Her Rx: Improving care for the dying

As a Catholic and a daughter who experienced her own father's final illness, Dr. Knudsen knows just how vital those issues are.

"Unfortunately, in the way our healthcare system is set up, we're very technology-oriented," she told The Evangelist. "We tend to push to the Nth degree; the goal is to cure. But we get so wrapped up in technology, we forget this treatment may give a patient a month" more of life.

Additionally, she said, doctors are often expected to see a new patient every 10 minutes. The pressure for such "productivity" makes it hard to learn about patients' spiritual and emotional needs.

Focus groups

The initiative will start focus groups in healthcare facilities to look at better care for seriously ill patients.

Dr. Knudsen often treats chronically ill patients living with liver or lung diseases or cancer. She said that she has a "special interest in patients who need the extra time and care that may be involved as they're dying."

Experience

"My father was a very religious man," she explained. "His faith was very strong, and he taught that to all of us. When you talk about suffering, you have to look at the spiritual aspects of a person's life and how important their faith and religion is. My father was one who wanted everything done [to prolong his life], because he loved life."

Helping to care for her father also taught her that "the families suffer with the patient."

Efforts at change

She believes in a threefold "clinical pathway" for treatment: pain management; "symptom management" that simply treats symptoms in terminal patients without performing tests to determine their cause; and "terminal management," which would provide insurance coverage for patients to die in the hospital if home or Hospice care is not appropriate.

She hopes to use her new position to further those goals and spread the results of national studies on end-of-life issues locally. While she believes that physician-assisted suicide has not become a "major issue" in this area yet, she noted that "patients who request it are suffering from something we haven't yet discovered. When we discover it, it goes away."

End times

"As a physician, I have no right to dictate this person is going to die at this time, because I think that is divinely directed," she said. "Sometimes, [a patient is] waiting for a loved one to arrive; sometimes, they don't die until everyone leaves, because they need to be alone. Sometimes, they don't die, but go on to recover."

Dr. Knudsen said that she is excited and enthusiastic about her appointment as spokesperson, and feels that the Church in the Albany Diocese has already done much to further the issues of better end-of-life care.

Goals

* educating physicians better in palliative care;

* teaching families to recognize that there are many choices in end-of-life care;

* helping doctors and families to plan end-of-life care together;

* making people better informed about the option of writing advance directives for their own future care; and

* "helping people to understand that death can be sad, but it's such a profound, meaningful experience that the lesson it teaches us is so much more than the sadness alone. The dying teach us about living."

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