T he P ortland O bserver • M arch
P age A5
15, 1995
HEALTH
Most Critical-Care Physicians Have Withheld Life-Sustaining Treatment
In a survey of critical-care phy
sicians. 96 percent said they had with
drawn or withheld medical treatments
from patients with the understanding
that death would follow.
Mechanical ventilation, which
helps patients continue to breathe
when they are unable to do so them
selves, was the t\ pe o f life-sustaining
treatm ent most com m only w ith
drawn.
T wenty-nine percent o f the phy
sicians reported withdrawing me
chanical ventilation from three to
five times in the preceding year, and
another 26 percent reported with
drawing it more than five times.
The survey of 879 critical-care
specialists, conducted in 1989-90,
appears in the February issue o f the
American Journal o f Respiratory and
Critical Care Medicine, published
by the American Lung Association.
, Women For
Sobriety
r
t
W omen for Sobriety, a support
group for women recovering from
addictions, meets every Tuesday,
5:30-6:45 p.m., at Town Hall, 3704
North Interstate. Conference Room
D.
One o f more than 300 groups
nationwide. Town Hall Women for
Sobriety utilizes a discussion format
to provide support based on the pro
gram 's philosophy, which centers on
issues ofw om en's self-esteem. Mem
bers learn strategies to form healthy
life and thinking habits.
N ot a Twelve-Step Program,
W FS is a non-profit organization
w hie h offers a phi losophy o f 13 State
ments, such as (#1): “ 1 have a life-
threatening problem that once had
me," and (#12): "1 am a competent
woman and have much to give life "
Emphasis is on growth and on the
present: Participants learn from the
past, plan for tomorrow, and live
today. Meetings are lead by a peer
moderator.
W omen are invited to call for
further inform ation or literature
(Karen, 235-0647), or simply to at
tend a meeting. A $2 donation is
requested.
Mental Health And
Chemical
Dependency
Spring Vacation Can Be A De
pressing Time For Kids...
Children who are left home with
nothing to do during spring break
can becom e leth arg ic, anxious,
moody and bored. Experts offer
guidelines on how to break the bore
dom.
Cures For TV
Addiction...
Children who watch too much
television, especially violent televi
sion programs, learn the wrong ways
to resolve conflicts and are not intel
lectually stimulated. Mental health
experts offer their opinions on the
popular programs and suggest guide
lines for television viewing.
Parental Guilt...
Parents today have to balance
their responsibilities at work and
home. They struggle to spend enough
time with their kids and still have
energy to be good employees. 1 he
result for many is often a guilty con
science. Experts can discuss this guilt
“ I'm not surprised at all that the
number ofphysicians w ho have with
drawn life support is high," says Louis
Libby, M.D. Libby is a Portland
pulmonologist and member o f the
Oregon Thoracic Society, the medi
cal branch o f the American Lung
Association o f Oregon.
“Most patients want the option
o f withdrawal o f life support when
the prognosis is bad," Libby says.
"W ithdrawal ofartificial life-support
allows nature to take its course. That’s
very different from physician-assist
ed suicide, in which a doctor takes an
active step, by administering medi
cation, to end a patient’s life.”
Molly Osborne, M.D., says the
survey's results don’t surprise her,
either. “Technical support should be
used when it can make someone bet
ter, but not when it simply prolongs
death,” she says. Osborne, a Portland
pulmonologist, is president o f the
Oregon Thoracic Society and a mem
ber o f the board o f directors o f the
American Lung Association o f O re
gon. Osborne was also a member o f
an American Thoracic Society task
force that developed a position state
ment on withholding and withdraw
ing life-sustaining therapy.
The new survey also found that
the year before the study was con
ducted, one-third o f the physicians
refused to withdraw a patient's life-
sustaining treatment even though a
patient or family members wanted it
to be discontinued. In three-quarters
o f these cases, the physicians felt the
patient had a reasonable chance to
recover.
“ It’s not as if all of the conflicts
between physicians and patients are
in a single direction," said the study’s
lead author, Dr. David Asch o f the
University o f Pennsylvania School
o f Medicine and the Philadelphia
VA Medical Center. “Sometimes
physicians continue therapy when
patients don’t want it, and sometimes
they discontinue it when patients do
want it.”
Dr. Snider says that either o f
these situations may occur when pa
tients’ wishes for end-of-life treat
ment clash with doctors’ opinions.
“A patient may be thinking in
terms o f his quality o f life and ability
to function, while his doctor may be
thinking just in terms o f preserving
life itself. It is the goals o f patients
that are critically important in this
matter, not the goals o f the doctor,”
he says.
The researchers conducting the
survey conclude that physicians don’t
automatically accept requests by pa
tients or their surrogates to limit or
Overhaul VA Health-Care System,
Veterans’ Groups Demand
With Congress working to “re
invent government,” four major vet
erans’ organizations have proposed
a sweeping cost-saving plan for the
nationwide veterans' health-care sys
tem.
