Feelings ran high during discussion of a proposal of guidelines for end-of-life care.
More than 50 people attended a meeting on Thursday, at El Camino Hospital, to discuss a proposed policy about the treatment of patients when they are dying. The policy attempts to determine when to end "non-beneficial treatment" - that would no longer do any good - and change to comfort care and pain management treatment.
Proposed and drafted by El Camino Hospital's Bioethics Committee, the policy follows pending guidelines from the American Medical Association, has proposed the policy. According to the draft policy, non-beneficial treatment would stop for:
those who request only comfort care;those in irreversible coma or permanent vegetative state;those permanently dependent on intensive care to sustain life;those "at the end of life";those with "severe, irreversible dementia."
Hospital chaplain, the Rev. Maryellen Garnier, a member of the Bioethics Committee, said that the proposed policy mandates "respect, dignity and pastoral care for all patients, and requires the hospital to meet the emotional and spiritual needs of the survivors as well."
She said that the policy is "not about ending medical treatment, but about changing treatment," from so-called "heroic measures" to measures that give comfort, relieve pain and maintain dignity during the dying process.
Dr. John Longwell, the chairman of the El Camino Hospital Bioethics Committee, presented the proposed policy. He also works at Alexian Brothers Hospital in San Jose, and introduced a similar policy now adopted there.
Joining him in a panel discussion were Ernle Young, ethics professor at Stanford University; Steve Heilig, executive director of the San Francisco Medical Society and chairman of the Bay Area Network of Ethics Committees; and Alice Mead, attorney for the California Medical Association.
Several El Camino physicians expressed serious concerns about the policy. Neurologist Dr. Susan Hansen said the policy, as written, would force her to "do euthanasia."
Neurologist Dr. Ron Hoffman said, "If physicians had to submit to peer review by the Bioethics Committee, it would amount to practicing medicine without a license."
Dr. Wendell Ferguson, orthopedic surgeon and chief of staff at El Camino Hospital, said he had "moral and ethical concerns" with the policy. He, along with several others, asked for definitions of terms like "end of life" and "of no medical benefit."
Pat Reardon Pagano, a registered nurse, said that a policy was desperately needed. "Nurses dread coming into the ICU," she said, "because they are made so sick by medical battery: overzealous medical treatment at the end of life."
Doris Hawkes, an elder-care attorney and member of the hospital Bioethics Committee, said, "People say, 'Why won't physicians tell me my mother's dying?'
"The purpose of a policy like this is to keep the doors of communication open about the D-word: death. That's what the members of the community want."
The next step will be further public input to work on a policy.
At the end of the meeting, Dr. Longwell said, "The next step for the Bioethics Committee will be to invite the participation of those who expressed the greatest concern with the proposed policy."