This information often prompts additional questions concerning your legal rights. Since these decisions affect you, as well as your family, you are encouraged to discuss these matters with them. St. Mary’s Spiritual Care Department is available to discuss these matters with you, answer certain questions, and assist you in filling out a pre-printed advance directive, if you wish. You are also encouraged to discuss these issues with your personal physician, who can assist you in making choices that will affect your health care.
Use of advance directives has legal implications, and our employees cannot provide legal advice; therefore, you are encouraged to discuss these matters with your attorney.
You are entitled to receive information about your medical condition, a proposed course of treatment, and prospects for recovery. If you don’t understand the medical terms, please ask.
Your doctor should be the primary source of your answers since you will be making many decisions together. The other members of St. Mary’s health team, such as nurses, social workers, therapists, and chaplains, can help.
As a patient you have the right and a responsibility to be informed. Once you have been given the information and have thought it over, you can agree to a procedure or treatment with more confidence. To enable you to make these decisions, you might ask the following questions:
- Why is this necessary now?
- Are there any other reasonable alternatives?
- What are the risks involved?
- What outcome should I expect?
Who Makes Treatment Decisions?
The doctor diagnoses the disease and recommends treatment. In some cases, there may be alternative treatments available, and you will be involved in the decision. When deciding on a treatment, your personal lifestyle and values will be important factors to consider.
Often treatment must continue for a long time, and more decisions will need to be made as the treatment progresses. At this point, you may want to discuss the following questions with your physician:
- How will this treatment affect my condition?
- What are the benefits of the treatment?
- What are the burdens of the treatment?
- For how long will the treatment need to continue?
When discussing reasonable treatments with your doctor, be as open as you can about your personal feelings and views, and any particular concerns or fears you may have.
If an illness progresses, there may be more serious decisions that the patient and family will need to consider. Many times, patients are unable to make these decisions, so others – usually the next of kin – must do so. That is why discussing your feelings about the issues presented in this brochure with your family and friends sometimes helps them to make a tough decision, should that become necessary. These decisions may involve life support systems, resuscitation procedures, organ donation, and tissue transplantation.
Decisions About Life Support Systems
People tend to think of life support systems as machines that keep you alive, such as a ventilator that breathes for you when you need help or are unable to breathe on your own. In the broad sense, however, a life support system can be something as simple as an intravenous solution (IV) that delivers nourishment to you.
Many of us have heard about people being kept alive on machines and want no part of it. But life support systems are used every day to help people overcome an illness. Ventilators, for example, are often used after surgery to support the patient’s breathing until s/he can breathe on his/her own. Unfortunately, there are situations that occur in the course of serious illness that may require you or your family to make a decision about prolonging life when there is little hope for a meaningful recovery. You should discuss with your doctor what a “meaningful recovery” means to you.
As a Catholic hospital which adheres to the Ethical and Religious Directives for Catholic Health Care Services 2001 Edition, St. Mary’s believes that life is a basic good to be preserved and regarded in relation to other values and the belief in a life after physical death. In some situations, continuation of treatment may merely extend the time of dying and perhaps interfere with the expression of religious and spiritual values held by the patient.
When it is apparent that there is no chance for meaningful recovery despite all that is being done, many people would prefer not to be placed or kept on life-sustaining systems. Deciding to forego life-sustaining measures in no way means that all medical care stops.
Decisions About Resuscitation
Code Blue is used at St. Mary’s as a potentially lifesaving set of procedures carried out on a person whose heart and/or lungs have suddenly stopped functioning. This resuscitation measure includes: external compression over the breast bone to stimulate the heart, electric shock to the heart, placing a tube in the windpipe and breathing for the patient, and using drugs to restore the blood pressure. This type of resuscitation involves using life support systems in a concentrated effort to save a life.
There are situations, of course, where resuscitation is usually not appropriate. For example, at the end of a terminal illness, the patient or family members may not want lifesaving measures to be performed. This decision would be appropriate if a reasonable rational decision was made by the doctor that lifesaving measures would be of no benefit to the patient.
In other situations, however, resuscitation is appropriate to assist with a sudden, sometimes unexpected, episode that may be corrected with quick, proper medical assistance. An example of this is an unexpected reaction to medication that may cause temporary breathing difficulties of a correctable nature.
Your doctor may bring up the question of whether resuscitation should be performed, and you may feel free to ask about this at any time. It is important that, whenever possible, such a decision be discussed with your family and your wishes be made known to your doctor.
What Is Comfort Care?
All patients are entitled to adequate relief of pain and suffering. Whatever the patient’s choice about life support, resuscitation, or other end-of-life measures, the patient is entitled at all times to adequate relief of pain and suffering. Patients will be provided adequate analgesia to relieve pain, may be supplied supplemental oxygen to relieve breathing difficulties, may be provided X-ray treatments designed to relieve pain, and will be provided whatever other treatments are necessary to ensure that the patient is comfortable at all times.
What Is Brain Death?
There are occasions when life support systems are no longer appropriate. The State of Indiana passed a law expanding the concept of death to include not only heart and lung failure, but also total brain failure.
Technology has allowed us to mechanically maintain the heart and lung functions of those who have lost complete functioning of the brain. When such a situation occurs and brain death is verified by a thorough assessment of the nervous system, the patient will be declared legally dead. This definition is important for two reasons.
First, if the patient has not addressed the issue of organ donation in an advanced directive, you may be approached about organ donation. In order for organs to be viable for transplant, the patient’s body must be kept on a ventilator until the organs are removed. Second, if for any reason the patient is not a candidate for organ donation, ventilator support will be terminated.
Decisions About Organ And Tissue Donation
The State of Indiana requires all hospitals to approach the legal next of kin at or near the death of a patient to inquire about organ and tissue donation. A request will not be made if it is known that the patient did not wish to donate or is not an acceptable donor. You may wish to discuss this with your physician.
St. Mary’s Spiritual Care staff, along with our Medical Center’s health care professionals, is prepared to assist you in making decisions about organ and tissue donation.
Making A Decision For A Loved One
As a relative, you may have had a chance to discuss the patient’s wishes with him or her at an earlier time.
If so, by letting the doctor know your loved one’s preferences, you can help carry out his or her wishes and thereby respect the personal dignity of the individual.
If you have not discussed this with your loved one, then you need to think seriously about the values that are important to him or her. Your doctor, nurse, social worker, or chaplain may help you decide what your loved one might have wanted in the situation if he or she were still able to express a preference. The decision that is made should convey, as far as possible, what the patient would want and not your own ideas or feelings.
A Team Of Caring Professionals
In addition to your family, physician, and clergy, the staffs of the following departments at St. Mary’s are prepared to help you through the decision-making process:
Spiritual Care. St. Mary’s Spiritual Care Department provides support and counseling for patients and their families. Chaplains are available to help explore alternatives from a spiritual perspective. They can be reached at (812) 485-4150.
Social Services. The Social Services Department helps with problems relating to health care after discharge and adjusting to lifestyle changes. Staff members can contact appropriate community resources to assist the patient. For more information about these services, please call (812) 485-4462.
St. Mary’s Medical Center Ethics Committee.
The St. Mary’s Medical Center Ethics Committee provides counsel and support, promotes communication, shares information, and clarifies ethical principles and concepts for patients, families, and the health care team. The committee can be contacted through the Spiritual Care office at (812) 485-4150.
Our Commitment To You.
Decisions like the ones addressed in this brochure are very hard to make, but they are facts of life that cannot be ignored. Fortunately, these dilemmas can be made easier to face through thoughtful discussion.