Thursday, July 19, 2012

Docs and Assisted Dying

While this article addresses the question of physician assisted dying, for me it also prompts a couple of questions:
1. When should doctors stop trying to cure a terminal disease? 
2. And should doctors stay at the bedside until death?

When my brother died two years ago of prostate cancer I noticed how some of the doctors involved with his care became physically distant as he neared death. Some didn't show up at all. 

What's the right thing to do?


Katie Moisse
ABC News
July 13, 2012

More than two-thirds of American doctors object to physician-assisted suicide, according to a 2008 study published in the American Journal of Hospice and Palliative Care. An editorial published in the New England Journal of Medicine argues that removing doctors from assisted dying could make it more available to patients.

Link: Redefining Physicians' Role in Assisted Dying, New England Journal of Medicine, July 12, 2012



Anonymous Anonymous said...

1. When to stop trying curative treatments? The answer seems so obvious in the hypothetical. Stop when I the patient say, "Stop." Or when my DPOA agent says, "Stop"--because we've had conversations and I've written at length in advance directives about what matters to me with relevance to advanced and/or terminal illness or injury. That should at least help with proxy decisions. Also, stop trying to cure if my condition is not curative. Of course.

But it's likely not so simple in the actual situation of unknowing or partial knowledge, even about curative or not. Lazarus occasionally gets up and walks out, and caregivers don't always know him by that name until later.

Or if the patient is young, it seems harder to predict what might happen--and not only harder for us to let go. The curative power of human bodies is quite amazing. Almost miraculous. Could it happen this time? Even specialized doctors can't always know.

And traumatized families know even less of that sort of thing. So they/we push too often even after physicians tell what they do know. The question clinical ethicists are most often asked is, by doctors, "How can we get the family to stop futile treatment?" Physicians seem to me more willing to do so than are desperate families. Not always, but often.

2. Caregivers who don't come around at the end? Yes. And sometimes it's because they were consults and are no longer on that case, or are off service--which happens regularly in a large teaching hospital. Or the patient is transferred elsewhere. Or the primary care doc is community based, either a long ways off from the hospital or skilled care facility, or doesn't have privileges there. Or has a family or other pressing obligations including possibly hundreds of other patients. I.e., it's maybe been too been easy for "Ethics" to be critical and accusatory without always knowing all the facts. Yes?

Anecdotally, A medical oncologist approached me this week specifically to ask about the family of her patient who had recently died. "Do I ever see them? How are they doing? The daughter has a wedding soon, yes?"

This physician obviously cared, and stayed, to the end, and thereafter. Had been involved every day for the last two weeks of the patient's life. Her oncologist retained composure as we talked, but barely. Care. Compassion. Non-abandonment to the end. It happens.

The patient who died was the mother of one of my former students. I conveyed to this physician that at the
funeral I was introduced to the family not as "my professor," but as "the one who helped us find Dr (oncologist)." That's what mattered most, the best thing I had done.

So I told this to the one who had cared to the end. That's when I noticed the oncologist's eyes glistening and moist.

Tarris Rosell, PhD, DMin
Rosemary Flanigan Chair
Center for Practical Bioethics

Friday, July 20, 2012  

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