Matters of life and death

An infant is born with no functioning brain. A teen is ravaged in a car wreck. A 90-year-old with dementia and pneumonia lies unconscious in intensive care.

Medical and moral decisions must be made. But there's no written directive for guidance. Family and physicians disagree. What now?

Every day, in a hospital somewhere in the USA, a group of strangers — the hospital ethics committee — is called in to help people make the choices of a lifetime.

While headlines scream about "death panels" and Congress wrangles over health care reform, these committees or consultants have worked in U.S. hospitals for nearly two decades.

They are typically volunteers: physicians, nurses, chaplains, social workers, ethicists and medical school professors, who mediate among facts, emotions, hope and fantasy.

"Culture and religion inform every decision about health, illness, disease and care, about true caring, about who can live, about the measure of quality in a life, about when suffering begins and how it ends. We bring our full selves to every bedside," says Dawn Seery, head of the five-hospital Methodist Healthcare System in San Antonio.

'Death denial'

They tackle questions of whether to begin or continue aggressive treatments or artificial life support, such as ventilators or feeding tubes. Only 25 percent of Americans have advance directives spelling out their values and choices for the day "when I'm not myself anymore and never will be again," Seery says.

Consider the often-heard demand that doctors "do everything!" to keep a patient alive.

An ethics committee will explore what's meant by "everything." Is it the full arsenal of possible treatments, or "everything appropriate and beneficial?" That could mean palliative (comfort) care instead of aggressive treatment for someone who is clearly dying, Seery says.

Consider a family's insistence that God will work a miracle.

"God does miracles on his clock, not ours," Seery says. "I would say: 'Here's what we can do and what we cannot. Sometimes a miracle will not happen in the way that you had hoped. The bigger miracle may be your belief in a second life in heaven.'"