Allowing Patients to Die: Louise Aronson and Bill Andereck

09/05/24 • 49 min

GeriPal - A Geriatrics and Palliative Care Podcast

In today’s podcast we set the stage with the story of Dax Cowart, who in 1973 was a 25 year old man horribly burned in a freak accident. Two thirds of his body was burned, most of his fingers were amputated, and he lost vision in both eyes. During his 14 month recovery Dax repeatedly demanded that he be allowed to die. The requests were ignored. After, he said he was both glad to be alive, and that the doctors should have respected his wish to be allowed to die.

But that was 1973, you might say. We don’t have such issues today, do we?

Louise Aronson’s recent perspective about her mother in the NEJM, titled, “Beyond Code Status” suggests no, we still struggle with this issue. And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics. The issues that are raised by these situations are really hard, as they involve complex and sometimes competing ethical values, including:

The duty to rescue, to save life, to be a “lifeguard”
Judgements about quality of life, made on the part of patients about their future selves, and by clinicians (and surrogate decision makers) about patients
Age realism vs agism
The ethics of rationale suicide, subject of a prior GeriPal episode
Changes in medical practice and training, a disconnect between longitudinal care and acute care, and frequent handoffs
The limitations of advance directives, POLST, and code status orders in the electronic health record
The complexities of patient preferences, which extend far beyond code status
The tension between list vs goals based approaches to documentation in the EHR

And a great song request, “The Cape” by Guy Clark to start and end.

Enjoy!

-@AlexSmithMD

** NOTE: To claim CME credit for this episode, click here **

But that was 1973, you might say. We don’t have such issues today, do we?

The duty to rescue, to save life, to be a “lifeguard”
Judgements about quality of life, made on the part of patients about their future selves, and by clinicians (and surrogate decision makers) about patients
Age realism vs agism
The ethics of rationale suicide, subject of a prior GeriPal episode
Changes in medical practice and training, a disconnect between longitudinal care and acute care, and frequent handoffs
The limitations of advance directives, POLST, and code status orders in the electronic health record
The complexities of patient preferences, which extend far beyond code status
The tension between list vs goals based approaches to documentation in the EHR

And a great song request, “The Cape” by Guy Clark to start and end.

Enjoy!

-@AlexSmithMD

** NOTE: To claim CME credit for this episode, click here **

Previous Episode

Stump the VitalTalk Communication Experts: A Podcast with Gordon Wood, Holly Yang, Elise Carey

Serious illness communication is hard. We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. That’s a hard enough task, given that most of us have never had any communication skills training. It feels nearly impossible if you add another degree of difficulty, whether it be a crying interpreter or a grandchild from another state who shows up at the end of a family meeting yelling how you are killing grandma.

On today’s podcast, we try to stump three VitalTalk expert faculty, Gordon Wood, Holly Yang, Elise Carey, with some of the most challenging communication scenarios that we (and some of our listeners) could think up.

During the podcast, we reference a newly released second-edition book that our guests published titled “Navigating Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope.” I’d add this to your “must read” list of books, as it takes readers through the VitalTalk method that our guests use so effectively when addressing these challenging scenarios.

If you are interested in learning more about VitalTalk, check out their and some of these other podcasts we’ve done with three of the other authors of this book (and VitalTalk co-founders):

Our podcast with Tony Back as well as Wendy Anderson on “ Communication Skills in a Time of Crises”
Our podcast with James Tulsky on “ The Messiness of Medical Decision-Making in Advanced Illness.”
Any one of our podcasts with Bob Arnold, including this one on the language of serious illness or this one on books, to become a better mentor.

Lastly, I reference Alex’s Take Out the Trash video, where he uses communication skills learned in his palliative care training at home with his wife. The results are... well... let’s just say less than perfect.

By: Eric Widera

Next Episode

Well-being and Resilience: a Podcast with Jane Thomas, Naomi Saks, Ishwaria Subbiah

Well-being and resilience are so hot right now. We have an endless supply of CME courses on decreasing burnout through self-care strategies. Well-being committees are popping up at every level of an organization. And C-suites now have chief wellness officers sitting at the table. I must admit, though, sometimes it just feels off... inauthentic, as if it's not a genuine desire to improve our lives as health care providers, but rather a metric to check off or a desire to improve productivity and billing by making the plight of workers a little less miserable.

On today’s podcast, we talk with Jane Thomas, Naomi Saks, and Ishwaria Subbiah about the concepts of wellness, well-being, resilience, and burnout, as well as what can be done to truly improve the lives of healthcare providers and bring, I dare say it, joy into our work.

For more on resources for well-being, check out the following: