Kenneth saw this firsthand, in a patient whose entire body seemed to betray him immediately after heart surgery.
"His kidneys failed, and he was having either liver failure or hepatitis," Kenneth recalls. "He had bowel perforation and a bowel infection, along with the heart infection; he was septic. The big thing that was going on at the moment was his feet were maybe becoming gangrenous, or otherwise were just self-amputating. His toes were beginning to fall off."
The patient's sister had instructed hospital staff to keep his feet covered with a blanket at all times, concerned that the site of them might further erode the patient's will to live. But consciousness itself turned out to be this man's personal hell: One night, he began pulling out wires and tubes and told his nurse he no longer wanted to live, and that it was time for him to go.
"Just leave that window open ..."
The family, understandably, did not want to believe hospital staff.
"That patient's sister was freaking out," Kenneth says, "really pissed off, and was telling her parents, 'We need to get these people out of here. They're the ones who are going to decide whether or not to pull the plug. They're not from around here; they're the ones making the decisions' -- and we don't."
The idea that ethicists are on some sort of "death panel" is giving the ethicists far too much credit, but it's a misconception that persists -- and it's especially strong in the rural farming community where Kenneth's hospital is located.
Who needs doctors when you got Grandpappy's Old Medicine cabinet?
"They've said right to doctors' faces, 'You don't [care if he dies] because you don't care about him, because he's black, because he's poor, etc.' When I say that a lot of people want to say that their family member's a fighter, specifically this happens a lot with poorer people and with minority groups, because they've not been treated right before, they don't get their due, and they feel at the end is where they're going to make it up."
Frader says this kind of distrust seems to have gotten worse since he helped found the ethics consultation service at the University Of Pittsburgh Medical Center 25 years ago.