Time to Go: Three Plays on Death and Dying with Commentary on End-Of-Life Issues PDF
Preview Time to Go: Three Plays on Death and Dying with Commentary on End-Of-Life Issues
Page iii Time to Go Three Plays on Death and Dying with Commentary on EndofLife Issues Edited by Anne Hunsaker Hawkins, Ph.D. and James O. Ballard, M.D. with Theodore Blaisdell, M.D. University of Pennsylvania Press Philadelphia Page iv The University of Pennsylvania Press will grant permission for performance of the plays in Time to Go only on the condition that performances will be free of charge. Parties requesting that this condition be waived must secure written permission from the author of the play in question, who can be contacted c/o the University of Pennsylvania Press. Copyright © 1995 by the Doctors Kienle Center for Humanistic Medicine All rights reserved Printed in the United States of America Library of Congress CataloginginPublication Data Time to go: three plays on death and dying, with commentary on endoflife issues / edited by Anne Hunsaker Hawkins and James O. Ballard with Theodore Blaisdell. p. cm. Includes bibliographical references and index. Contents: Journey into that good night / Berry L. Barta—Stars at the break of day / Marjorie Ellen Spence—Time to go / CE McClelland. ISBN 0812215192 I. Death—Drama. 2. Donotresuscitate orders—Drama. 3. American drama—20th century. 4. Right to die—Drama. I. Hawkins, Anne Hunsaker, 1944 . II. Ballard, James O. III. Blaisdell, Theodore. PS627.D42T56 1995 306.9—dc20 9432201 CIP Page v Dedicated to the memory of JANE WITMER KIENLE, M.D. Page vii CONTENTS Acknowledgments ix Part I: Advance Directives: Starting the Dialogue 1 Introduction 3 Notes 19 Part II: The Plays 21 Journey Into That Good Night 23 Berry L. Barta About the Author 23 Author's Introduction 23 Text 25 Commentary 36 Suggestions for Performance and Discussion 40 Stars at the Break of Day 46 Marjorie Ellen Spence About the Author 46 Author's Introduction 46 Text 48 Commentary 64 Suggestions for Performance and Discussion 68 Time to Go 72 CE McClelland About the Author 72 Author's Introduction 72 Page viii Text 74 Commentary 90 Suggestions for Performance and Discussion 94 Appendix A: The Values History 101 Appendix B: Living Will Declaration 107 Appendix C: Durable Power of Attorney for Health Care 111 Appendix D: Resources for Consumers and Providers 117 The Introduction was written by James O. Ballard, with Anne Hunsaker Hawkins adding the concluding section. Commentaries on all three plays were written by Hawkins. Suggestions for staging and discussion are the work of Hawkins and Theodore Blaisdell. Ballard compiled the appendices. Page ix ACKNOWLEDGMENTS Many people have made generous contributions to the development of this book and the project on which it is based. No contribution, however, could be more important than that of Lawrence F. Kienle and Jane Witmer Kienle. The Doctors Kienle Center for Humanistic Medicine not only funded the scriptwriting contest that yielded the plays in this book, but also subsidized the book's publication. The Kienle Center began as The Center for Humanistic Medicine of the Milton S. Hershey Medical Center in 1979, founded through the joint efforts of the departments of Humanities, Medicine, and Behavioral Science. Its mission was—and still is—to support, facilitate, and initiate education and research that will render the delivery of health care more humane, both locally and nationally. It was in 1985, when Dr. Jane Witmer Kienle (a retired psychiatrist) and Dr. Lawrence F. Kienle (a retired radiologist) joined The Center as benefactors, that it really began to thrive. The Kienles were looking for an institution which would support the advancement of humanistic medical values, and it is our great good fortune that they found Hershey and its Center for Humanistic Medicine, which has been transformed by their generous backing. The Center now includes representatives from eighteen different departments and supports many educational and research projects that concern humane medical practice. With the sudden death of Jane Kienle, to whom this book is dedicated, we lost a dear friend. However, Larry has worked tirelessly to see that the entire scope of Jane's and his vision for The Center would be realized. A new era began in 1992, when a generous additional gift led The Center to be renamed "The Doctors Kienle Center for Humanistic Medicine." This book illustrates the goals and work of The Kienle Center: to advance the partnership of medical professionals, patients, and the community in fostering the most effective and compassionate medical care possible. It is the position of The Kienle Center that, during this period of medical reform, nothing is more crucial than maintaining the connection between technical excellence and humane values in care. We hope that our book will serve this purpose. Page x The editors wish to thank Sherman Hawkins, professor emeritus at Wesleyan University, for his many contributions to our medical theater project. We are also grateful to Ted Blaisdell, a fine physician as well as a superb actor and director; Russell Miller, founding member and student organizer of the Hershey Medical Theater Group; Robert Biter, talented actor, director, and playwright, who succeeds Miller as HMTG student organizer; and all the medical students, physicians, staff, and their spouses who served as actors in our plays. We are grateful for permission to use copyrighted material in several instances. William Carlos Williams's, "The Red Wheelbarrow," in The Collected Works of William Carlos Williams, 1909–1939, vol. 1, copyright © 1938 New Directions Publishing Corporation, is used by permission of New Directions Publishing Corporation. An excerpt from W. H. Auden's "Musée des Beaux Arts;" in W. H. Auden: Collected Poems, ed. Edward Mendelson, copyright © 1940, renewed 1968 by W. H. Auden, is reprinted by permission of Random House. An excerpt from Dylan Thomas's "Do Not Go Gentle into That Good Night'' is reprinted by permission of Harry Ober Associates, Random House, Inc., and Alfred E. Knopf, Inc. ''The Values History" (Appendix A), an excerpt from David J. Doukas and L. B. McCullough, "The Values History: The Evaluation of the Patient's Values and Advance Directives," Journal of Family Practice 32 (1991): 145–53, copyright © 1991, is reprinted by permission of the authors, the Journal of Family Practice, and Appleton and Lange Publishers. The model documents contained in Appendix B and Appendix C are reprinted by permission of the American Association of Retired Persons. Page 1 PART I ADVANCE DIRECTIVES: STARTING THE DIALOGUE Page 3 Introduction The Problem In our country's health care institutions, decisions are made every day regarding the use of lifesustaining medical treatment. It is estimated that 80 percent of deaths occur in a hospital or nursing home setting, and that for 70 percent of these individuals a decision is made either not to start or to terminate medical therapy. 1 This scenario is all too familiar to health care workers. A patient with a prior diagnosis of advanced lung disease, metastatic cancer, or AIDS is readmitted to the hospital complaining of severe shortness of breath. Things go from bad to worse, and an urgent decision must be made whether mechanical ventilation will be initiated. The patient is now too ill to comprehend and participate in decision making. The patient and physician may have had a mutual understanding that the longterm prognosis of the underlying disease process is not good, but the two have not discussed what the patient would want done or not done in the current situation. The physician may have reason to believe this new complication is reversible, but at the same time there is a painful awareness that the patient may remain dependent on the ventilator, even if the underlying lung infection is resolved. The family is divided, with some members urging the doctor to "Do everything possible"; others saying, "Just make him comfortable"; and yet others, ''Do what you think is best." Furthermore, the physician may even fear legal action if he or she withholds or terminates life support. The site where these endoflife decisions are made may compound the problem. Patients with lifethreatening illnesses such as those depicted above are frequently sent to tertiary care medical centers, with the understanding and hope that they will receive the latest and best treatment available. The "best" treatment has come to mean highly technical and costly therapy that has the potential of sustaining life indefinitely by mechanical and pharmacologic means. In these medical centers, not one but
The list of books you might like
