Physicians appreciate a tool for choice, but not euthanasia
When your career has been all about preserving lives, it's never easy to pull the plug and let one go.
Local doctors are reacting to legislation signed last week to develop an out-of-hospital do-not-resuscitate (DNR) order for terminally-ill patients to use to end their suffering with dignity. Governor Tom Vilsack has signed the new law, with support from the Iowa Hospice Organization.
Doctors will be able to issue the new DNR order on behalf of a patient, while being protected from court action. The Iowa Department of Health will be ordered to create a bracelet or medallion to be worn by those who do not wish to have their life artificially extended in the event of a medical emergency - even by an ambulance or paramedic crew.
How does someone pledging to save lives deal with the necessity to stand by and watch them end?
Veteran Storm Lake doctor David Crippin believes that most area physicians support options for a patient to dictate the end of their own lives - at least in cases of incurable disease or irreparable trauma.
"At least there should be some awareness of a person's own wishes. So often we see people in a condition where they are so sick or elderly that when the time arises in an out-of-hospital situation, the odds of bringing them back are very low. There are situations where there is no hope and you almost hate to put a person through it," he said. "Where there is an incurable situation, we have to believe that it is an option to let them go."
The legislation, taking effect in July, will prohibit family members from reversing the out-of-hospital DNR, although a patient may appoint another person who would be able to make the decision to revoke the order in a situation where the patient cannot make the decision.
The law is not a moral dilemma for the medical field, Crippin believes, since it is a form of "passive euthanasia" along the same lines as hospital do-not-resuscitate orders and living will orders.
"It would be a lot different if Iowa were trying to move into active euthanasia, and I don't think we should do that. As a doctor, you would find cases where a person is depressed and wants to end it all, but a couple months later, they might not feel that way. If you assist in taking lives, there's no opportunity for that change of mind," Crippin said. "We don't want Iowa to become another Oregon."
The Iowa law will also relieve emergency workers of the obligation to provide life-saving measures to terminally ill patients being cared for somewhere other than a hospital.
"A key component to providing quality end-of-life care is giving terminally ill patients choices and ensuring those choices are honored," said Becky Anthony, director of the Iowa Hospice Organization. "The bill is an important tool because it respects the wishes of the patient in terms of where and how they will live out their final days."
Crippin said those situations happen frequently for Storm Lake physicians, who deal with so many elderly people as well as those with terminal illnesses.
"It comes to that a lot. As people get older, they tend to be discussing these decisions with their doctor. I think that unless perhaps they have an incurable cancer, the majority of patients would still just as soon have a run at whatever you can do to try to extend their lives, but there are those who feel very strongly against that as well."
Crippin estimated that about half the patients age 65 and older that he sees do not want their lives artificially extended through respirator machines and other medical measures.
"As a doctor, you don't push that, but you will bring it up. You are required by Medicare to ask if there is a living will or a power or attorney, so the issue often comes up at that point," he said. "It is natural to think about your wishes as you get sicker or older."
Crippin said he respects his patients regardless of their decision on how they wish to end their lives. "In a way, the people choosing to make a DNR are trying to do their families a favor. If the situation does happen, at least the family will know what the person wanted and not have to try to determine that themselves. If the patient doesn't choose to make their wishes known either way, how is their family going to know?"
The out-of-hospital DNR law may especially have an impact in rural areas like the region surrounding Buena Vista County.
"We have a shortage of people who know CRP and other life-saving skills, and we are in a rural environment where a person's home may be half an hour from the nearest hospital and some distance for an EMT or paramedic to reach them in a case of emergency," Crippin said. "By the time help arrives in the case of a very ill or elderly person, the odds of bringing them back may not be good."
Under the new law, the individual signing the DNR can revoke it at any time. It does not apply to automobile accidents, where emergency medical workers in the field will still be required to provide life-saving measures.
More than 35 state now have similar out-of-hospital DNR laws on the books.