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November 7 , 2005
End-of-life decisions come to forefront at Thursday symposium

BY eric rangus

Three days after suffering a heart attack in May 2003, Roland Knobel’s wife of 57 years, Mary Jo, passed away quietly and with dignity at the age of 79. Following her heart attack, which had significant effect on her quality of life, Mary Jo’s physician asked her husband what interventions (meaning, advanced medical care) he wished for her.

Knobel, emeritus professor of international medicine with expertise in health administration and health ethics, knew exactly what he—and most importantly, his wife—wanted. No artificial respiration or other invasive care, only a morphine drip to ease pain.

“It was time,” said Knobel, now 82.

The reason Knobel knew his wife’s wishes is that she had done what only about 35 percent of Georgians do: filed a durable power of attorney for health care. A durable power of attorney is one of two “advance directives”: binding, legal documents that state a person’s wishes for end-of-life care should he or she no longer be able to express them.

The importance of advance directives will be a theme of Georgia Health Care Decisions Week, which runs statewide from today, Monday, Nov. 7, through Sunday, Nov. 13.

To note the importance of the week, the Center for Lifelong Learning’s Academy for Retired Professionals, Emeritus College and the Center for Ethics are co-hosting the symposium, “Do Your Loved Ones Know Your Wishes?” on Thursday, Nov. 10, from 1–3:30 p.m. in the Center for Lifelong Learning on the Briarcliff Campus. It is free and open to the public. The entire Emory community, regardless of age, is invited to attend.
“Younger people can wind up in the hospital for all kinds of things,” Knobel said. For instance, Terri Schiavo, whose husband and parents battled in court for years about her end-of-life wishes, was only in her 20s when she slipped into a persistent vegetative state.

“But advance directives are most important for people nearing the end of life in nursing homes or hospitals,” he continued.

Advance directives are spoken or written decisions that specify instruction for medical treatment. There are two kinds: a living will and a durable power of attorney for health care.

Living wills allow people to state their health care wishes if unable to speak for themselves. They also permit doctors, under specific conditions, to withhold or withdraw certain medical care (such as a respirator).
A durable power of attorney for health care goes into more detail about a person’s wishes. It allows a person to appoint someone to speak for him or her and convey decisions about medical care. That’s the role Knobel filled for his wife.

An advocate for the importance of end-of-life decisions, Knobel (who goes by “Knob” to his friends and acquaintances) is director of the Memorial Society of Georgia, a nonprofit organization that assists people in making end-of-life preparations. He also sits on the board of the state chapter of similarly themed national nonprofit Compassion & Choices.

It was with the political muscle of these groups and others that Knobel began lobbying the Georgia Legislature last year to bring end-of-life choices to the forefront. That work resulted in the General Assembly unanimously passing a resolution earlier this year that created Georgia Health Care Decisions Week to highlight the need for citizens of all ages to talk with loved ones about their wishes for medical care.

“Do Your Loved Ones Know Your Wishes?” is Emory’s contribution to the cause of raising awareness about end-of-life decisions.

Attendees will hear opening comments from Mary Cobb Callahan, director of the Academy for Retired Professionals; Emeritus College Director Eugene Bianchi; and Center for Ethics Acting Director Kathy Kinlaw, followed by a 45-minute panel, featuring Wesley Woods’ Laurent Adler and anesthesiology emeritus professor Carl Hug, and moderated by gynecology and obstetrics emerita Professor Elizabeth Connell.
School of Law visiting professor and state Rep. Mary Margaret Oliver (one of the co-sponsors of the bill that created Georgia Health Care Decisions Week) will follow with a talk on “Legislative Actions and the Formulation of Health Care Decisions Week.” Knobel also will speak about “Financial and Philosophical Aspects of Advance Directives.” The symposium will wrap up with a showing of “Final Choices—Valley of the Shadow,” a 2000 documentary on end-of-life care, with a reception to follow.

Perhaps most importantly, attendees will have the opportunity to sign their own advanced directives at the symposium’s conclusion. Knobel won’t be one of them. He has had both a living will and durable power of attorney for some 20 years. He updated them about five years ago.

Like his wife, Knobel wants no interventions other than a morphine drip, a decision supported by his two children. “It needs to be recognized that the quality of life is important,” he said. “A person shouldn’t be without that.”

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