Respecting another person’s wishes can be a difficult thing to do, especially when I don’t agree with their choice. In the situation of a patient, if he or she has made known the conditions under which they wish me to withhold ‘extraordinary’ measures such as surgery or even ventilator support I am not at all troubled.
However when these wishes have not been made known and family members take it upon themselves to make this decision, on occasion I will find those decisions troubling.
If there is no hope for survival or more importantly functional survival, then it is a decision I myself would probably make. However, recently I have been confronted with situations that have caused me to be a bit unsettled.
One of course was the patient I spoke of in my story titled, ‘An Unusual Way to Die’. Then, there were two others; one was a patient of mine and the other a family member.
Alice Stram was an 87-year-old woman who had fallen at home. Because she was on the blood thinner Coumadin she developed a sizable hematoma compressing the right side of her brain. When I arrived at the hospital that Sunday morning to perform her surgery I was told her son would not sign the consent for surgery.
When I spoke with him he appeared somewhat angry that I was suggesting that he even consider allowing his mother to undergo surgery. I was somewhat confused and so I asked him, ‘As of a week ago your mother was independent, living at home, was she not?’ He replied and somewhat emphatically, ‘She was independent as of three days ago!’
So I asked him why he did not want me to perform surgery, but he just glared at me and said nothing. A woman, I assumed to be the daughter-in-law, sitting by the bed to Alice’s left, looked up and said to me, ‘But she’s too weak to have surgery’, which made absolutely no sense to me as I replied, ‘Excuse me? She is going to die without surgery’. But she said nothing in reply.
The husband sat by the bed to Alice’s right holding her hand silently, looking to his son for anything that was to be said.
What troubled me was that Alice walked into the hospital and then had lapsed into a coma over the last eighteen hours or so while the son thought about what should or should not be done. It was conceivable that with surgery Alice could have walked out of the hospital, but her son would not give his permission for me to do what I could to see if that would happen.
The third instance is family member who shall remain anonymous. Because of various events in her life she has made choices that not only have I disagreed with but have angered me as well. But as I contemplated my feelings I had to acknowledge how much that person had a positive and truly inspirational effect on my life.
In fact you could say that God used her to be an angel in my life. So, in reply, my thoughts to that person were that we are placed on this earth for a reason. And though our lives may have physical (and emotional) limitations God wants us to know we can still enjoy the life He has given us. More importantly though, is that more times than not our joy doesn’t come from within but from the happiness we bring to others.
Last night as I meditated, I was very tired but Jesus used that fatigue to truly open my heart to several words in the Prayer of St. Francis… ‘that where there is wrong, that I may bring the spirit of forgiveness; … Lord, grant that I may seek to comfort than to be comforted; … For it is giving that we receive. …’
As a physician, the Hippocratic Oath dictates that I must always respect the wishes of my patients, but it is also my responsibility to help that patient, to the best of my abilities.
I’m not sure what motivated Alice’s, son’s staunch opposition to surgery but since she could not speak for herself there really wasn’t much else I could do. Perhaps I could have brought her case to the attention of the ethics committee, but these things take time and I doubt any judge would overrule the wishes of the family of an 87-year-old woman.
On the other hand, with my family member, while I may not agree with choices made or things said I must still respect her decisions. The only thing I really can do is to try to lovingly instill in her a desire for life, the life God blessed us with, if not for herself, than for her family who loves her.
One might argue that it is her life and it is up to her to decide what is best and right for her. But I would argue our lives are not solitary but interwoven with the lives of others and that we have a responsibility to them just as they do to us.
‘For the body does not consist of one member but of many…
that there may be no discord in the body, but that the
members may have the same care for one another.
If one member suffers, all suffer together; if one member
is honored, all rejoice together.
1 Corinthians 12:14, 25-26
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