Everyone should know what their rights are at the end of their lives and realize there are many choices they can make.

That was the message presented during the second part of a three-part Community Medical Ethics program sponsored by Thiel College, UPMC Horizon and Holy Trinity Lutheran Church, Greenville.

The topic for the seminar, held Tuesday at Thiel College, was "End of Life Decisions: Making Your Choices."

The program included moderator Dr. Rhonda Gay Hartman, interim assistant director of the Consortium Ethics Program at the University of Pittsburgh, and panelists Rev. Martin Roth, senior pastor of Holy Trinity Lutheran Church, Greenville; Rafael Sciullo, president of Family Hospice and Palliative Care in Pittsburgh and chairman of the National Hospice and Palliative Care Organization and Dr. Alexander Vujan, a Jamestown family practitioner.

"We're talking about what our rights are from a medical standpoint," Dr. Hartman said.

Dr. Hartman said in the case of a terminal illness, if pain can be managed and the patient can be comfortable, it could be a very meaningful life chapter. Options are available, such as hospice care, and advance directives can instruct family members to a loved ones wishes.

An advanced directive can be a living will, a document written while a patient is still alive, or a durable power of attorney, a person designated to make decisions when the patient is no longer competent. Sometimes, Dr. Hartman said, the best choice for durable power of attorney is not always a spouse or a family member, and often family members are relieved when this responsibility is given to someone else.

But even when an advanced directive is in place, a dying patients rights can be violated.

Dr. Hartman presented the case of Maria Duran, a 34-year-old woman from New York who needed a liver transplant. Because she was a Jehovah's Witness, Mrs. Duran did not want to a have a blood transfusion.

She appointed a man named Larry Johnson, a fellow Jehovah's Witness, as her power of attorney, and underwent the liver transplant in Pittsburgh. The operation was successful, but afterwards, Mrs. Duran's body began to reject the liver. She was no longer competent to make her own decisions.

Johnson consented to biopsy and dialysis, but when doctors said Mrs. Duran needed a blood transfusion to live, Johnson refused. That's when Mrs. Duran's husband, Lionel, who is not a Jehovah's Witness, filed a petition in court to become his wife's emergency guardian and consented to a blood transfusion. Despite the blood transfusion, Mrs. Duran died.

Dr. Hartman said under Pennsylvania law, a person has the right to refuse even life-sustaining treatment.

Dr. Hartman also showed a video about Bob Collins, an Irish television producer suffering from cancer of the adrenal glands. Collins chose to enter a hospice program, where he could be comfortable, be with his daughters and girlfriend, and create "the space for healing to happen."

"That's what hospice permits you to do. It permits you to choose," Sciullo said. "Dying really is a process and hospice has made it that. It's not a single event in your life that includes just one person ... you're embarking on a journey."

Rev. Roth said a spiritual dimension plays into the dying process.

"In the broadest terms, I'm convinced it does not matter whether someone holds a religious view or not," he said.

Rev. Roth said he finds it helpful as a spiritual guide on the journey to ask open-ended questions.

"Sometimes people are aware of their inner beings," he said. "With spiritual guidance, they're able to discuss this."

Healing doesn't always have to mean curing a disease, Vujan said, pointing out the Collins video.

"Perhaps we're never more alive than when we're realizing, this is it, I'm going to die from this," he said, adding that in our culture death is treated like a medical condition when it is actually one of the most natural things that can happen.

"We are born, we're going to die," Vujan said.

About 90 percent of terminally ill patients want to die at home, but 80 percent die in medical institutions, Dr. Hartman said. Vujan said families are often very uncomfortable about their loved one dying at home, and the patient ends up dying at a hospital.

"They wanted to die at home, yet the family is not quite ready for it," he said.

The third part of the series, "End of Life Decisions: How to Direct Your Care," will be held from 1 to 3 p.m. or 7 to 9 p.m. Sept. 24 in the Lutheran Heritage Room of the Howard Miller Student Center at Thiel College. The program will deal with advanced directives.