Readers React

How a compassionate doctor can make all the difference in a good death

To the editor: Emergency-room physician Eric Snoey’s essay on withholding intense, life-saving treatment from a frail 90-year-old patient — instead obeying her advance directive and relieving her pain as she slipped away — reminds me of my mother and my wife. ("'The patient is Code 3 critical. Her frail, 90-year-old body is failing. How much should I do to save her life?'" Opinion, May 22) 

My mother was 93 and alert when I went to the hospital that final day. She had an advance directive not to be kept alive by extraordinary or artificial means. When her hospice nurse asked why she, wearing an oxygen mask and gasping for air, wouldn’t relax and let go, she answered, “I don’t want to die.” Those were he final words. 

Sobbing, I thanked her for bringing me into the world and all she had done for me. She died within the hour.

It will haunt me the rest of my days that I did not have that same opportunity with my wife of 60 years — to thank her for sharing her life with me and to tell her how deeply I loved her — because she was hooked fatally and for the first time to a dialysis machine, as ordered by a doctor on weekend duty. I will forever have misgivings about that choice. 

Charles Van Cleve, Rancho Palos Verdes

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To the editor: I am an overweight 90-year-old man with significant cardiac disease who smoked for 25 years before stopping in my 40s, and I anticipate a major medical catastrophe sometime soon. 

Different folks have different wishes with regard to such an experience. But my hope is that whatever event occurs is a fatal one, and I have executed an advance declaration to forestall any treatment that preserves a life of little or no quality, a declaration I have discussed in detail with all my children as well as with my personal physician. 

But if I should (unfortunately) survive the event and end up in an emergency room, I hope that someone like Dr. Snoey is caring for me. My death will be as natural as my life has been.

Donald Schwartz, Los Angeles 

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To the editor: Medical knowledge coupled with seasoned confidence. Consideration of a patient’s wishes. Courage and thoughtfulness. 

I hope a physician like Dr. Snoey is on duty when it is the end of my life.

I will attach a copy of Dr. Snoey’s piece to my own advance directive.

Holly Hunt, San Diego

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To the editor: Dr. Snoey clearly practiced patient-centered care in the treatment of his elderly patient in the intensive-care unit.

One thing he could have done earlier, which may have helped things go smoother in the ICU, was suggest to this patient that she complete a POLST (Physician Orders for Life-Sustaining Treatment) — a form that clearly states the kinds of medical treatment a patient wants (or doesn’t want) during serious illness or at the end of life.

Unlike an advance directive, a POLST is an actionable medical order in California, and emergency responders and other health professionals in all health settings are required by law to honor the patient’s wishes. 

If Dr. Snoey’s patient had completed a POLST when her condition began to deteriorate, she could have had more control over her medical treatment at the end. She may even have chosen to avoid re-hospitalization during her final days and be treated and kept comfortable at her nursing home instead of in the intensive-care unit.

Judy Thomas, Sacramento 

The writer, a lawyer, is chief executive of the Coalition for Compassionate Care of California.

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