Some Patients Prefer to Opt Out : Medical Gains Raise More Life-or-Death Questions

The 20-year-old woman faced the facts.

Her body had rejected one kidney transplant. Another might fail. Dialysis and chemotherapy lay ahead.

She and her doctor, a minister and her family sweated through the necessary talk.

Finally, she made a decision. She decided to die.

That was almost 20 years ago, but the doctor in that case carries the same conviction today that he did then--his patient appropriately made a decision with the help of the professional and personal people she trusted.

Dr. John C. Hudell, 69, who retired recently as vice president of medical affairs at Mercy Center Hospital, believes that people should become more attuned to the issue.

Advances in medical technology are forcing life-or-death questions more often.

Focus on Quality of Life

“We are keeping people alive so long that we have to decide, with the patient, whether he wants to be kept alive. . . . What guarantee is it, a long life, if it’s going to be spent in a nonfunctional state in a nursing home, or worse, on various mechanical devices?” he said.

“We’re doing it, but should we be doing it all the time?” said Hudell.

Hudell said the case of the woman with the bad kidneys occurred at a time when transplant technology was fairly new, when a person needing such an operation had to be otherwise very healthy.

“It was her decision. She found herself so miserable, life so unpleasant, that she didn’t want the kidney. She didn’t want dialysis. If she got the kidney, she’d have to go through dialysis. There was the possibility of another kidney rejection. She decided it wasn’t worth the struggle, and she wanted to opt out. She died, eventually.

“But with our technical advances--the bypasses, the brain surgery procedures--the public is coming to expect that life should be almost eternal,” he said.

New Factor in Medical Field

That is not an easy expectation for doctors to deal with because of another factor that is altering the medical field landscape.

“The relationship between the patient and the physician has changed with our social structure. The old, solid relationship that lasted for years is gone with our mobility. People tend to move more, and they are often introduced in the emergency room,” Hudell said.

He encourages people to consider the so-called “living will,” a document recognized by most states as having the authority to allow a person to reject artificial life-sustaining means used under certain circumstances.

“People should decide for themselves before an emergency situation comes up what they wish for themselves. One never knows when that moment will come. They might like to make that decision, but might not be able to,” he said.

Has Own Living Will

Hudell has already made his own living will, he said, requesting no artificial life supports if he cannot live without them.

On a lighter note, he said he is considering retraining so he can return to practicing medicine, which he gave up when he became chief of staff at Mercy 10 years ago.