Americans uphold a "death denying" attitude, Dartmouth Medical School's Dr. James Bernat told the audience during a speech last night about medical ethics at the end of life entitled "Dying Well."
Bernat described various "life-ending acts," including refusal of life-sustaining therapy, physician-assisted suicide, euthanasia, palliative care and refusal of hydration and nutrition.
Palliative care, which Bernat considers "the most appropriate treatment," involves total care of dying patients whose diseases are not responding to curative treatments.
Very comparable to the function of a hospice, palliative care "affirms life but regards death as a normal process," Bernat said. He is deeply involved in a palliative care team that includes physicians, nurses, occupational therapists, physical therapists and anesthesiologists.
Palliative care systems face barriers in developing thoroughly, Bernat noted. Deficits in doctors' knowledge about the focus of palliative care, fear of legal repercussions, different laws regulating uses of certain medications and overall attitudes about the practice can impede its growth.
"I don't want to put the all the blame on doctors," said Bernat at the end of his speech, commenting that the attitudes of society at large are integral to change.
"I think a lot of what the medical profession does is pushed by what others want," he said, adding that Americans are frequently unwilling to accept the approaching death of a loved one.
Refusal of life-sustaining therapy, the first of the life-ending acts he outlined, represents "an advance in healthcare both medically, ethically and legally." The liberty rights clause of the 14th Amendment in the Constitution is the basis for all Americans to refuse these treatments, he argued.
Physician-assisted suicide and euthanasia require more active physician involvement in assisting a patient's death. In both practices, upon request of the patient, the physician provides medical means for the patient to end his or her life.
Oregon is the only state in which physician-assisted suicide is explicitly legal. Under the Oregon Death with Dignity Act of 1997, physicians can legally write lethal prescriptions after a series of requirements is satisfied, such as competency of the patient and review of the request by two doctors. Oregon's unique act is currently under scrutiny by the Bush administration.
According to Bernat, there has been a huge improvement in Oregon towards building up systems of palliative care, so fewer patients are requesting physician-assisted suicide.
Euthanasia, popularized by the infamous Dr. Jack Kevorkian, and requiring a lethal injection administered by a physician, "is illegal in every jurisdiction in the U.S.A.," Bernat noted.
Palliative care, for Bernat, is the superior method, but change in attitude and practices does not come about overnight.
"It does not address the quantity of remaining life but does address the quality of remaining life," he said.
