Ogden Standard Examiner
New state form may clarify end-of-life care Living Will Act scrutinized in Weitzel case
Tue, Apr 23, 2002
By NESREEN KHASHAN Standard-Examiner Davis Bureau
LAYTON -- A proposal by the Utah Department of Health could give physicians additional protection from civil or criminal actions when they honor a dying patient's wishes to withhold extraordinary life-sustaining measures. The state agency has created a form to be used when terminal patients enter the medical care system, or in other instances at the discretion of health-care providers. The hope in creating the form is that it will help clarify for doctors what kind of end-of-life care their charge wants to receive. Unlike legal documents like living wills or advance directives, the form is a doctor's order that is intended to accompany the patient as he or she travels through various medical treatment facilities. In the past, Utah's Living Will Act has been criticized for its impractical applications in medical care settings. A living will must be translated into a doctor's order before its instructions can be followed, and in many situations family members are not even aware that such a process is necessary. "We continue to hear of instances where family wishes were not being honored," said Doug Springmeyer, chief legal counsel for the state health department. "This form puts in friendly and more complete terms the decisions families and patients have to make: do you resuscitate, use antibiotics, or comfort methods. It asks how heroic or how limited do you want us to be." While many of the complaints have come from patients and families, most recently the law was attacked by former Davis Hospital and Medical Center psychiatrist Robert Weitzel, who has said that he was prosecuted in the deaths of five elderly patients who suffered from dementia although their families instructed him to allow their relatives to pass away naturally. A jury found Weitzel guilty of manslaughter and negligent homicide in July 2000, but those charges were overturned by a judge who ruled that the prosecution withheld information about a witness that may have benefited the defense. Weitzel is now scheduled for a November retrial on those same charges. According to prosecutors, the legal issue in the Weitzel case is whether the five patients who died within a 16-day span beginning in December 1995 were terminal when they were admitted into the doctor's care. Davis County attorneys accuse Weitzel of blasting the patients with lethal doses of morphine, while the doctor has maintained that he was providing comfort care. Weitzel has portrayed the prosecution as a threat against advance directives and living wills, even going so far as making such an assertion in the headline on the introduction to his Internet site about the case. The high-profile nature of the case, which was recently featured on the CBS news program "60 Minutes," has raised the specter that the publicity could create a chilling effect for doctors who provide comfort and end-of-life care. Although the committee that created the form predates the Weitzel trial, Utah Medical Association Executive Vice President Val Bateman said its imminent use by the state's medical community should assuage some of those worries. "This document might clear up those fuzzy boundaries between appropriate pain control, malpractice and criminal negligence," Bateman said. "Better defining what those boundaries are is something we are all working toward." While the UMA has officially declined to comment on the Weitzel prosecution, last month the group issued a statement to its members stressing the need to continue educating doctors on how to administer appropriate pain management and end-of-life care. The document is a result of four years of work between the state health department, the UMA and the Partnership to Improve End-of-Life Care in Utah. As early as this fall, the state could make the appropriate use of the form a state law when patients request that it be used. The law would penalize health care providers who fail to transfer the document with the patient or follow its care instructions. Maureen Henry from the Partnership said she believes the form will help bridge a gap between the perceptions of attorneys and doctors over how to execute a dying person's wishes without violating legal or moral codes. More importantly, she said the form will do what living wills in Utah have not succeeded in accomplishing - getting patients and their families to think about the issues involving end-of-life care. "There is almost a false sense of security that signing a living will imposes," Henry said. "This form will help promote good medical practice by helping to ensure that those conversations take place, and that the conversations are documented in the record in a way that is easy to understand."
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