Theirs were two prominent deaths. And two vastly different ends to life.
"Certainly, the recent deaths of Terri Schiavo and Pope John Paul II focused the world on the issues of death and dying and contrasted the opportunities we have dealing with it," said family practitioner and physician executive Richard Wopat, M.D., in a telephone interview.
Wopat, who practices in Lebanon, Ore., and serves as chief quality officer at the five-hospital Samaritan Health Service in Corvalis, was in Washington, D.C., this week at the 37th annual meeting of the American Hospital Association, where he was winding down a three-year term on the AHA board of trustees. He was one of three physicians to address end-of-life issues as the AHA used the opportunity to focus national attention on its campaign to promote the use of advanced directives.
"I think it is an ideal time to raise this to a level of public understanding," Wopat said. Schiavo died at a hospice facility after her feeding tube had been withdrawn at the request of her husband. Michael Schiavo, absent a written directive, said the decision reflected his wife's wishes. The case became a cause celebre as Michael Shiavo's decision was fought by Terri Schiavo's parents up to the U.S. Supreme Court, and in Congress.
The Pope, meanwhile, slipped slowly into death in his living quarters at the Vatican.
"You couldn't have asked for two more conflicting ways of dying between Schiavo and the Pope," Wopat said. "Whether he (Pope John Paul II) had a prior directive or not, he had the clarity to make his wishes known at the end."
Pearly Graham-Hoskins, M.D., an AHA trustee and an internal medicine physician at Bladen Medical Associates in Elizabethtown, N.C., said she has fielded a growing number of questions about advanced directives during the past month. The AHA also has received requests from members for resources, she said.
"This campaign is not about politics; it is about personal choices," Graham-Hoskins said.
Air Force Lt. Col. Linda Lawrence, MC, a board member with the American College of Emergency Physicians, is the commandant at the F. Edward Hébert School of Medicine School of Medicine and associate professor in the Department of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md.
Lawrence said patients need to answer questions about end-of-life care before an emergency arises. If a patient ends up in an emergency department without any advance directives, Lawrence said doctors will take heroic measures to save that patient's life, and technology allows doctors to prolong life in ways that once were not possible. Making wishes clear can help ease anxiety or guilt for family of critically ill patients who can no longer communicate their wishes.
Part of the AHA effort is a new Web-based resource, putitinwriting.org, where people can find information about advance directives and living wills in English and Spanish. The site also links to state-by-state listings of sample advance directives and instructions prepared by the National Hospice and Palliative Care Organization.
"As a family physician, I delivered babies for 20 years and I still care for people when they are dying and it's one of those situations where if they're well prepared, it's sad, but not a tremendously wrenching experience," Wopat said. "The AHA's take is, let's do everything we can to educate people around the issues of death and dying and then put it in writing."
Absent that, he says, "You lose focus on the what the patient wants, we drive up the cost of healthcare and cause pain and confusion," he said.
Still, he said, "it's always a difficult balance when you bring into the discussion cost issues."
Wopat said that in his experience, cost has not been a factor in decisions to provide life-prolonging care; on the contrary, prolonging life is the default position, and perhaps not what the patient might have wanted had they been able to communicate their wishes.
Drafting an advance directive doesn't require a lawyer, Wopat said, but he adds patients do need to "think about (their wishes), document them, and talk about them with your loved ones."
Even if you have a written document, "if your spouse (or family) doesn't know what you want, it puts a lot of tension at the end of life," he said. "This should not be a debate between people at the end of life -- this should be a discussion prior to that between the physician and the person and the family."
Wopat said he has written his own advance directive and encourages his patients to do so, too. Hospital leaders should do the same with their own staffs and employees.
"If you see the staff is committed to doing it for themselves, it shines a light on it to make sure they have it for each of their patients," he said.
