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#41
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Charles Gray wrote:
I have problems with actual termination of humans-- it opens so many cans of worms, legal and ethical alike. Definitely so. It should always be difficult concept to wrestle with, or we've gone terribly wrong. I think the problem is that the idea that the doctor will do everything to keep you alive has ignored the fact that we *are* going to die at some point, and that as medical technology gets more advanced that point that be delayed long past where it should happen. But on the other hand, that's a terrible decision to make-- and there have been cases of criminal or ethical charges being brought against doctors who have done so, even with the cooperation of the family. Dr. Kevorkians antics didn't help the debate any either, of cousre. Totally agree. There may have once been a time when a physician, in agreement with patient or family, would quietly "speed" the process of dying. But litigation, a looser bond between patient and physician (no more Dr. Welby's it seems), and grandstanders like Kevorkian haven't helped in the debate. SMH |
#42
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In article , Stephen Harding
wrote: Charles Gray wrote: I have problems with actual termination of humans-- it opens so many cans of worms, legal and ethical alike. Definitely so. It should always be difficult concept to wrestle with, or we've gone terribly wrong. I think the problem is that the idea that the doctor will do everything to keep you alive has ignored the fact that we *are* going to die at some point, and that as medical technology gets more advanced that point that be delayed long past where it should happen. But on the other hand, that's a terrible decision to make-- and there have been cases of criminal or ethical charges being brought against doctors who have done so, even with the cooperation of the family. Dr. Kevorkians antics didn't help the debate any either, of cousre. Totally agree. There may have once been a time when a physician, in agreement with patient or family, would quietly "speed" the process of dying. To say something of a middle ground, which I think is perfectly ethical medicine -- and I can point to such things as extensive supporting writings by Catholic theologians steeped in right-to-life -- is what St. Thomas Aquinas called "the principle of double intent', and has all sorts of applications and misapplications in medicine. We have a political environment that says "narcotics (an imprecise term)" are EEEEVIL. Yet there are chronic pain states where long-term use of incredibly high dosages can return someone to normal enjoyment of life, without sedation, cravings, etc. Perhaps the most dramatic personal experience I have had is a woman with severe sickle cell disease, which can be incredibly painful. To a person with no acquired tolerance, a lethal dose of injected morphine can start at around 200 mg and is pretty certain at about 600 mg. She has a surgically implanted pump that delivers, hourly, over 1000 milligrams of morphine, bypassing the blood-brain barrier so greatly increasing the effective dose. If I were to be given that dose in a vein, much less in the spinal fluid, I'd probably be dead before the needle could be removed. In her case, very careful adjustment of the dose let her go back to full intellectual capacity and workload as a chemical engineer, wife and mother, active in her community and church, etc. On the other hand, in, say, a pain crisis in terminal cancer, it has been understood there is no absolute maximum dose as long as pain exists. If you bring up the dose quickly in a debilitated patient, however, morphine is going to interfere with breathing. It may be possible to compensate for some of these side effects, but at some point, that may mean intubating the patient and making them respirator dependent. The reality is that in certain pain management situations, absolutely ethical and humane medicine will do things that hasten death, but improve the quality of remaining life. But litigation, a looser bond between patient and physician (no more Dr. Welby's it seems), and grandstanders like Kevorkian haven't helped in the debate. Don't be so sure some of the Welby tradition doesn't endure, if in changed form. Balancing grandstanders like Kevorkian are thoughtful physicians like Timothy Quill. Some searches are useful -- Quill, clearly from the heart, wrote an extensive article on how he had chosen, after long reflection and consultation, to provide the means of assisted suicide to a long term patient. This patient was not terminal, but had made a quality-of-life decision that she didn't want aggressive treatment for her leukemia. An academic physician (SUNY Albany, IIRC), he's a very respected speaker in ethics discussions, recognizing the answers are not clear-cut. |
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