makes response personnel “complicit” in the act.
“Nobody has the right to force that upon another person,” Smith stated.
He also worried that assisted suicide advocates would think the registry to be a “splendid idea.” Mobile suicide clinics like the Final Exit Network could ask prospective suicides to make sure they were on such a registry before admitting them.
Smith thought it was “fine” to limit such registries to those who are dying naturally in the hospice, but he saw a need to make sure the registry is “very limited.”
“Otherwise you’re going to perhaps lose people who might have been saved and would have been very happy they were saved,” he commented.
“The benefit of doubt should go to saving a life, not the other way around. I’m worried we’re giving the benefit of doubt to death instead of life.”