“I have given you the power to make these decisions. Use it.” These were Melissa Sitter’s instructions from her husband when he was hospitalized with end-stage melanoma.
It’s a very profound job they have of lovingly guiding people towards dying well
“I felt that Tom had given me such a terrifying responsibility,” says Melissa Sitter, more than two years after his death. “How do you know which is the right moment? You’re grieving, you’re overwhelmed, and there is so much medical information to consider. Thank goodness one of the nurses mentioned the possibility of an ethics consultation.”
Sutter’s Program in Medicine and Human Values (PMHV) provides clinical ethics consultations at Sutter Health hospitals in Santa Rosa, Lakeport, Novato, Castro Valley, Burlingame, and at California Pacific Medical Center in San Francisco. A professional bioethicist speaks directly to the patient if possible, to the family, and to the doctors and nurses involved. The goal is to help providers and family members make the healthcare decisions that the patient would make if he or she were capable of doing so.
The growing need for bioethics consultations is linked to medicine’s success: People are living longer, even with serious diseases such as cancer. Each patient has different healthcare goals and a unique cultural context for determining those goals. An ethics consultation takes into account the patient’s wishes, the physicians’ and nurses’ professional values, and accepted moral standards. For patients with advanced illnesses, the consultation process also helps determine the ethical appropriateness of medical treatments.
Thomas Sitter was no longer able to speak for himself, but he’d made his wishes very clear to his wife, Melissa. PMHV’s William Andereck, M.D., and Ruchika Mishra, Ph.D., directed a process that allowed each member of the care team, plus the Sitters’ children, to recognize that Tom had passed the point of heroic medical measures.
“After our ethics consultation the family said, ‘Wow, you really care for our dad as much as we do; thank you,’” Melissa Sitter says. “It’s a very profound job they have of lovingly guiding people towards dying well. Because of them, my husband died a death of great dignity, in my arms, just as he wished.”
Melissa Sitter lives in St. Helena and is particularly pleased that the program has expanded its reach to her local hospitals in the North Bay. “Access to this program could be, possibly, the best thing in our last moments of life,” she says.
Ultimately, the program’s work and public education comes back to the same goal: to provide personalized advice in ethically challenging situations, and to help the entire care team treat each patient with respect, dignity, and appropriate care.