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Friday, July 05, 2002The article is part of an ongoing series that JAMA has been publishing, called “Clinicians Corner” The format is similar to a case presentation, but instead of the doctor telling the story, the patient does the telling. This is great, because the patient has the opportunity to share his perspective of the disease or other problem being addressed. The doctor also gives his perspective, and the authors provide commentary. This particular article was about physician-assisted suicide, and how to address the issue when a patient brings up the subject. The authors and the participants are from Oregon, where the practice is legal. Unfortunately, the patient in this case had Lou Gehrig's disease and was too weak to participate in the format. It's a good article. It avoids the morality issue and focuses instead on the best approach to addressing patient fears about dying. But, there is one portion of it that left me wondering. It was this exchange: Ms. T (hospice social worker): Dr. R (the nursing home doctor caring for the patient) was very angry, saying he had "ordered hospice, not physician-assisted suicide." He was very angry at hospice for allowing the conversation to open up. He felt betrayed by our hospice and our advocacy for exploring the patient's wishes. He basically accused me of helping the patient commit suicide. Dr. R: I was upset. My intention in referring him to hospice was to make sure that he had a comfortable death but not assisted suicide. The article doesn't explore why Dr. R may have reacted in anger to Ms. T, other than he was opposed to assisted suicide. It doesn't record just exactly what Ms. T said to Dr. R when she called, it only records his response to her as she remembers it. It would have diverted too much from the focus of the article to delve into that issue, but my focus is different, so I'm going to take a guess. I suspect that Dr. R reacted angrily because he felt Ms. T was pressuring him to provide physician-assisted suicide to the patient. This supposition is further backed up by the fact that Dr. R recused himself from the patient's care after the conversation with the social worker. I can attest that this sort of coercion happens with hospice care, and I don't even practice in Oregon. In my state (Ohio), physician-assisted suicide is not legal, but there is, sometimes, a tendency for the hospice staff to ask for more morphine than is necessary for the patient's problem. I have had requests for morphine from hospice staff when the patient seems quite comfortable and in no distress. I always suspected the requests were more an attempt to hasten death than to treat pain, and recent events have proven those suspicions correct, for those sorts of requests suddenly stopped after Attorney General John Ashcroft issued his directive that prohibited the use of controlled substances in physician assisted suicide. In fact, I now get requests to stop morphine because it is sedating the patient too much, even when the patient does have pain. Ashcroft's target might have been Oregon, but doctors and hospices all over the country took note. posted by Sydney on 7/05/2002 08:21:00 AM 0 comments 0 Comments: |
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