Chaplain's Corner

A while back I was sitting around a table in a conference room with members of the Region’s Palliative Care Team. After discussing one of the cases one of the members of the team expressed exasperation with the fact that this particular patient had been given a treatment that wasn’t really consistent with the patient’s end of life goals. The final statement on this matter was, “Just because we can doesn’t mean we should.”

“Just because we can doesn’t mean we should.” This is an important principle. God has enabled people to come up with some pretty incredible medical capabilities. Occasionally participants in our medical establishment get so focused on what can be done, that not enough thought is given to asking the questions: “Should we be doing this at all?” or “Should we be doing this in this particular situation?”

This principle is especially true in Palliative Care. Palliative Care is one of the most respectful specialties in medicine. A lot of effort is expended in discovering from the person what they want for the end of their life. Once that is understood, decisions are made based on the person’s personal goals, not based on what can be done. For example:  Jessie was diagnosed with advanced brain cancer. There were a number of treatment options: chemotherapy, radiation therapy, even a surgical procedure was available. But before the treatment plan was established, the question was asked:  Jessie, what do you want for the final months of your life. Jessie was a widow and 87 years old, she had one daughter who lived in Calgary. Jessie’s desire was to make one final trip to visit her daughter, and then she wanted to come home, put her affairs in order, be admitted to the hospital when she couldn’t manage any longer alone at home and die. Her goals determined the treatment plan, not what was possible, but what she wanted.

Or take for instance Ernie, a 50 year old father of 4 who is diagnosed with colon cancer. Surgery was certainly recommended, followed by chemotherapy. Ernie wasn’t ready to think about preparing for the end of his life. He loved his life, had too much to live for and said to his doctor – do everything possible to get me through this. Everything would mean a surgery that would leave Ernie with an irreversible colostomy. That was fine with Ernie, he’d learn to live with that because living at all cost was his goal.

Hazel’s children were angry. Hazel hadn’t been herself for awhile and had refused to run off to the doctor every time her children urged her to do so. Hazel was been admitted to the hospital after she collapsed at home one day and couldn’t get up. Investigations discovered that Hazel’s hip had broken as a result of undiagnosed and fairly advanced multiple myeloma. Hazel was a very intelligent woman and quite assertive. She quizzed her doctor about the nature of her disease, about the stage of her disease, about the prognosis.

After hearing her doctor out and having all her questions answered, Hazel decided not to have the hip repaired and not to accept any treatment except Palliative Care. The Doctor had told Hazel she had 3 – 6 months to live. She didn’t want those months spent trying to eek out a couple of more months in this world, she simply wanted to allow the disease to take it’s natural course and to make the most of the time she had left trusting the Palliative Care folks to keep her comfortable until the end. After a meeting with the Doctor, Hazel’s children came to respect her wishes and spent the last months of Hazel’s life enjoying their mother and helping her complete her final work in this world.

These examples come from the world of Palliative Care, but many others could be raised from other forms of medicine. Just because medical science has developed a procedure and course of treatment, doesn’t mean it must be used what the appropriate disease presents itself.

I see this often working in Long Term care. A resident begins to complain of abdominal pain. Upon initial investigation the doctor reports that his initial suspicion is abdominal cancer of some type. The doctor has a conversation with the resident and his family and asks the question:  “Would you like me to order further tests to see what is going on in your abdomen. I suspect Cancer of some kind from my examination and from your symptoms.” The resident asks, “So, if I say yes and you do the tests and you find Cancer, then what?” The doctor replies, “Well, I will share with you the treatment options: maybe chemotherapy or surgery or possibly even radiation therapy.” The resident replies, “Doc, I’m 93 years old, frankly I’m tired of living, I really haven’t adjusted well to living in this personal care home and I’m quite certain that I would say no to all of that.” The Doctor responds, “I understand. In that case, since you are not inclined because of your situation to accept treatment of any kind, I would recommend that we not even bother with the tests.” “I agree” the resident responded and that was the end of it. He died comfortably a few months later. Tests could have been done, treatment could have been offered, doing the tests and moving ahead with treatment may have even resulted in a few more years of life for this gentleman. But just because we can doesn’t mean we should.

Somewhere in the last 25 years or so a corner was turned. People no longer are content to submit unquestioningly to whatever the doctor recommends. People have begun to be less “victims” of the system and more partners and agents involved in the system. This is good. More recent medical doctors are trained to embrace, encourage and respect the desire and goal of a patient. No longer are people just accepting whatever the doctor orders. Medical care is becoming more and more a collaborative affair. This is how it should be.

Yes, doctors are highly trained. Yes, they have some phenomenal tools at their disposal to both diagnose and treat disease. More can be done today than ever before. Research promises that as time goes on more and more will become possible. Sometimes participants in the system get so enamored by these advances, the technology, and the possibilities that the goals of the patient can be pushed to the side or even forgotten. But it is very important that you and I never forget that we are not obligated to receive any medical treatment. That it is a very important consideration when our bodies are being treated by practitioners in the medical system that the treatment be consistent with our personal goals.

But let’s not forget the other side of this coin. Just as a physician has no right to impose treatment without our informed and willing consent. The physician is not obligated to give treatment if the treatment requested is not indicated nor has little hope for improving the situation for the patient.

The treatment of disease involves a relationship between a doctor and a patient. Although one party in the relationship may have advanced training and years of experience, these do not give the doctor any greater power in the relationship. So when you and I are not feeling well and we seek medical help remember that just because medical science can do things, doesn’t mean we must accept what it offers. It is your personal goals, personal convictions, personal desires that should make the determination as to whether you accept the doctor’s recommendation for treatment. In the final analysis, you are responsible to choose whether what the doctor has to offer you is something you want. It is your responsibility to determine whether the risks that involved are risks you are willing to take and if the benefits hoped for are worth the risks you are being asked to make. Be a responsible agent as you engage the medical system. In the vast majority of cases, we will want to accept the recommendations of our doctors. But there may be times when our goals and the goals of our doctor are not in sync and at those times I would encourage you to talk clearly with your doctor about your goals – they are important!