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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