As medical knowledge and technology rapidly advance we live longer, more often with life-threatening and life-altering conditions. New twists on old questions arise; medicine can not be practiced or utilized without ethics. Not only doctors and caregivers, but family, friends and community must seek to understand death, its changing venues and experiences. We all must face it; the only choice is to do so with unprepared trauma or with the relative peace that comes from that understanding.

Called "end of life ethics" these evolving questions and answers are key to a dying process that is as peaceful, gentle, and comfortable as possible for everyone. Death can be a positive catharsis or a miserable experience. So much depends on how we approach it.

What kind of care is appropriate - how much, how little, and who decides? How do others cope with those decisions? Do we "let" the dying decide whether to refuse life-saving medication, ask for more narcotics or refuse them altogether, even if that person seems less than in full control of mental faculties? Who decides if they are, and how much should that matter? Should any medication be forced upon a person with a fatal condition at any stage, or should respect for their wishes - however uncomfortable it may make others - be paramount?

How about the healthcare providers and loved ones, their relationships, interactions and reactions, misplaced blame and expectations, and how those affect the person dying as well as each other? Emotions run very high regarding death, often getting in the way of natural and necessary processes. Often the dying person is so worried about, or negatively impacted by, others' emotional discomforts that he hesitates to ask for what he most needs. Understanding and education help reduce conflicts, misunderstanding, and pain, as well as interference with those needs.

To that end Hospice of North Idaho will host an interactive, nationwide viewing of an educational DVD on end-of-life ethics by the Hospice Foundation of America from 8 a.m. to noon on Wednesday, Nov. 14, at St. Pius X Catholic Church at 625 E. Haycraft Ave. in Coeur d'Alene. A local panel of medical, legal, and spiritual experts will explore ethical issues and dilemmas and answer questions following the video.

Program organizers say that by its conclusion, participants will be able to describe the principles and process of ethical (and bio-ethical) decision-making, and address disclosure and communication dilemmas, surrogate decision-making, artificial nutrition and hydration, and palliative sedation. They will also better understand complicating factors when patients are children and adolescents, how cultural values and beliefs influence the end of life, and describe the ways end-of-life issues can create moral distress and influence grief reactions of families, hospice and palliative care providers and volunteers.

Healthcare workers may request continuing education units. For information contact Grant MacLean at HONI (208) 772-7994 or gmaclean@honi.org.

Sholeh Patrick is a columnist for the Hagadone News Network. Contact her at sholehjo@hotmail.com.