japanese war crimes-- was hiroshima

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

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.