Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Wednesday, June 02, 2004

    Death Becomes Them: Oregon's assisted-suicide law has been given a supporting hand by the Ninth Circuit Court of Appeals, which ruled that doctors in the state can't be prosecuted for over-prescribing lethal narcotics, as long as they do so under these circumstances:

    A patient must make two oral requests for the drugs and one written request after a 15-day waiting period. Two doctors must determine that the patient has less than six months to live, a doctor must decide that the patient is capable of making independent decisions about health care and the doctor has to describe to the patient alternatives like hospice care.

    The law also requires that the drugs be self-administered by the patient, rather than given by a doctor or family member, to avoid involuntary euthanasia. The death certificate, under the law, must state the cause of death as the underlying disease, not suicide.

    That seems to be a prudently written law - on the surface. But the problem with assisted suicide is that it assumes the doctor-patient relationship exists in an emotional vacuum. That doctor's never get weary of hearing a patient complain about intractable health problems, and that patients are never influenced by their doctor's attitude (or the attitudes of family members.) Consider one doctor in England who found it all too tempting to first relieve his patient's suffering, and then to relieve his own.

    Death is scary, no doubt about it. It's the ultimate loss of control. And that, in the end, is what really motivates those who seek physician-assisted suicide. It isn't so much to avoid physical pain, as to insure that they will ultimately be in control of those final days:

    Barbara Coombs Lee, the president of Compassion in Dying Federation, said she saw the suicides not as "an impulse to self destruction," but as "an impulse to self preservation - preservation of the self I cherish."

    That point of view clearly grates on Dr. Stevens. Although he said he did not want to "put people down or label people," he added, "the 'P' word is not 'pain.' The 'P' word is 'pride.' " He explained, "Rather than being death with dignity, it's death with vanity."

    Which also calls to mind the British doctor:

    The only valid possible explanation for it is that he simply enjoyed viewing the process of dying and enjoyed the feeling of control over life and death, literally over life and death.

    One can argue that it makes the world of difference whether it's the patient who enjoys the control over life and death or the physician. But the problem is, that's a distinction that's too easily blurred in the symbiosis that is the doctor-patient relationship.

    Oregonians must sense this on some level. The suicide option is rarely chosen. Which disturbs Dr. Marcia Angell, representative of the medical establishement to the national press:

    But Dr. Marcia Angell, a former executive editor of The New England Journal of Medicine and a supporter of doctor-assisted suicide, said: "He can call it vanity. Somebody else might call it admirable independence."

    If anything, Dr. Angell said, the Oregon law may be too restrictive and may not reach everyone who could benefit from it.

    "I am concerned that so few people are requesting it," she said. "It seems to me that more would do it. The purpose of a law is to be used, not to sit there on the books."

    The nerve of dying Oregonians. Why are they malingering and eating up valuable Medicare tax dollars when they could so easily put us all out of their misery?

    Not coincidentally, Dr. Angell also advocates a single-payer healthcare system. Her attitude, unfortunately, is not uncommon among those who think the state knows best how to run things. And it isn't hard to imagine where that sort of attitude could eventually lead us in end-of-life care, especially in a wholly state-run system: from physician-assisted suicide to state-mandated euthanasia.

    posted by Sydney on 6/02/2004 07:54:00 AM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006