Play

 

Today Sr. Margaret McBride joins me for Part 2 of our conversation. In Part 1, we covered a very difficult decision Sr. Margaret had to make, agreeing to an abortion in order to save the mother, which resulted in her excommunication [from the Catholic Church] in 2009. She was re-communicated in 2011, which led to the transition from Catholic Healthcare West to Dignity Healthcare.Sr. Margaret McBride cropped

 

Sister, I know you play a broader role with many patients as they face end of life, and I want to get your impressions on end of life based on your experiences.

EOL issues are really important especially in a Catholic health setting because we pride ourselves on our ability to give people comfort and support, both spiritually and psychologically, as well as hope and faith during a time of transition. If we look at the ethical and religious directives, the beauty about Catholic healthcare [is] you’ll see wonderful documentation about end of life care, and how it [centers around] respect and dignity of the human person.

The other thing that the Church really encourages us is to make sure that patients are comfortable and without pain. Now there is an element of the Church that says that individuals who want to suffer can have redemptive suffering. But we are not to impose redemptive suffering on anyone. So our goal is to keep the patient comfortable and help the transition so their dying can be as peaceful as possible.

We have a lot of opportunity—especially at Saint Joseph’s, which is very neuro-centered—with traumatic brain injury [cases]. Many times families will want everything possible done for their loved one but when we have the conversation with them that your loved one is not going to be able to return to work or it’s going to mean that you’ll have to have a 24-hour care-giver in the home if you take your loved one home, often times they become much more realistic. Often that’s a decision-making point for individuals because they rely so much on the ability of the individual to contribute to the livelihood of the whole family.

Do you think the decision-making is driven on some level by guilt or they just want their loved one with them longer?   What drives that initial conversation, where they say, do everything that you can?

[It has to do with] our society and the American medical system. Because we can do it is the challenge. Not so long ago there was a 96-year-old woman and the doctor said [she] could go on dialysis. Well, what does that mean and how realistic is that for a 96-year-old? Just because we can do it, should we do it? Those are the conversations we have to have. I think sometimes we offer too much to patients’ [families] in way of chemotherapy, radiation, dialysis, and then we don’t allow them to make a really important decision about how challenging this can be. The other good part about the Catholic Church is that it always asks, what is the burden? So that if we overburden someone, the Church says we don’t have to provide that service. Of course what is burdensome for one person may not burdensome for another. {Still} we don’t have to impose something that causes a burden for someone.

We have a long debate going on about [staff in] positions actively assisting to expedite death. I get the idea we should be providing comfort and sometimes that involves giving drugs [during which time] the patient expires. What about those cases where it’s a little less clear? Where people want to pass? How do you avoid that slippery slope where maybe [the patient] is depressed and not very comfortable, and wants be put out of their misery?

The Church says that if your purpose is to make someone comfortable and free of pain, and if medication causes their death, your intent was to cause comfort not death. I think that’s a distinction we have to make. We’re seeing more states that are thinking about assisted suicide and approving it, and that’s a different kind of conversation. I think we never want to have a conversation about assisted suicide if [patients] are depressed. Our goal would be to resolve their depression, because that could change their outlook on the decision to make. I’m not saying that individuals don’t have the free choice to make a decision. But even with Oregon, we found that not that many people exercise physician-assisted suicide. I think what people want to know is that there is an out if they need it but not necessarily choose it.

We physicians are really trained to cure, whenever possible. We almost make ourselves believe we can cure or fix something that’s not fixable. How can your side of the fence help the more technical folks? I always think of physicians as both priests and scientists, but sometimes in America we’re so heavily laden with technology that the priest side gets pushed out and we forget the spiritual side. Any advice for physicians on how to become more centered?

You’re right. It’s extremely hard for physicians whose whole training has been focused on cure. It’s important to listen to the patient and what their goal is. Is their goal just to go home for one more night, be in their own bed and have their pet jump on the bed? Is it one more meal with their wife? Sometimes the goals are very simple, but we don’t listen. That’s where palliative care comes in, and [we] really take the time to listen. What are your goals for treatment? Do you want to try to be cured? If we know what those goals are we can help the patient achieve those goals.

I almost have this vision in my head of a physician pop quiz. Where you’d walk around the hospital and meet the physicians and say, OK pop quiz: What is the goal of your patient? My bet is that many of them don’t have an answer. They’re like, to live. [Not] shall we ask the patient?

And sometimes goals are really simple. Like my daughter’s getting married in a month and I want to walk her down the aisle. It may be that those very simple goals are what we should try to focus on. Maybe it’s one more treatment; maybe it’s not one more treatment.

I don’t believe I’ve had that conversation when I should have. Atul Gawande’s book, Being Mortal, embraces that a lot. I know you’ve read that as well.

Yes [that book] has a lot to say about dignity, respect, and it gave examples of things we can do. It gave great stories. It’s a great book to make us think of our mortality. I think when our technology increases we get less conscious of mortality, but the reality is that as our technology increases our sense of mortality needs to go hand in hand. Recently one of our sisters was interviewed—she was 103—and someone asked her what she was doing differently now that she was 103 versus 102. And she goes, “not much.” And I think that’s true; we all want to live as well as possible, but when that’s not possible, what then are the goals of life? Another thing is that we’re going to live longer with chronic illness and that issue is going to be very important for all of us to have to deal with. We’ll be living longer but not as healthy. What is that going to mean?

Yes the focus on quality and not just quantity. Sister I very much appreciate this discussion. I hope you’ll join me for one more session to talk about Catholic nuns here in America.