September 13, 2002

End-of-life issues addressed at Dean’s Lecture Series

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Dr. Timothy Quill encouraged health care professionals to keep an open dialogue with terminally ill patients, being prepared to answer difficult questions. (photo by Dana Johnson)

End-of-life issues addressed at Dean’s Lecture Series

Dr. Timothy Quill, professor of Medicine, Psychiatry and Medical Humanities and director of Palliative Care Programs at the University of Rochester School of Medicine, spoke to a group of students, faculty and staff last week about end-of-life issues and how to know when to stop life-sustaining measures.

Quill’s lecture, “Palliative Care: Challenges and Opportunities,” was the first of the Dean’s Lecture Series. Vanderbilt University School of Medicine began the monthly lecture series to offer thought-provoking speakers and topics selected by students and administrators to augment what students are taught in the classroom and in the clinic.

“A feeding tube is so simple to put in, but it’s so profound in its consequences,” Quill told the group. It is the responsibility of health care professionals to help people die well. “If everybody is going to die, we may as well learn how to help people do this as well as possible.”

Quill said that about 15 percent to 20 percent of the population completes an advanced directive, a document that states what medical procedures you want done in case you have a serious illness or accident and are unable to speak for yourself. A relative or friend can make the decisions for you, or you can specify in writing which medical procedures you do or do not want performed.

About 90 percent of people surveyed indicated that they want to die in their own homes, and physicians are often the “weakest link” in end-of-life care, Quill said. “Many don’t see this as their job,” he said.

Health care professionals should keep an open dialogue with terminally ill patients, being prepared to answer difficult questions such as “How long do I have? What would you do in my shoes? Should I try experimental therapy? Will you help me die?” Quill said.

But physician-assisted suicide should be the “last of last of last resorts,” Quill said. His advice to physicians who are asked by the patients to help them die: “Never do it unless you can live with the consequences. It’s nothing a doctor should do without thinking it through thoroughly,” he said. Quill said if a doctor discusses the reason for the request with his or her patient, there’s usually an underlying reason like too much pain or concern about family members, problems that can be eased with some intervention.

The speakers for the Dean’s Lecture Series are chosen by the speaker board, a group of mostly second-year medical students who wanted to be involved in bringing interesting speakers to Vanderbilt.

“We want speakers who will be engaging and able to provide insight into their area of expertise,” said Quyen Luc, a second-year student on the committee. “The speakers who are coming this year really showcase the varied interests of the speaker board members and of the medical students in general.

“The Dean’s Lecture Series brings speakers to Vanderbilt who have achieved and accomplished amazing things. This is a chance for the students to gain a new perspective on material learned in class or on the wards and to explore different aspects of medicine.”