Pope John Paul II told a group of doctors Saturday that resorting to extreme measures to try to keep alive the terminally ill at all costs does not respect the patient.

March 25, 2002

By Howard LeWine, M.D.
Harvard Medical School

How does this article relate to me?

According to Pope John Paul II "extreme measures at all costs, even with the best intentions, would be, in the end, not only useless, but not fully respectful of the patient who has reached the terminal stage." In my years of practice and teaching, I have met few colleagues and patients' families who would disagree. The problem often arises, though, that we are not absolutely certain death is at hand.

Modern medicine is blessed with almost daily advances in surgery, drug therapy and technology that help prolong life. No sooner do physicians get comfortable with our limits than we hear of something else that "just might work." Patients and their families hear about these same breakthroughs and wonder if maybe this newest treatment might be the solution. Doubt creeps in, causing patients and their loved ones to think that perhaps it is too soon to stop trying. More often than not, even when the patient, the family and the physician see death staring them in the face, this doubt once again raises its head.

What changes do I need to make?

We all need to become more comfortable with discussions about what we want for ourselves if (or, more likely, when) we get so sick there's no real chance of recovery. Most of my patients, and myself included, fear severe disability more than death. Discussions about end-of-life care between family members or close friends should begin while we are well. That makes the discussion when someone becomes ill part of an ongoing conversation rather than a new and rushed discussion.

This way, when the time comes to make those tough decisions, the dialogue will be less awkward. Patients will feel more comfortable saying when enough is enough. Families can support these wishes. And should the patient become too ill to make his or her own decisions, then the family can communicate them. The treating physicians can then focus their care around what the patient wants.

Advanced directives are written instructions stating what you want to happen if you aren't able to make your own health-care decisions. Signing a durable power of attorney for health care and a living will is just the beginning. What's more important is the discussion you will have with your loved ones, telling them what you want and how you feel. Following through with your wishes then becomes easier for them should that time arise.

What can I expect in the future?

Pope John Paul II is setting a good example for other world leaders. Heads of state, CEOs, sports stars and Oscar winners need to publicly speak out on this issue. It doesn't have to be presented as a "downer," and it isn't harping on illness and death. Instead, talking about these issues can be a celebration of the great advances in prevention and treatment of disease balanced against what our health-care system isn't doing so well — taking care of people at the end of their lives.

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