On Sunday, former first lady Barbara Bush announced through a spokesman that she would seek no further medical treatment and focus on ‘comfort care.’
When people learned that 92-year-old Barbara Bush planned to focus only on “comfort care,” they may not have expected her to die so quickly.
She said through her spokesman on Sunday that after repeated hospitalizations, she would not pursue any further medical treatments. She suffered from congestive heart failure and chronic obstructive pulmonary disease, according to family spokesman Jim McGrath.
We know that congestive heart failure is a serious, sometimes-fatal condition whose sets of symptoms and severity vary from patient to patient. Chronic obstructive pulmonary disease, also known as COPD, is an incurable progressive disease that makes it increasingly harder to breathe.
Comfort care, also known as palliative care, focuses “focuses on managing patients’ symptoms to keep them comfortable and retain their dignity,” Dr. Haider Warraich told Kaiser Health News.
Warraich, a fellow in cardiovascular medicine at Duke University Medical Center and author of Modern Death, “applauded the Bush family for putting the phrase ‘comfort care’ into the public sphere so that other people can consider it ‘a viable option at the end of life,'” Kaiser reported.
The first debate, however, is over the meaning of “comfort care.”  Warraich said comfort care doesn’t mean the patient won’t receive medical help:
For heart failure patients, he said, “comfort care” usually means opting not to use a breathing machine or CPR. But patients do continue to receive medical treatment, including morphine to ease shortness of breath and diuretics to remove excess fluid from their lungs, he said.
But, he said, it’s important to be able to have this type of discussion so that families can decide what they want for their own members before they’re “in the clutches of death.”
The National Hospice and Palliative Care Organization lists the following duties for members of a hospice team:
- Manages the patient’s pain and symptoms;
- Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
- Provides needed drugs, medical supplies, and equipment;
- Coaches the family on how to care for the patient;
- Delivers special services like speech and physical therapy when needed;
- Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
- Provides bereavement care and counseling to surviving family and friends.
But to some, hospice care sounds like “assisted suicide.” A poster to the forum at AgingCare.com even said exactly that:
“I don’t think I’m ok with this at all. Everyone said, “Oh hospice is just wonderful,” blah,  blah, blah. What I see is assisted suicide, and everyone else standing on the other side of the fence saying, “Oh look, she has hospice, her daughter will be so supported we don’t need to do anything now.” [Edited for grammar, spelling and proper punctuation]
Some people, of course, will see it exactly that way, especially when it’s their loved one who’s at the end of his or her life.
Others, however, see it as a death in which dignity and comfort is preserved, and they feel that’s more important than other measures that will potentially only prolong suffering just for the sake of keeping someone alive a little bit longer when medical knowledge makes it clear there is no hope for improvement.
Should everyone be able to make that decision for themselves? And if so, how far should they be able to go in that decision? It’s one thing to say they don’t want any “heroic measures” taken if they’re near death, as in a “Do Not Resuscitate” order. It’s another to say that when they reach a point of terminal illness, that medical care designed to prolong life should be suspended in favor of keeping them comfortable and stress-free until their death comes. And it’s still another to say that when they are in a terminal illness, they will be given the mechanism to end their death earlier than nature would do so in an assisted suicide.
Everybody loves to complain about the notion of a “slippery slope.” Everything is, in some way, a slippery slope to something. But it’s a complaint that, in the case of comfort care vs. assisted suicide, will likely always be tossed around.
If one can have the choice to forego treatment of a terminal illness, why can’t one have the same authority to decide when their quality of life has reached a point at which they no longer wish to live?
If you faced a terminal illness, would you want to be kept alive no matter what? Or would you want to at least have a say about when enough is enough? Would you want the chance to say, in addition to all of that, when it’s actually time for death to come?
But if it’s your relative who’s facing the end of their own life, your desire to keep them around longer may not be as strong as their desire to complete their journey. Who, in that case, has the more important opinion? Who, in that case, should get to decide?
If assisted suicide is wrong, then how is “comfort care” acceptable? If it’s inappropriate for someone to decide for themselves when they wish to end their own life if they’re facing a terminal illness, then why is it appropriate for them to refuse medical care at all, even if it will only prolong the “inevitable”?
We’re all going to die, of course. That is one of life’s few certainties.
The question that we all need to think about going forward is the amount of control we should be able to expect in how that process occurs when the time comes.
Unfortunately, there’s no single correct answer here. What people feel is right will depend on their personal views of life, death and spirituality. The question, however, is how much control should individuals have with respect to their own demise and how much freedom a country whose citizens claim to value freedom so much are willing to grant to people with different points of view from their own.