Rules on Dying Ease Pain

Working together, the San Diego County Bar Assn. and the county Medical Society have established guidelines for right-to-die decisions that should make it easier for them to be made at the bedside rather than in a courtroom.

The guidelines, developed by a committee of doctors and lawyers over a two-year period, resulted from the wrenching court case about whether a 92-year-old comatose La Mesa woman should be taken off nutrition and hydration. Her daughter argued that that would have been her wish. Her doctor refused, and the case went to court. After several months of legal anguish, Anna Hirth was moved out of her nursing room and died after being removed from nutritional support.

The guidelines might not have kept the Hirth case out of court. But the judge in her case says the guidelines would have eased the legal process.

These guidelines, say the doctors and lawyers who worked on them, do not cut new ethical ground. Rather, they clearly spell out for doctors existing law and precedent, so that physicians or hospitals should not have to research each case.

The guidelines also should prove helpful for patients and their families.

Respect for the patient’s wishes is a strong theme throughout the guidelines, even if the patient is unable to make the decision himself. Surrogates are advised to follow the patient’s wishes or view the treatment from the patient’s perspective. The importance of spelling out one’s wishes before an illness comes through loud and clear.

If the physician finds the patient’s wishes ethically objectionable, he does not have to follow them. But the guidelines say that it is the physician’s duty to then transfer care of the patient to another doctor who can act according to the patient’s desires.

That attorneys and physicians were able to work out such a consensus is, in and of itself, a major accomplishment. Each profession had to be able to look at the ethical and moral considerations from the other’s perspective.

We applaud the committee’s work. It was an endeavor that could benefit any of us at a painful time.