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Patrick D Hahn

Patrick D Hahn
Baltimore, Maryland, USA
June 07
I used to wash trucks for a living.


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APRIL 7, 2009 11:20AM

Should doctors kill? Part 3

Rate: 4 Flag

relax, this won't hurt a bit

Click Here to read Part 1 of this post 

Click Here to read Part 2 of this post

The style “bioethics philosopher” ought to denote a watchdog of the medical profession, but all too often they act more like lapdogs, trying to convince the rest of us that further expansion of the power and privilege of the medical profession is always in our best interest. Consider this essay by Len Doyal, Professor Emeritus of Bioethics at the University of London, who argues that doctors should have the right to kill us (without our consent) when they judge that our lives are no longer worth living.

I’ve written abut the proposal before, but I was reminded of it again when I read this paper by Baohui Zhang and her co-workers in Archives of Internal Medicine about end-of-life care.

Dying is big business. Thirty percent of all Medicare expenditures are spent on the five percent of patients who are in the last year of their lives; one-third of this is spent in the last month. Zhang and her colleagues interviewed 603 patients with terminal cancer, and their primary caregivers. 188 of them had discussed their end-of-life wishes with their physicians; the rest had not. No significant differences was found between these two groups in terms of age, sex, or type of cancer. However, patients who had end-of-life discussions with their physicians exhibited a greater degree of impairment, more co-morbidities, and a greater symptom burden than those who did not have such discussions.

The patients who did not discuss end-of-life care with their received more aggressive medical interventions, including chemotherapy, intensive care unit stays, resuscitation, and mechanical ventilation. Medical expenses in the last week of life for this group were 35% higher. They also reported more physical and psychological distress, and, in the opinion of their caregivers, had a lower quality of death, than patients who had made their end-of-life preferences known.

But isn’t it worth it, to have even a few more moments with loved ones? Isn’t life just that precious?

Here’s the punchline: THEY DIDN’T EVEN LIVE ANY LONGER!

Actually, the patients who received fewer aggressive interventions lived a little longer (although the difference was not statistically significant), even though they were sicker to begin with.

What does all this have to do with physician-assisted suicide? Everything.

There is no doubt that dying can be a gruesome and prolonged and humiliating process for the patient. There is no doubt this process can be emotionally and financially devastating for their families. But to a huge extent, the medical profession is the source of the problem.

I’ve already given some of the reasons why I think giving our doctors the right to kill us is such a rotten idea. I’ve pointed out that it is already ridiculously easy for doctors and nurses to get away with murder, and I don’t want them to get into the habit of killing us. I’ve argued that the medical profession has a horrendous record of stopping at the point of diminishing returns, or even at the point of negative returns.

But there’s another reason. It makes no sense, no sense at all, to demand an expansion of the powers of the medical profession to rectify a situation which, to a huge extent, is the product of medical hubris in the first place. Next thing you know the government will be buying failed banks and giving huge bonuses to the people who ran the banks into the ground in the first place.

Photo via Wikimedia Commons 

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Perhaps we need an Open Call with the subject, "end-of-life." Anyone with me on this one?
I agree on the open call, I've read a lot of really good posts on the topic lately :)

Now, for the meat of your post - the power shift really needs to be going the other way. Patients should be in control of their own care. They don't want the chemotherapy? Let them live their life, and die, the way they are comfortable. On the other hand, they want the extreme treatment despite the risks? Let them have it, it's their body, their illness, and their life. Doctors are trained to be advisors, not gods. Yet so many feel they are both.
My mom just died at almost end stage Alzheimers. She got pneumonia and spent several days on a respirator. I would never recommend it. I think we should have let her go. My hospice counselor said that sometimes relatives feel like they have to "do everything possible before they let them die."
I'm really struggling with this issue as a medical provider living in Washington state, where we just passed (by 60% vote) the right to request assisted death. I'm a nurse practitioner, and cannot, by this law, complete the lengthy process for a person who is requesting assistance. But I think I would if I could. I agree with your perspective on the medical profession, that's why I do palliative and end of life care, I don't really believe in "Western Medicine". I agree with most of what you say about the medical profession, although with a slightly softer understanding, since I know physicians and nurses to be humans, too. But when I am directly confronted with people who are facing their own personal mortality and want to have some control over how and when they die, it really affects me. Thanks for sharing your thoughts about this. I would certainly answer an open call on the subject, but then, this is really what I blog about all the time.
To Risa Denenberg:

Thanks for commenting.

It's a measure of the degree to which the medical profession has browbaten the rest of us into feeling incompetent that people feel the need for professional services here. Why do people think the coup de grace can't be adminstered by the patient himself or a loved one? What are people afraid of? That they'll forget to swab the arm with alcohol first?

But if we really do need the service of professionals here, let's have a separate caste of executioners. This shouldn't be done by people working with patients who expect to go on living.
Thanks to all for your comments.
am against medical hubris but not wholly against administered death. it should be fine if I ask for it and do so willingly, without coersion, under perfect mental health conditions. physical pain may not be all that pleasant to live with. rated.