Chaplain Jerry L. Carter

Breaking Through

For most of the last year, a red cardinal has been assaulting the windows of our administration office, banging repeatedly into the window as if determined to fly through. When not attacking that window, he visits the third window down from my office. He perches on a shrub and then flies breast first straight into the window, backs off a few inches and repeats his attack. He will make half a dozen attempts, go back to his perch and in a few minutes he is at it again.

I watched him for several minutes yesterday as he flew repeatedly into the window. Can he not process in his bird-size brain the futility of his efforts? What draws him to his task? What keeps him motivated, energized? Why does he keep banging his body, breast and beak into an impenetrable object?

Who knows how many thousands of time he has repeated his actions. I admire his dedication. I am amazed at the relentlessness of his efforts. But they have been and will remain futile.

Unfortunately no one on this side of the glass can tell him his futility.

It could be that there is a dynamic equally as energized at work when we attempt to assist family members who are facing decisions to limit life sustaining treatment as further aggressive treatment becomes futile. They see their beloved one in the desperation of extreme illness. But they also think that a little more time or the next medication or the sheer will of the person will pull them through the crisis. Some wait for a divine miracle and passionately believe they will receive it in time. Often they believe the magic of modern medicine can conquer all.

In 1999, the Texas Legislature enacted the Advance Directive Act of 1999. In that statute, a process has been created for resolving disputes between patients and physicians. There are times when physicians want to discontinue a treatment that the family wishes to continue. There are also times when a family wants to discontinue a treatment that the physician wishes to continue. The process calls for communication between the family, the physician, and the hospital ethics or medical committee.

This process is very open. For example, the physician requests that the ethics committee meet to consider his/her case that further aggressive care is futile. The patient’s family or surrogate decision maker is given forty-eight hours written notice of the meeting of the ethics committee. Family and/or the surrogate decision makers are invited to be present when the case is presented. They may participate in the meeting, presenting their case for continued aggressive care. If in the deliberation of the ethics committee the committee agrees with the physician, then they may give the family written notice of intention to withdraw life sustaining treatment in ten days. During the ten days, the hospital works with the family to attempt to find another facility that will accept the patient. If no other facility is found after ten days, the hospital may withdraw treatment above the family’s objection. The family also has recourse to go to the County Court at Law for an extension of the ten day period.

In the small hospital I serve, we have not had to resort to this process. Perhaps it is because some of the most difficult cases are transferred to larger facilities before reaching the point of futility and the necessity of this process. However, I like to think that we have been fortunate enough to be able to develop communication with the families who are facing these grim decisions. We take the time to listen to their concerns, goals and needs. Our physicians attempt to explain in clear terms the patient’s condition and prognosis. Palliative care physicians, chaplains, social workers and nurses all assist with the communication, listening well and speaking with compassionate understanding. When a situation is futile, communication is the key that frequently breaks through the glass.

Do you have thoughts about professional practice you’d like to share with your colleagues? Send an e-mail info@PlainViews.org.