Eroding Patients' Rights

Extracts from the encyclopedia compiled

By

DR. MRS. Meenal Kumar, M.D. senior gynecologist and menopause consultant, sector 20 civil dispensary, Chandigarh
DR.R.KUMAR M.S., OPHTHALMOLOGIST AND HEALTH COLUMNIST, 232, SECTOR 16, CHANDIGARH

If you've been admitted to a hospital any time in the last five years, you've been asked whether you have an "advance directive". The Patient Self-Determination Act of 1990, which went into effect in December of 1991, requires all hospitals, nursing homes, and hospices to inform patients upon admission of their right to sign such a document. All of us have heard of a living will or durable power of attorney for health care. I venture to guess that most of us do not know what they really are.

What we are told we want to avoid at all costs in this day of high-tech health care is "being hooked up to a bunch of tubes and machines" should we become very ill. To be thus treated is appallingly undignified. In order to protect ourselves from being degraded in this manner, we are told, we should sign a living will or appoint a power of attorney for health care. If we don't, we may find ourselves the recipients of treatment we don't want (P J King, RN Chairman, Bioethics Committee, Pro-Life Wisconsin).

It is vitally important to understand this: There is no law, no medical society, no religion, no church, and even no pro-life organization which insists on forcing a dying person to be kept alive by heroic or burdensome means. You need no advance directive to protect yourself from unwanted treatment. You (or your family members if you are unable) need only refuse it. The American Medical Association Code of Medical Ethics says that "physicians are not ethically obligated to deliver care that, in their best professional judgment, will not have a reasonable chance of benefiting their patients."

At least two things need to be understood about living wills. First, they are not about giving patients control over their health care; they are about taking away decision-making authority and giving it to the physician. A standard living will focuses on just one option -- the rejection of medical care.

Secondly, we need to be aware that living wills do not protect patients; they protect doctors. A living will gives the physician immunity from civil or criminal liability for withholding or withdrawing treatment. Repeatedly court cases have illustrated that, once freed from liability, some doctors are willing to deny ordinary care--even food and water--to severely handicapped people who are not dying.

On the surface, a living will seems harmless enough. Below is the declaration from one such document:

If I should have a terminal illness and if I am no longer able to make decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw treatment that only prolongs the dying process and is not necessary to my comfort or to alleviate pain.

This is the only part most people see. The laws and policies governing the use of living wills, however, explain how they are to be interpreted. These, few see. The U.S. Veterans Administration [Policy M-2, Part I, Chapter 31, 1991], for example, defines "terminal illness" as a "debilitating condition which is medically incurable ... and which can be expected to cause death ... [and] includes but is not limited to conditions where death is imminent, as well as chronic and debilitating conditions from which there is no reasonable hope of recovery." Such a definition would allow for the removal of life-sustaining treatment from persons with heart disease or diabetes. The "attending physician" is the physician responsible for caring for the patient at any given moment. "Treatment" is any intervention performed or ordered by the physician. Such interventions may include food, fluids, antibiotics, or insulin for a diabetic.

Living wills empower physicians, not patients. With a living will, the physician need not even consult with a patient's family regarding a non-treatment decision. Even if he does, he is under no obligation to follow their wishes.

A durable power of attorney for health care (DPAHC) provides for the appointment of another person to make medical decisions should the patient become unabl

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