Life and Death and the Bioethics of Elder Care

Life and Death
TAMPA -

Of all the areas where technology has blurred the lines between what some people believe is right - and others believe is wrong - what may be most effected is advance care for the elderly.

The care includes 'do not resuscitate' orders, the role of hospice and our society's trend of treating seniors as a burden instead of as productive elders.

Several doctors discussed the dilemma of bioethics during the annual conference of the Florida Council on Aging. It's being held through Thursday at the Tampa Waterside Marriott Hotel.

One of those taking part was Robert Walker, an associate professor of medicine at USF.

Walker says doctors have a special name for patients with terminal diseases, whose families refuse to issue a 'do not resuscitate' order. They call them 'futility cases.'

WALKER: And what do we do when we have a clear-cut case of medical futility, where we have families saying, 'no, we're not going to make them DNR, we can't stop the ventilator, no, we don't want the hospice, do everything.' So that's a tough, tough problem. It's very demoralizing for the caregivers, because in some cases, they feel like they're really torturing individuals. So what's the answer there?

The most famous such case, of course, was Terri Schiavo. Her parents wanted her kept alive at all costs;' while her husband wanted her feeding tube removed.

WALKER: After the Terri Schiavo case, there was great interest in getting advance directives - as if that would solve all the problems. But I think we all knew enough about that to say had there just been that piece of paper that there wouldn't be any issues in that case - I don't think so.

Kenneth Goodman is director of the bioethics program at the University of Miami. He pulled no punches when he discussed how politicians spent months working exclusively on the fate of one woman, while ignoring the rest of Florida's at-risk population.

GOODMAN: How is it, with a straight face that you could have elected officials talk about their commitment to vulnerable people - and at the same time, not provide adequate resources for DCF - or for that matter, for all the aging centers around the state to do their stuff.

Throughout much of Terri Schiavo saga, USF professor Jay Wolfson was named her guardian. He steered the conversation back to how some doctors have no one to blame but themselves.

Wolfson noted the Institute of Medicine reported several years ago that between 45,000 and 100,000 people die every year in this country because of medical errors.

And then, there are unnecessary procedures.

WOLFSON: Charging for things that are not done. Whether you're a hospital, a physician office, a clinic, a laboratory, a nursing home. You charge Medicare or Medicaid or a private insurance company or the family or a private individual for things that were not done. Happens all the time.

Wolfson says this kind of fraud exposes the patient to risk, by performing a service that wasn't necessary that could lead to a medical complication.

WOLFSON: The foundation of all this stuff is values. Where our values lie. Where they reside, and whether we walk the walk, or it's just a bunch of talk. I'm convinced that in our country, we are NOT our brother's keeper. That we like to say that, but we are not. And that we are not really concerned about really helping. We're very selfish. We're egocentric, self-centered, narcissistic, instant-gratification oriented, My Generation epitomizes that. And it's going to be very hard to turn it around.

Goodman said it's up to doctors and caregivers to raise their level of values. He raised an ethical 'what - if' that might someday come true.

GOODMAN: If there were an avian flu epidemic, we're not going to have enough ventilators. It's really quite that simple - there aren't enough ventilators in Florida. How should we apportion those resources?

One of the answers he got was: raise the cost of the ventilator, and let only those who could afford it get one. So, as Dr. Goodman said, 'If you don't get it, you catch a bad case of death.' He says there's got to be a better way.

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