A dying loved one has signed a “do not resuscitate” order at one hospital. She falls deathly ill and is taken to a different hospital, where doctors, completely oblivious to the DNR order, revive her. Question: Once the error is discovered, should she be permitted to die according to her original wishes?
These and other difficult questions will be tackled Jan. 30-31 during “Ethics at the End of Life,” a town hall-style meeting hosted at the University of Mississippi. Free and open to the public, the symposium convenes in Bryant Hall. Registration and a reception are set for 6:30 p.m. Friday, followed by the 7:30 p.m. opening session. Sessions resume at 9 a.m. Saturday and run until approximately 3 p.m., with breaks and lunch. An optional campus tour follows. The event is sponsored by the Society of Philosophers in America, with support from the American Philosophical Association and the Mississippi Humanities Council. Continuing education credits are available. For more information, visit http://www.philosophersinamerica.com/.
While some may think the event is geared for professors and other scholars, SOPHIA is working to bring everyday people into the dialogue – especially the nurses, doctors, lawyers, social workers and hospice workers who face these issues daily.
“It’s an unconventional format in that nobody is going to read a research paper,” said John Lachs, professor of philosophy at Vanderbilt University, who will serve as facilitator and keynote speaker. “Everyone’s perspectives are important. We’ll just sit down and talk. Hopefully, the conversation will move on its own.”
“Philosophers think in the abstract, so we wanted to get together with people who deal with these very tough issues and learn from them,” said event organizer Eric Thomas Weber, UM assistant professor of public policy leadership. “We also hope to bring value to their work as practitioners.”
The scenario at the beginning of this story was reality for the family of Eric Weber’s wife, Annie. Her grandmother, Barbara Murray, signed a DNR, but during a medical crisis, she was rushed to a hospital unfamiliar with her medical records. Murray was revived, but was on and off of life support for more than two years before dying in 2003.
“In that moment, she was put on a ventilator,” Annie Weber said. “But if we hadn’t had the ventilator in the crisis period, she would have been gone.”
Murray had been living with multiple sclerosis for almost 40 years, and had a series of MS-related ailments, so her family was emotionally prepared for her death – and even her “near death.”
“The feeling I got from my family was that she had a wry sense of humor about (being revived),” Annie Weber said. “But the rest of the family took it in stride. No one got terribly upset about it.”
Still, there were unexpected questions and issues to deal with. After Murray was removed from the ventilator, she received 24-hour, in-home care, including an oxygen machine and feeding tube. Murray lived that way for about 18 months.
“She could afford it, but lots of people can’t,” Annie Weber said. “My family took each decision as it came. And each decision took us in a direction we hadn’t expected to go.”
Eric Weber said his wife’s situation was far from horrific, but that it raises the right questions.
“For another family in the same situation, it could come down to ‘send the kids to college’ or ‘pay these medical bills,'” Eric Weber said. “It sounds strange, but that’s why it’s worth talking about.”
For all the murky questions and heated debate about when life begins, there’s a very simple reason why end-of-life issues are seldom pondered, Lachs said.
“Clearly, we don’t want to talk about dying – or even think about it,” he said. “When life begins, you’re talking about satisfaction and promise. When life ends, you’re talking about pain, suffering and loss. Who likes to talk about that?”
When those conversations do happen, they can quickly drift into morally ambiguous waters, Eric Weber said.
“We have so much control over how we conduct our lives, but little control over how we end them,” he said. “There’s a lot of stigma attached to how you choose to die. In one case, an angry teenager isn’t able to make that decision, but should a 90-year-old sick person be entitled to more freedom?”
One problem, Eric Weber said, is that policies can’t account for the nuances that are in play when someone is facing death.
“Sometimes, it seems cruel to stick to the rules,” he said. “As philosophers, our job is to consider that while these policies mean well, they sometimes have repercussions that are damaging to people. In fact, you may do greater harm than good.
“It’s not that the people driving the ambulance should be sued. The issue is how can we drive future policy and action so that we minimize the ill effects of well-intended policy?”
As neither philosopher nor physician, Annie Weber has her own ideas.
“What I took way from experience is that you can debate the principles involved,” she said. “But in reality, life doesn’t always present you with a question or choice that you’re completely prepared for.”