Bioethics for the The Healthcare City: NBTS connects faith & medicine
Dr. Raynard Smith, Assistant Professor of Pastoral Care at NBTS organized a provocative conference at Robert Wood Johnson University Hospital this October. For one amazing morning, medical personnel--Doctors, physician's assistants, nurses, hospital administrators-met with clergy and lay members of faith communities to discuss collaborative approaches to meeting the medical, moral and spiritual needs of patients who are approaching death.
The John Suydam Memorial Bioethics Conference was entitled, "Entering the Valley: Practitioner Orders for Life Sustaining Treatment (POLST) and Spirituality: What does it all mean?" It was produced in collaboration with Robert Wood Johnson University Hospital, Saint Peter's University Hospital, and Robert Wood Johnson University Hospital Hamilton. Participation was required as part of "Grand Rounds" for many in the medical community.
The conference centers around the POLST form - POLST stands for New Jersey Practitioner Orders for Life Sustaining Treatment. It is a medical order that is signed into law in the state of New Jersey and 26 other states, it is also a form which documents a conversation between or about a seriously ill patient and is actionable throughout the medical community.
"The POLST form is essentially a SCRIPT to guide the conversation and an agreement about how to proceed with medical treatment."
David Barile, MD presented one of two keynote addresses: "Decision-Making in Geriatric Medicine: An Introduction to the NJ POLST Form." Dr. Barile presented us with data about the "Silver Tsunami"-how the international community is bracing for the tidal wave of people who will be living far along into old age. As a gerontologist, Dr. Barile has seen how medical science likes to make generalizations. But when it comes to an aging population, "there is no average 90-year old. Some are vibrantly caring for themselves, some are working, while others are in persistent vegetative states," he says. The danger is that society and the healthcare industry tends to suffer from "age-ism" - making assumptions about the needs of patients based solely on their ages. The single most important thing a doctor can do is to ask patients who are faced with a difficult prognosis, "In the light of your prognosis, what are your goals, your hopes for the future?" and then collaborating with the patient to employ medical interventions to support the patient's goals.
Rev. Abigail Evans spoke candidly about the natural inclination to avoid talking about death, especially in healthcare environments. "I like to say, 'Sex' has come out of the closet; 'Death' is now pushing on the door." She notes that recent polls say that 90% of Americans feel you should pray about decisions at the end of life and for comfort in dying.
Rev. Abigail Evans, PhD, delivered the other keynote, "Collaborative Approaches to Addressing Medical, Moral and Spiritual Issues." We know we have to start putting some boundaries around medical technologies, she said, when it becomes clear that the focus seems to be on lengthening our dying instead of enhancing our living. Technology and medical science have put us in the position where we now have to defend our end of life instead of focusing on simply experiencing the end of life." In moments of crisis, she urged, clergy, physicians and family members need to work together in order to allow for healing in the midst of dying. Managing hope can be challenging. False hope can trip us up at the bedside of a dying patient. Colostomy patients, she notes, adjust better when they are told they will never recover completely. They learn how to live within their limitations. "We must remember many senses of hope. There's a hope of miraculous physical recovery, the hope of renewed sense of meaning, and a more transcendent hope for spiritual healing and peace."
A full half of the conference was devoted to small group discussions of actual case studies, presented by Amir Bukhari, MD. Cross-specialty groups made up of members from faith communities and healthcare providers brainstormed approaches to difficult situations faced by patients and families approaching death.
The bioethics conference was funded through the support of Honorable John Kuhlthau and Dr. Carol Kuhlthau, in honor of John's grandfather, John Suydam,.