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August 1988 - San Francisco Police Officers Association

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<strong>August</strong>, <strong>1988</strong><br />

Notebook<br />

Page 7<br />

RETIRED<br />

MEMBERS<br />

COLUMN<br />

by Gino Marionetti & Mike Sugrue<br />

\ '<br />

/<br />

\i l\<br />

,i<br />

Movin' On<br />

Service Retirements<br />

Sgt. George Wallace<br />

Sgt. Alexander Barron<br />

Insp. Thomas Dickson<br />

Insp. David Kellogg<br />

Insp. Ben Luttringer<br />

Insp. John Minoli<br />

Insp. Dennis O'Connell<br />

Off. Budd Armstrong<br />

Off. Raymond Costello<br />

Off. Ronald Haight<br />

Off. Joseph Stone<br />

Turning Out The Light<br />

Part Two<br />

Particularly disturbing is the question of whether to<br />

withhold from a patient such life-sustaining substances<br />

as food and water. There are social, psychological and<br />

traditional aspects of these elements that make their<br />

withdrawal especially difficult.<br />

Doctors do not relish having to play God at a bedside,<br />

surrounded by a patient's usually distraught loved ones.<br />

Nor are those loved ones always united in their approach.<br />

"I saw a long-absent son come in from Cincinnati," says<br />

one doctor who practiced all his life in the South, "full<br />

of guilt for having not been a devoted son, and letting<br />

everyone know how much he really cared for his ailing<br />

mother by declaring, 'We will spare no expense to keep<br />

my mother alive,' This even though other family members<br />

who had been close to the patient knew she really did<br />

not want her life prolonged."<br />

When dealing with such situations, doctors or hospital<br />

administrators can never be sure from whom a legal action<br />

might come: from the daughter suing the doctor for<br />

prolonging her mother's agony and bankrupting the family<br />

from the son charging negligence or malpractice for<br />

letting his mother die when her life might have been<br />

prolonged<br />

There is, of course, substantial organized resistance to<br />

anything approaching a willful decision - by patient, doctor<br />

or family - to end a life. The Roman Catholic Church<br />

has been critical of right-to-die groups, seeing their agenda<br />

as too sweeping because it fails to distinguish between<br />

ordinary and extraordinary means for sustaining a dying<br />

patient.<br />

The pro-life groups have also been opposed to naturaldeath<br />

or right-to-die legislation. "So long as we hold all<br />

human life inviolate," says John C. Wilike, M.D., president<br />

of the pro-life National Right to Life Committee, "then<br />

everybody is safe. When we begin to put relative values<br />

on some lives and delegate to someone the right to take<br />

a life, no one is safe."<br />

While the sentiments concerning euthanasia or intentionally<br />

ending life are well defined, the issues of<br />

withholding or withdrawing life-prolonging treatment are<br />

less clear.<br />

But with cries of anguish coming from the heart and<br />

pocketbooks of the country, public opinion is beginning<br />

to solidify. The real issue: Do individuals have the right<br />

to make their own health-care decisions And the consensus:<br />

Yes, it's a matter of choice.<br />

Numerous court cases, TV documentaries, talk shows,<br />

movies, and endless storis in the press have echoed what<br />

Mark Rosen, M.D., of Mount Sinai Medical Center in New<br />

York said at an end-of-life seminar sponsored by the National<br />

Health Council late last year: "People who work<br />

in intensive care know there are worse things than death."<br />

After a national three-hour teleconference on "Who<br />

Lives, Who Dies, Who Decides" moderated by<br />

Nightline's Ted Koppel in 1986, questionnaires from approximately<br />

2,000 people were analyzed: Ninety percent<br />

believed adults who are competent to make decisions<br />

should have the right to refuse life-support measures even<br />

over the objections of family and physicians. Seventy percent<br />

felt that immediate family, not the courts, should<br />

make the decisions on behalf of incompetent patients.<br />

Many organizations have joined the cause, endeavoring<br />

to convince the medical profession, the courts and<br />

lawmakers that people have the right to make their own<br />

decision about when it is time to remove life supports.<br />

The Society for the Right to Die and Concern for the-<br />

Dy-ing provide counseling and guidance to individuals seeking<br />

help. The Society, for example, often helps relatives<br />

of a terminal patient see that their loved one's rights are<br />

protected and his or her wishes carried out. The Hemlock<br />

Society, based in Los Angeles, goes further: Although its<br />

literature insists that it "does not encourage suicide," it<br />

seeks to persuade society that terminally ill patients should<br />

be free "to end their lives in a planned manner."<br />

A monumental study - A Matter of Coice - done for<br />

the Special Senate Committee on Aging, and the apparently<br />

overwhelming public consensus on a subject no<br />

one wanted to think about 10 years ago, seems to be having<br />

an impact. Early this year, the Roman Catholic<br />

Diocese in Providence, Rhode Island, said it was morally<br />

permissible to remove the feeding tube from a comatose<br />

woman who had suffered a cerebral hemorrhage two<br />

years earlier. And the statement by the Reverand Robert<br />

