Saturday, August 29, 2015

In Belgium has the Slippery Slope Begun in "Death with Dignity"?

There is controversy in Belgium about physician assisted suicide in patients with non-terminal illness.  Click here to read the New Yorker article.

“Last year, thirteen per cent of the Belgians who were euthanized did not have a terminal condition, and roughly three per cent suffered from psychiatric disorders. In Flanders, where the dominant language is Dutch, euthanasia accounts for nearly five per cent of all deaths.”  (In Washington and Oregon it is 0.2% of all deaths.) Some physicians who actively support euthanasia have concerns about “the cowboys” who push the limits on accepting patients who are not terminal, but find life unacceptable for whatever reason.  They see no difference between helping patients who are actively dying and helping a non-terminal patient die.  These controversial physicians feel that if a patient wants to die, then they support their autonomy.  Anything else is paternalism!  Has the slippery slope begun?

Monday, August 17, 2015

Patient or Person

The patient was wheeled into the amphitheater classroom in front of 125 medical students.  Francis Wood Sr, the graying Chief of Medicine was holding forth for us that day.  “Students today I’m going to show you a very interesting case.”

Then he paused as if collecting his thoughts. “Now I’ve just made two mistakes in introducing Mrs. Ellison.  What were they?

We sat there not having any idea what he was talking about.  We had been immersed in pathology, disease, physical exams, and seeing patients.  Dr. Wood said, “Well, first of all I introduced Mrs. Ellison as a case.  What’s wrong with that?  I don’t think she wants to be a ‘case’ but really thinks of herself as a person.  We need to respect the fact she’s a person with a disease – not just a disease we happen to be interested in.  Secondly, when I identified her as ‘interesting’, I wasn’t really talking about her, but about her disease.  In a sense I was allying myself with the disease against the patient!”

Dr. Wood was the person who led me to choose Internal Medicine for residency training.  I hoped to learn about people, the human condition and what can go right or wrong in the spans of our lives. My Dad was my other mentor.  An old-style GP he had a small office, delivered babies, gave ether anesthesia, did minor surgery, etc.  He knew families and they knew him.  He knew he was aging when he was delivering the next generation of babies.  “Jim, get to know the families, what they do, what they value, and try to gain their trust.”

But something’s happened in our rush to modernize care with new “efficiencies.”  For example: every Tuesday, in  “hospital X” your doctor changes – a new Hospitalist takes over.  They review the records as they inherit 12-15 new patients.  Their job is to speedily move you through the hospital and off to Skilled Nursing or home or some other venue such as an Adult Family Home.  There’s a name for this:  “Transfer Trauma”.  We have more technology, but less continuity.  We must ask, “does anyone really know me, know my family, understand my fears and hopes?”  Perhaps some can afford a “concierge doctor” as a bridge, but it’s no solution for most folks.  Hopefully, we will have loved ones to be strong advocates and fill in some of the gaps.  We need to be a person, not an “interesting case.”

The funeral as we know it is becoming a relic — just in time for a death boom

By   Karen Heller April 15 Ed note: Funerals are changing in ways that will bring culture shock and a shake of the head of s...