SEMINAR ADDRESSES ISSUES OF `LIFE'S END'

One woman came to the "Christian Care at Life's End" seminar Sunday because she doesn't want her daughter in Texas to have to make difficult decisions if her mother's health suddenly should fail.

Another, Ethel Priest of Jackson, hoped that people will pray and seek pastoral guidance before signing an "advance directive" document that outlines beforehand which life-prolonging measures can be used if the patient's condition is terminal. "It makes them partners in possibly displeasing God," she said.

About 35 people came to Trinity Lutheran Church to attend the two-hour seminar sponsored by the SEMO-Trail of Tears Lutherans for Life.

The panelists were Deborah Taylor, a nurse at Southeast Missouri Hospital; Judge Stanley Grimm of the Missouri Court of Appeals; the Rev. David Dissen, the church's administrative pastor; Dr. Allen L. Spitler of Cardiovascular Consultants of Cape Girardeau; and Janice Unger, director of the Lutheran Home.

Taylor cares for many people whose lives are threatened by illness or accidents. Part of her job is to introduce them to the living will. Its dictates are followed when a patient has an incurable condition and is unable to participate in the decision-making process.

A living will can outline very specifically which procedures are not to be used to prolong life -- for instance CPR or antibiotics -- or can generally prohibit extraordinary means, which would include a ventilator.

Taylor pointed out that a patient who signs a living still will receive oxygen, water, pain medicine and food.

Living wills, established by the Missouri Legislature in 1985, can help both the patient and family members, Taylor said. "When they are upset, they don't have to deal with that. They've already made that choice."

But Dissen contended that living wills can be too inclusionary, that they ought not apply to people with Alzheimer's disease and crippling injuries. He gave examples of parishioners who had recovered from injuries after doctors gave them no chance.

Dissen objects to the use of the word "vegetable" to describe human beings whose brains have ceased to function.

"That is the terminology of evolutionists," he said. "Evolutionists do not believe that we are the direct creation of God."

Touching on the subject of euthanasia proponents, he warned, "Many of the elderly are being judged as a physical, mental or social nuisance."

Another document that falls under the heading of advance directives is the durable power of attorney. In the case of medical care, it appoints someone to speak on behalf of a patient who has become incapacitated. The patient is not required to be terminal for the health care durable power of attorney to take effect.

Grimm, who is from Cape Girardeau, said a durable power of attorney is an important document no matter what your age. "We never know what will happen to us," he said.

Recalling the heart bypass operations he had at 48 and again at 58, Grimm said crucial decisions about health -- for instance, whether to smoke and what foods to eat -- don't just occur at life's end.

"We make life-prolonging choices on a daily basis," he said.

Spitler said scientific advances are forcing society to make new choices about when and how to die "whether we want to or not."

Soaring health care costs, longer life expectancies and the ability to keep people alive through technology have raised questions of rationing health care by age, he said.

"The medical technology and treatment options are outstripping the resources," Spitler added.

By the year 2040, he said, an estimated 1 million Americans will be over the age of 100.

These realities have created a Brave New World of difficult-to-answer medical ethical questions.

Quoting a medical writer, Spitler said, "People don't die all at once anymore. They die in pieces. It's difficult to decide which piece to stop at."

People who live at the Lutheran Home are known by the staff to be either "no code" or "full code," depending on whether no extraordinary means or all means are to be used to revive them if they arrest.

At that, Unger said, families often insist on sending "no code" patients to a hospital when they are stricken.

"I think they want to say, We did everything we could," she said.