J. McManus - apparently the first of its kind endorsed<br />

by a diocesan Church official - revealed the changing<br />

attitude toward what constitutes living and death: "Based<br />

on what the doctors have given as a prognosis, I believe<br />

this woman is dying, that the dying process began the<br />

moment she suffered the massive cerebral hemorrhage<br />

[two years ago], and all the medical treatments have only<br />

served to prolong that."<br />

Most important, the medical profession has<br />

acknowledged the ethical problems created by the tremendous<br />

improvement in life-sustaining techniques. "Until<br />

recently," says a Georgetown University law professor,<br />

"doctors thought they were competent to cover<br />

everything. Now they are aware that things they once<br />

thought medical are no longer solely medical." Some<br />

hospitals have appointed ethical advisers to help their<br />

physicians arrive at life decisions with peace of mind and<br />

some degree of certainty.<br />

Charles M. Culver, M.D., Ph.D., plays such a role at<br />

Mary Hitchcock Memorial Hospital in Hanover, New<br />

Hampshire. One colleague calls him "Captain Ethics" and<br />

at times it might appear he's playing God, but Culver<br />

doesn't see it that way: "I see myself as reporting what<br />

is relevant in moral philosophy and health law and then<br />

talking things through so the doctor sees his choices more<br />

clearly." He does not watchdog the staff, and he never<br />

intervenes; sometimes it is just a matter of a doctor stopping<br />

him in the corridor and saying, "I have an interesting<br />

case." This generally leads to conversation, with Culver<br />

giving his suggestions.<br />

Guidelines have also been issued by such institutions<br />

as the American Medical <strong>Association</strong>'s Council on Ethical<br />

and Judicial Affairs and the Hastings Center in Briarcliff<br />

Manor, New York, which specializes in medical ethics.<br />

The AMA council said that "it is not unethical to discontinue<br />

all means of life-prolonging medical treatment" for<br />

terminally ill or irreversibly comatose patients, providing<br />

the patient's family or other surrogates concur. The<br />

Hastings Center's guidelines reached similar conclusions,<br />

although there were dissenting opinions on some of the<br />

points and recommendations.<br />

Perhaps the most important point in all the recent efforts<br />

to guide doctors through this difficult territory was<br />

summed up in one of the Hastings guidelines: "When the<br />

patient has the capacity to decide about treatment, it is<br />

the patient who is the key decisionmaker.... When the<br />

patient lacks the capacity, the key decisionmaker is someone<br />

else...."<br />

In many guidelines there are references to "advance<br />

directives," and here is the real means of avoiding the kind<br />

of nightmares cited in this article. Doctors agree that every<br />

case is different; but when that difficult decision must be<br />

made, advance directives often provide critical information<br />

about the patient's wishes concerning the use of lifeprolonging<br />

technology and who the patient delegates to<br />

make those decisions.<br />

As Robert Pilpel, project coordinator for the National<br />

Health Council's bioethics program, has said, "Death is<br />

a four-letter word in our society." None of us want to think<br />

about death or even physical or mental incapacity, and<br />

this is understandable. Yet each of us, at whatever age,<br />

should give it some thought - and talk about it with our<br />

families. There are two legal tools you - and your spouse,<br />

your children, your parents, your siblings - should consider<br />

assmbling now to help ensure that what you want<br />

to happen at such a critical time will happen: the living<br />

will and the durable power of attorney.<br />

We agree with the poet Dylan Thomas that you should<br />

not go gently into that good night. But these two<br />

documents will help you, your family and your doctors<br />

at a time when what is needed most is everyone's<br />

understanding of how you feel about a critical decision<br />

that someone, sometime, may have to make for you.<br />

Reprinted from<br />

Modem Maturity, June/July <strong>1988</strong><br />

Mark Kai Co.<br />

802 Clement Street<br />

S.F. California<br />

415-751-7232<br />

RETIREMENT DINNER FOR<br />

TOM DICKSON<br />

THE EMBODIMENT<br />

OF AN INSPECTOR<br />

Wed.<br />

Aug. 31, '88<br />

Fort Mason<br />

Officer's Club<br />

$25 Per Person<br />

Couples Welcome . . -<br />

L ',<br />

No Host Cocktail<br />

7-8 PM<br />

Dinner At8<br />

Salad, Veal Oscar,<br />

Wine, Dessert<br />

FOR TICKETS<br />

M. Folena 553-9070<br />

D. Carlson 553-1550<br />

• J. Wallace 553-9073<br />

C. Peters 553-9074<br />

Retirement Dinner<br />

Tues. Aug. 30th, <strong>1988</strong><br />

ltalianAmerican Social Club<br />

25 Russia At Mission<br />

No Host Cocktails 6 PM To 7 PM<br />

Dinner At 7 PM<br />

$2700 Per Person, Includes<br />

Choice Of Entree: Roast Beef, Roast<br />

Chicken, Roast Pork, Chicken Cacciotore<br />

Or Roast Veal, Shrimp Salad, Wine, Tax<br />

Tip & Gift<br />

1)<br />

CONTACT:<br />

Dennis Costanzo, Steve Spranger,<br />

Ralph Eieig At Co. H 5531603<br />

Day Shift 0600-1600 Hrs.<br />

kt --rr<br />

UNO VEIDMAN<br />

165 Page Street<br />

S.F. California<br />

415-431-8988<br />

'U Y"<br />

' \c-..') '/1<br />

A7<br />

I

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