'Playing God'

For the second time, you've presented the alarming view of medical ethicist Daniel Callahan, who wants to deny life-extending medical care to persons who have exceeded a "normal life span," and for the second time I've fumed for hours after reading it {Ethics, Jan. 26}. It's some consolation to read that he hasn't yet worked out all the details or decided exactly what the normal span is, but even printing this idea in a serious newspaper suggests that a totalitarian approach to health care is a real possibility in the foreseeable future. In my opinion, people who want to decide what's best

for everyone don't fully understand or trust a free society where people make their own, sometimes faulty, decisions.

Callahan is unhappy because 20 to 30 percent of the federal health budget is devoted to health care for the elderly. Don't the elderly have 20 to 30 percent of the illness, and haven't they contributed a great deal to the federal budget? There is no visible evidence that care for the elderly is superseding care for other groups.

Of course, no sensible person would suggest that the only available transplant organ be given to a 70-year-old patient rather than to a patient of 45, even if the older one is richer, nor would most people favor keeping a hopelessly ill patient of any age alive a few more days or weeks by the use of very expensive technology. But public opinion should nip in the bud, right now, any notion of denying potentially helpful treatment to persons who have passed a certain age, as long as we remain a reasonably affluent and free nation.

Callahan and like-minded persons should understand that people do not cease to be full human beings when they reach 65, 75 or even 85. The person who is cured of a life-threatening illness at age 70 or later may afterward negotiate a peace treaty, compose a symphony, write a novel, contribute to a cure for cancer or simply enjoy another five or 10 years of living in this beautiful and fascinating world. Joann Naugle Washington

Don Colburn writes that the durable power of attorney is a stronger protection than a living will for those who desire to specify the treatment they want or don't want in the case of severe illness. That statement needs some clarification.

Most durable powers of attorney authorize the designated representative to make only financial decisions on the author's behalf. It is unclear whether all states will allow a durable power of attorney to be used for health-care decisions. Some states, such as California, have statutes that allow health-care durable powers of attorney. But an opinion by the New York attorney general says that a general durable power of attorney does not authorize decisions concerning health.

Anyone considering making a durable power of attorney, either in connection with or instead of a living will, should be sure of two things. First, the document should specifically authorize the attorney in fact to make health care decisions. Second, the applicable state law should recognize the use of the durable power of attorney for this purpose. Vicki Gottlich

National Senior Citizens Law Center Washington

It is a distressing enough fact to know that daily society is finding so many "practical" uses for "fetal tissue." However, I am appalled to read in your article about women and families who would even consider the creation of life (or pregnancy) for the sole and explicit purpose of abortion.

At one time, the purpose of creating life itself was an expression of love with the outcome being the shared joy at giving birth to a new life created by that union.

Has mankind no conscience but to now think of breeding unborn children (or fetuses as some prefer to call them) for the purposes of medicine, or whatever future use? Marni Miller Gaithersburg

The Nursing Shortage

The article by Jeanette Hartshorn, president of the American Association of Critical-Care Nurses {Second Opinion, Jan. 12}, reiterates the concern regarding a shortage of critical-care nurses in the United States. That 82 percent of all hospitals in our country have stated that they have a shortage of critical-care nurses should cause every hospital's chief executive officer great concern. I fear, however, that this will be just one more article written by a professional stating a problem that will go unheeded until we have needless death and dying because the hospitals will be caught without sufficient health care professionals.

Recently, hospitals have attempted to replace registered nurses in noncritical intensive care environments with licensed practical nurses, technicians, pre-hospital care providers or other individuals who, they believe, can fill the void in the registered nurse practice. However, their failure to replace the critical-care nurse knowledge base that saves lives daily is neither cost-effective for the hospital nor safe for the patient.

In order to protect the patient and therefore prevent meritorious malpractice litigation, I urge hospitals to recognize that registered nurse health care professionals are specialists. Is $40 to $60 an hour too much to pay to save life and limb, and malpractice costs? I don't think so. Linda C. Carl, RN President, Critical Care Consultants

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