FROM THE EDITOR’S CORNER
Rabbi Harold Stern
The next New York City Long Term Care Ethics Network conference will approach the hot button topic of palliative care for dementia residents. There is much in the news media on this topic, considering the Palliative Care Promotion Act currently in front of Congress, that would advocate the availability of higher levels of morphine content prescriptions to alleviate pain for terminal illnesses. Notwithstanding where individuals stand on that worthy divide, the first ethical question to be addressed is whose pain is being relieved? I pose for your consideration whether the pain and suffering being palliated is that of the identified patient or resident, or that of the family member, or even the health care practitioner? I raise the definition of health care staff to include all members of the team and suggest that we devise an “objective test,” if one can in fact be so structured, to help us better identify the authentic needs of the patient/resident vs. those of others in his/her sphere. I think this test must be supra- legalistic and include spiritual and moral mores in its criteria.
The related questions of prolonging pain, quality vs. sanctity of life and distribution of scarce resources and their implications for decisions regarding informed consent, artificial nutrition and the moral agency in everyday decision making must be weighed in terms of both biomedical and organizational ethical parameters. Again, we must stretch the definition of spiritual and cultural determinants beyond the Judeo-Christian model, openly inviting all models into the calculus of this important decision affecting those for whom we care. This issue of the Ethics Network News opens new vistas in health care. Let us reason together and stand on the shoulders of giants as we peer into the future. As we embark upon the brave new world of the new millennium, with its wondrous technological advances and the alacrity of treatment decisions that can be executed in nanoseconds, let us pause to reflect how our decisions may shape the future of health care for the next century.
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