The Philip Littman Memorial Fund
for Medical Ethics

To My Dear Friends,

Reflecting on the years since establishing the Philip Littman Memorial Fund for Medical Ethics at MJHS Hospice, I am humbled by the continued generosity and steadfast support of Phil’s friends and family members like you. This fund has helped their patients ensure they can have end-of-life experience that follows their values and wishes. This resource was invaluable to our family as we navigated the complexities of Phil’s terminal illness, and I am committed to continuing to honor his legacy by promoting this program both as a donor and as an active member of MJHS’s Ethics Committee. I hope you will consider joining me again this year to support this worthy cause.

Looking Back On This Year

Over the past year, the Ethics Committee has been charged with tackling difficult issues to inform organizational policies and provide guidance to clinicians. Topics have included Do Not Resuscitate (DNR) policies and patients who voluntarily stop eating and drinking. We collaborated with nursing homes to assist them in enrolling terminally ill residents in hospice and consulted on 15 “isolated” patients to determine if they would benefit from end-of-life care. In addition to creating policies, the Ethics Committee helps clinicians struggling with situations where competing priorities make it unclear how to provide the best care to their patients. 

Earlier this year, we heard a case about a 62-year-old man with end-stage alcoholic cirrhosis. He lived alone and refused care, alternately abusing or firing his home health aides frequently while drunk. His poor diet, end-stage disease, and heavy drinking resulted in a cycle of frequent falls, emergency room trips, and discharges home after stabilization. Yet, despite alienating many people who attempted to work for him, he trusted his hospice nurse and social worker. As he declined physically and mentally in an unsafe living situation, the team requested an ethics consult to explore the tension between their obligation to honor his wish to remain at home and give the best possible care in a safe environment. 

It was determined that allowing him to die in his home, even though he was more likely to continue falling and experience symptoms of distress, was the best way to honor who he was. 

Indeed, he declined and experienced one final fall, resulting in an emergency room trip. The following day, he requested a visit from his hospice nurse. Barely conscious, he greeted her with a smile and a weak “thank you.” He died comfortably that night. While upset that he could not die at home, the team took comfort in knowing they had honored his wish not to live his final weeks in a nursing home.

As an added benefit for professional development, MJHS Hospice is developing a scholarship for staff to attend programs for certification in medical ethics, ultimately aiming to fund at least one member in each of the seven location-based teams. We believe this expertise will allow all staff more direct and informed discussions of questions and ethical complexities during their weekly team meetings. All these policies and case consultations are complex but essential to honoring the patients’ values. Phil always prided himself on understanding each of his patients to inform their care. 

There is no better way to honor his legacy than with a gift to the Philip Littman Memorial Fund for Medical Ethics at MJHS. Your continued support makes this critical work possible, and I, along with so many patients, families, and community members, am grateful for this resource.

Warmly,

Trish