If you have pneumonia, would you take antibiotics to get better? What if you developed advanced dementia and had a “do not resuscitate” order—would you still want antibiotics for pneumonia?
Many people have opinions about such matters but may not have the paperwork in place to make their wishes known when the time comes. And if they do try to fill out the forms, they may not be familiar with terms like “allograft,” unless someone can help explain that it’s a reference to organ donation.
That’s why Pitt medical and social work students have been teaming up with a Duquesne University legal clinic as part of an innovative interdisciplinary effort to help older Pittsburghers with advance care planning.
On May 16, three of the professors involved in the program gave a presentation about it, “The Health Care Power of Attorney: A Scalpel, Not a Sledgehammer,” at an American Bar Association event, the 2024 National Aging and Law Conference at the University of Miami School of Law in Coral Gables, Fla.
Those presenting were Pitt’s Elizabeth Mulvaney (center), clinical assistant professor in the School of Social Work, and Karl Bezak (left), assistant professor of medicine in the School of Medicine, along with Grace Wankiiri Orsatti (right), assistant professor of clinical legal education at Duquesne’s Thomas R. Kline School of Law, who started the Duquesne Kline Wills & Healthcare Decisions Clinic in 2019.
“We provide estate planning, incapacity planning, end-of-life planning and alternative to guardianship services to low-income clients all over the Greater Pittsburgh area,” Orsatti said.
Bezak, who specializes in hospice and palliative medicine, said that through his training he has learned “how important and nuanced advanced care planning work can be.”
Leslie P. Scheunemann, assistant professor of medicine, School of Medicine, said that Pitt medical students’ involvement in the program evolved from elements of the School of Medicine’s previous curriculum: the geriatrics area of concentration and the “geriatrics week” for third-year medical students.
Denise Smith-Russell, program manager for visually impaired people at the Moorhead Towers senior housing community, was a guest speaker in the class Scheunemann taught on Advance Care Planning during geriatrics week in 2022. She connected Scheunemann with Orsatti, who had been organizing life planning events in underserved communities in Pittsburgh. From there, Scheunemann pulled in Mulvaney as well as other Pitt faculty members from fields touching on aging, including palliative care, pharmacy and occupational therapy.
This spring, Dorothy Yam and Sriya Kudaravalli, both third-year medical students, led other students in participating in some of the clinic’s life planning events at locations including the Thelma Lovette YMCA in the Hill District, Life Pittsburgh in McKees Rocks, and Macedonia Family and Community Enrichment Center.
In Allegheny County, which Pitt research shows has the country’s second-highest concentration of people over age 65, there is a substantial population that needs help with end-of-life planning, the students said.
They are also sensitive to cultural differences around discussing death, having grown up with relatives who face language barriers—Yam's family comes from various post-Soviet republics and Kudaravalli’s from South India.
“You are asking people to grapple with their own mortality,” Yam said.
“We can explain what brain death means in a medical context, in a social work context, and then the law student puts it into the form,” she said. “Your wishes, your values matter. That shouldn’t be a service reserved for people with a certain income level.”
The students “have had outstanding learning experiences while providing a valuable community service,” Scheunemann said. “They want other students and community members to be able to have similar experiences.”