Choosing Death

Giving burn patients the say

A woman, admitted to the hospital with severe burns covering 95% of her body, asks a doctor if she is going to die. The physician replies carefully that although he cannot predict the future, survival in cases like hers is unprecedented. Does the woman want ordinary medical care or maximum-effort treatment, involving the use of life-prolonging machines? She chooses the ordinary care, consisting basically of painkillers and intravenous fluids, and dies quietly within hours.

This procedure, allowing terminal burn patients to choose death, in effect, sooner rather than later, has been in use at the Los Angeles County-University of Southern California Medical Center's burn unit for two years. During that time, 21 of 24 patients diagnosed as "having injury without precedent of survival" have chosen ordinary medical care and an earlier death. The other three -- all men characterized by hospital personnel as "take charge types" in their 50s or 60s -- also died; the longest survivor lived seven days.

The unusual policy of allowing the patient -- and not relatives -- to decide is feasible in massive burn cases because the victim's nerve endings are anesthetized by the injury, leaving him lucid and free of pain for the first several hours. In fact, says Dr. Bruce Zawacki, 42, head of the burn unit, relatives have been "overwhelmingly relieved" that the burden of decision making is taken off their shoulders. Says Zawacki: "In the long run it is better for our mental health and the patients' mental health to lay the cards on the table." Part of the policy is increased attention to the dying patient's need for compassionate human contact. Says Nurse Sharon Imbus: "We are very pro-life here, but if you choose ordinary medical care, we will be with you. We will stay with you. You won't be alone."

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