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    Sunday, September 12, 2004

    Euthanasia: A local reader asked me to comment on this story from a couple of months ago. It's the story of a local emergency room physician who gave an elderly woman succinylcholine. It's a sad story, and one that I avoided before because I know the doctor involved, at least professionally.

    An elderly, "comfort care only" patient was transferred from her nursing home to the ER in the middle of the night because the nursing home didn't know what to do when she developed abdominal pain. She was much too frail to withstand surgery, and since she was "comfort care only," that wasn't an option anyways. The emergency room doctor who drew her case just happened to have a mother who was in the last stages of terminal cancer himself. The patient's pain didn't respond to morphine or to other pain medication. At some point, the doctor made the decision to give her a drug that wouldn't stop her pain, but would stop her breathing. And it worked. She stopped moaning.

    There were so many other ways this could have been handled. Hospice could have been consulted. Morphine could have been increased to alleviate her pain, even if it depressed her breathing and eventually resulted in her death. That would have been passive euthanasia, and perfectly acceptable. The intent would have been to keep her comfortable, as per her wishes. Death would have been a side effect, not the primary intention. But in this case, the use of succinylcholine made it active euthanasia. Succinylcholine does nothing for pain. Its only use is in anesthesia to paralyze the diaphragm so the patient doesn't breath against the ventilator. The only intent possible in this case was to end the life of the patient. (That is assuming it wasn't given in error.)

    Everyone understood this. The doctor's colleagues understood it. They turned reported him to the hospital adminstration and confronted him about it. The hospital administration understood it. They reported it to the police,to the coroner, and to the state medical board. And the coroner understood it. She ruled the cause of death a homicide after she learned of the cirucmstances.

    Everyone understood it except the county prosecutor who declined to press charges, and the state medical board which, according to their website, still hasn't taken any action. (As of the newspaper story, he was still practicing in Ohio.) The only logical conclusion is that the prosecutor believes euthanasia is OK, and so does the state medical board.

    The most disturbing aspect of the case is that the doctor chose to silence the patient, not to treat her pain. She still felt pain until her dying breath. She just couldn't vocalize it. Succinylcholine is the ideal drug for ending the suffering of the caretaker, but not the patient. Which is, after all, the problem with active euthanasia in general. It's never quite clear exactly whose suffering is being relieved. (The same thing happened in an Oregon ER in 1997, before they approved assisted suicide. The prosecutor's office also declined to press charges, stating that they would never be able to find a sympathetic jury.)

    posted by Sydney on 9/12/2004 01:11:00 PM 0 comments


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