Library Series To Focus On End-Of-Life Decisions

By Jan Howard

A two-part lecture series, “Sunset Series — Decision Making at the End of Life,” will be held at the C.H. Booth Library on November 16 and December 7 from 7:30 to 9 pm., sponsored by the Danbury Health Systems Ethics Committee and the Cyrenius H. Booth Library.

 In part one, “Understanding the Options,” on November 16, topics will include How to Avoid Bitter Endings as Families Disagree, Medical Ethics and Their Impact on You, and Understanding Advance Directives.

During part two, “Choices to be Made,” on December 7, the topics will be Resuscitation Options and Organ Donation and Transplantation.

Participating in the panel will be Dr Daniel G. O’Hare, PhD, a professor of medical ethics and ethics consultant; Julia MacMillan, a critical care nurse; Cheryl Edwards, a nurse and donation coordinator; and Dr Phillip Kotch of Newtown, a retired surgeon, who will serve as moderator of the lecture series.

Preregistration is urged. Sign up is at the library’s main floor circulation desk or by calling 426-4533. There is no fee for the two-part series.

There will be adequate opportunity for a question and answer period.

During a preseries planning session by the panelists in September, it was noted that fewer than 18 percent of people in this country have advance directives and that some of these are nonspecific and confusing.

The panelists noted the importance of making end-of-life decisions before they become a crisis.

“We will try to introduce what are difficult topics for people to consider,” Dr Kotch said. “It is an attempt to educate the public and individuals. We’re trying to be proactive.”

“It’s to alleviate some of the confusion and distress of families in making decisions,” Ms MacMillan said.

Dr Jan Mashman, co-chairman of the Danbury Health Systems Ethics Committee, said that because end-of-life decisions are something that most people are not prepared for and have never made before, decisions on what to do at the end of life should be made before it becomes a crisis.

“We want the public to have a dialogue on an ongoing basis,” he said. “All society should be engaged in this dialogue.”

People should indicate their wishes to family members or friends through advance directives so they know what should be done regarding their care and end-of-life decisions, he noted.

“Death and dying are painful,” Dr Mashman said. “But it’s more painful through miscommunication.”

Ms MacMillan said it is never too soon to have an advance directive, adding that even young people should make their wishes known through such documents.

Dr O’Hare said that there is a naïve belief among laypeople that they have no control in end-of-life decisions. “They do have control,” he said.

“When you are in the system, you are sensitized to it,” Dr Kotch said of end-of-life decisions. However, he added, “Laypeople are overwhelmed by it.”

Dr Mashman said that Connecticut’s advance directive is too complicated. It should be simpler so it is more understandable, he said.

In the two-part series of the Sunset Seminar, Dr O’Hare will address the confusion and frustration often experienced by patients and families who find themselves immersed, with little or no preparation, in the health care system.

The rapid advancement of increasingly technological possibilities in health care frequently produces difficult and anxiety-producing choices for individuals. This can be particularly acute in the context of end-of-life care.

Dr O’Hare will highlight the benefit of advance planning for health care and attempt to communicate a method for negotiating the health care system.

In part one of the Sunset Series, Ms MacMillan will talk about the importance of anyone at any age to communicate wishes to family members, verbally and through completing advance directives. She will provide the purpose of having an advance directive (living wills, health care proxies, and durable power of attorney), how to utilize it, and give a description of what the terminology actually means. She will use case presentations to emphasize the points she will make.

In part two, she will talk specifically on resuscitation measures and the options available and decisions necessary to make in the event an end-of-life issue is to occur. She will also talk briefly about other options available, such as Hospice and the new CARES program.

Ms Edwards is a nurse with more than 25 years of experience, primarily in critical care and home Hospice settings. She has had extensive experience working with patients and their families faced with prolonged dying as well as sudden death.

She will discuss various aspects of the donation process from affirming your wishes to the process of transplantation.

Dr O’Hare currently lectures in medical ethics at New York Medical College, the Graduate School of Social Service of Fordham University, and the Anesthesiology Education Program of Gonzaga University in Spokane, Wash. He is the consultant ethicist of several hospitals and health care agencies, including Danbury Hospital and Ability Beyond Disability.

Dr O’Hare previously served as the first institutional ethicist at Memorial Sloan-Kettering Cancer Center in New York. He has published in the areas of ethics, AIDS, death and dying, hospice care, and physician-assisted suicide.

A frequent speaker both nationally and internationally, Dr O’Hare was named a Harris Fellow by the American Bureau of Medical Advancement in China and lectured at medical and nursing schools in Asia. He also serves on the board of directors of several health care agencies, including the Foundation for Hospices in Sub-Saharan Africa.

With nearly 30 years experience with terminally ill patients and their families and loved ones, Dr O’Hare also conducts a bereavement series at the Frank E. Campbell Funeral Home in New York.

Ms MacMillan has been a critical care nurse for 30 years and has always had an interest in end-of-life issues and patients’ rights.

She has served on Danbury Hospital’s Ethics Committee since 1991 and became co-chair of the committee in 2000. She has also been the Nursing Ethics Committee chairperson since 1991. She is actively involved in the American Association of Critical Care Nurses and is currently president of the local chapter. She has given several presentations on advance directives and end-of-life issues to senior centers and other venues.

Ms Edwards presently works for the New England Organ Bank as a donation coordinator. Her responsibilities include bereavement counseling for families whose loved one has died suddenly, as well as honoring people’s wishes to save lives through organ and tissue donation. She works with the families of donors as well as hospital staff and transplant professionals and recipients to fulfill the donor’s wishes.

Dr Kotch is a retired surgeon and former chairman of the Danbury Hospital Department of Surgery. He is also former chairman and current chairman emeritus of the Danbury Health Systems Ethics Committee, assisting in all facets of the committee.