Internationally Known Palliative Care Physician to Address End of Life Choices at Sept. 18 Event 

University of Michigan Health System by Nicole Fawcett

September 2, 2008

If you were diagnosed with a terminal illness, do you know where you would want to die? Hooked up to machines in a hospital’s intensive care unit? Or at home where you’re comfortable but where that life-saving technology would not be available?

Few people think about end of life care until they are actually faced with making those decisions for a loved one.

On Sept. 18, the University of Michigan Health System, Saint Joseph Mercy Health System and Hospice of Michigan, together will present internationally renowned palliative care physician David Kuhl, M.D., who will talk about these issues and offer advice for patients and families living with a terminal illness. The event will be held at 7:30 p.m. Sept. 18 at Washtenaw Community College, Morris Lawrence Building, Towsley Auditorium. Tickets are $10 at the door.

“It really is important for people to have these discussions with their family members and to put it in writing,” says Maureen Goode, M.A., R.N., clinical nurse consultant and nurse ethicist with the Palliative Care Education program at UMHS. “The disadvantage when you don’t talk about this ahead of time – which is what happens to most of us – is that tomorrow if your loved one has a heart attack, you don’t know his values and preferences for medical care.”

Kuhl’s speech, which is open to the public, is part of a two-day program for health care professionals put together by U-M Health System, Saint Joseph Mercy Health System and Hospice of Michigan. The program is designed to teach health care professionals how to address the issues surrounding patients and families who face end of life decisions.

Kuhl, author of “What Dying People Want,” began his career in palliative care 15 years ago. He then developed a program for people with cancer or AIDS at St. Paul’s Hospital in Vancouver, British Columbia. He helps people understand the psychological and spiritual realities that confront people at the end of their life and offers ways to find hope and meaning amongst the sadness.

Technological advances in medicine have raised ethical questions about how much effort should be made to keep a person alive. It’s not a question of euthanasia, which involves intentionally causing death to someone with a terminal illness. Rather, palliative care involves compassionate therapies that address the physical, psychological, social and spiritual suffering of a patient or family.

“Often, we miss the questions to ask. We focus on ‘Do you want to be resuscitated or not?’ Instead, what we really need to ask about is values: ‘What gives meaning to your life?’” Goode says. She advocates for primary care doctors and nurse practitioners to ask about their patients’ values so that they can advocate for the patient’s wishes when the time comes.

Liz Beger, R.N., nurse manager and member of the Palliative Care Team at St. Joe’s, agrees. “At Saint Joseph Mercy Hospital, we are creating a Life Preference Proposal, which will direct the medical team in planning end of life care that corresponds with the patient’s values and wishes, when appropriate. I think all of us involved in this joint initiative recognized that identifying and honoring a patient’s values and wishes are an essential component when providing end of life patient care.”

Goode also suggests families look for those “teachable moments.” If a neighbor or friend dies, use it as an opportunity to discuss with your family each person’s own values and wishes.

“We don’t take advantage of these opportunities as much as we should as families,” Goode says. Encourage family members to sign an advance directive, she suggests, and don’t let the conversation end after one attempt. “Keep bringing it up,” she says. (For information on advance directives, go to http://www.nlm.nih.gov/medlineplus/advancedirectives.html.) The Palliative Care Education program at UMHS has focused over the past year on educating nurses in end-of-life care. Some efforts were targeted at specific units while others, including a two-day conference in June, have been designed to educate as many nurses as possible. The June conference featured 100 nurses who were then urged to share what they learned with other nurses in the U-M hospitals or outpatient clinics. Programs are planned to continue into 2004.

Saint Joseph Mercy Health System’s Palliative Care Team includes representatives from nursing, pharmacy, social work, pastoral care and two physicians. Although many initiatives are underway, the team is currently working to bring those initiatives together to develop a formalized plan. 

Doors open to the Sept. 18 community event at 6:30 p.m., and the program runs from 7:30-9 p.m. Kuhl will sign copies of his book afterward. Nicola’s Bookstore in Ann Arbor will be selling Kuhl’s book throughout the two-day conference. For more information about the event, please call (734) 763-8035.

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