The plan, which has been pre
sented to Congress, calls for over
haul o f the Department o f Veterans
Affairs (VA) health-care system and
vastly improved VA efficiency. The
result, state the veterans’ organiza
tions, will be more services to more
at lower cost to the American taxpay
er.
The organizations -- AM VETS,
Disabled American Veterans. Para
lyzed Veterans o f America and the
Veterans o f Foreign Wars - in their
ninth annual “Independent Budget"
for the department o f Veterans Af
fairs call for the removal o f outdated
VA regulations.
Current law, for example, limits
access by most veterans to outpat ient
VA medical services, forcing VA
hospitals to treat them in far more
expensive inpatient settings. While
these eligibility rules were designed
originally to ration access to V A care
and limit costs, they actually have
hamstrung V A ’s ability to be effi
cient, according to standards o f care
in the United States today.
The 147-page "Independent
Budget" finds that a simple change in
the law allowing V A physicians more
options in treating patients will save
VA a significant amount o f money.
The report cites VA studies indicat
ing that up to 40 percent o f those
being treated as inpatients in VA
hospitals could be treated more effi
ciently as outpatients or in other less
expensive ways.
I n fact, the report states V A could
save up to $2 billion yearly by pro
viding care more appropriately and
efficiently. The saving could be used
to reduce the amount of money Con
gress must appropriate to VA to al
low it to provide veterans with ap
propriate medical care. However,
restraining the growth o f Congres
sional appropriations is possible only
if VA can keep the payments it re
ceives from insurance companies and
other third-party payers for the care
it provides certain veterans.
Currently, VA must give most
o f these collections ($535 million in
FY 1995) to the treasury. The report
indicates that with improved proce
dures, V A could collect at least $800
million in third-party reimbursements
in the near future. These collections
would be a steady source o f VA
revenue, easing the burden on ever-
inadequate Congressional appropri
ations increases. But the Veterans
groups warn that their budget plan is
a mandatory two-step process. The
Congress cannot reduce the growth
o f VA appropriations without allow
ing V A to become more efficient and
to keep its alternative funding sourc
es.
The report indicates that if the
Congress does nothing to implement
these reforms, funding for V A health
care services in Fiscal Year 1996
would have to be $ 18.8 billion — $1.8
billion above the level requested by
the Clinton Administration. With the
$2 billion in projected efficiencies
and the added third-party payments,
the actual budget request for FY 1996
could drop to $16.6 billion — $400
million less than the Administration’s
request.
The veterans groups also call for
changes in law to remove certain
inequities and emphatically state their
opposition to proposals to means test,
tax or eliminate compensation for
veterans with service-connected dis
abilities. In addition to improvements
in benefits, the veterans’ groups iden
tified serious problems in the deliv
ery o f benefits. They cited protracted
delays in VA claims and appeals
processing as evidence o f underly
ing systemic deficiencies in need o f
prompt correction and urged Con
gress to provide the necessary re
sources and VA to undertake neces
sary reforms to remedy these defi
T here's more concern than ever
among parents about the messages in
popular music. Many songs have
frank lyrics on topics like sex. drugs,
and even murder. And the videos that
promote these songs are just as ex
plicit Mental health experts can an
swer questions about whether popu
lar music encourages anti-social be
havior in children, or if music is a
positive outlet for the complex emo
tions o f adolescents
To schedule an interview, or if
you have any questions, call me at
(503) 649-4761 or Marcia Erickson
at (503) 230-6305
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and suggest ways to alleviate it.
The Effect Of
Popular Music On
Kids...
find that the laws governing either
suicide or homicide forbid the w ith
drawing or withholding o f treatment
when the decision is made in good
faith.
The researchers say the findings
suggest that doctors need better
guidel ines for making dec isions about
life-sustaining treatment.
There is an important step pa
tients can take to help ensure their
w ishes about life-sustaining treatment
are followed. Dr. Libby says. He
recommends everyone fill out an
advance directive, such as a living
will, which explains your wishes for
medical care, including life-sustain
ing treatment.
For more information on breath
ing problems and lung disease, call
the American Lung Association o f
O regon at 2 4 6 -1997 o r 1-800-
LUNG-USA.
continue life-sustaining treatment,
but consider these requests along
side many other factors. These fac
tors include the doctor's judgm ent
about the patient’s prognosis, fears
o f malpractice suits, and a percep
tion that' withdrawing life support is
illegal or unethical.
Dr. Snider says that fears about
legal problems surrounding life-sus
taining therapy are misguided. "In all
states, withdrawing or withholding
life support is legal, providing prop
er procedures are followed," he said.
"Fear o f malpractice actions related
to withdrawing or withholding life
support also unfounded.”
In his editorial, Dr. Snider noted
“malpractice and criminal actions
related to withholding or withdraw
ing treatment have been virtual ly non
existent." He added that every court
examining this issue has refused to
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