Tuesday, April 27, 2010

Love's Demand.

From Thaddeus Pope at Medical Futility Blog: "Hastening Death Can Be Love's Demand."

Here is an abstract of a presentation that I will make at the 2010 Film and History Conference, this November, in Milwaukee.

For several years, I have been writing about the mechanisms for resolving medical futility disputes. One of the primary causes for such disputes is the firm conviction of family members that love demands continued life support for the patient. Love requires not “giving up” on the patient.

More than four decades after the introduction of technology (such as dialysis, ventilators, artificial nutrition & hydration) that can prolong life but not cure or reverse disease, many individuals still hold unrealistically optimistic notions about what medicine can offer chronically critically ill patients. And even those who believe and understand the prognosis often cannot let go.

Hospital clergy, ethics consultants, and social workers spend significant time counseling families, and help them appreciate that consenting to palliative care or hospice is not only consistent with love but even required by love. Three movies beautifully exemplify this re-conceptualization of love: The Event (2003), It’s My Party (1996), and My Life (1993). In each, family members oppose the patient’s decision to forgo therapy or to hasten death. They feel that love demands biological life be prolonged as long as possible. But as the ongoing or inevitable decline becomes increasingly obvious, the family realizes that love demands supporting (and even helping) the patient make a peaceful exit.

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Rationing or Rational Care.

Yesterday PBS posted an excerpt of the Miller Center event "Debating the Ethics of Rationing End of Life Care," a roundtable that included Dr. Arthur Caplan, Dr. Ira Byock, and some guy with a Texas accent going on about "faceless bean-counting bureaucrats." And a nurse, Marie Hiliard of the USCCB's Advisory Council and the National Catholic Bioethics Center.

Oh wait, that was Kenneth Connor from Center for a Just Society where it's all about Judeo-Christian values all the time, whether you're Jewish or Christian or not. Cause if you're not, God and your government think your health care should be! Connor is so radical, I have no idea why he was even included here; his participation only legitimizes the Just Society premise (Their God makes your health care decisions, not yours) and muddies the chance of a productive conversation. I guess the organizers were going for "fair and balanced" controversy.

In other words, moderator Susan Dentzer, editor in chief of Health Affairs, set up the premise that two doctors are pitted against two "pro-life" activists.

Byock and Caplan make strong cases. The other two have Luntz-like talking points. I can't help but feel that a great opportunity was missed here.

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Ebay Ends "Murderabilia" Sale of Kevorkian's Van.

Ah well. Ebay has ended the timely sale of Jack Kevorkian's van.

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Some Questions for Us -- From Jack.

Amber Wolleson, MD, reviews "You Don't Know Jack" for Pallimed and asks the right questions, to which I add some of my own:

He pleads a sympathetic case for his cause. The terms he uses are ones that we would be familiar with: death with dignity, quality of life, end suffering. He speaks about why must someone make the decision to have their feeding tube removed and die slowly when we could just end things quickly, humanely. Who are we as doctors to make someone go through that when we have the ability to spare them?

Why is it so easy to paint Kevorkian as a buffoon, a lunatic, and a murderer?

One statement I found interesting: "terminally ill is not a definable term". I would love to hear what everyone thinks of that.

The importance of the question is undeniable. Death with Dignity laws rely on the definition. Yet we work hard to believe in miracles -- or at least miraculous recoveries -- when we personally face loss. Is this not the area where the unquantifiable variables of medicine and the unknowable aspects of the human body are most profound?

I wondered when I started watching the film how the story would be slanted. It was clearly pro Dr. Kevorkian. I was left wishing for more balanced view of the issues. I felt those against what he had done were vilified and painted as overly religious. (I know very nonreligious people who are against assisted suicide.) I have always seen this as a very complex issue. To just get one side does not do it justice. I was left feeling a bit like the media was trying to manipulate my views rather than just trying to entertain me or even educate me. I would like to see a palliative care perspective. Is death all we have to offer?

What fear and bias against death -- the existence of which often impedes a good death -- causes us to ask that question with such humility? Is death all? When it comes it is everything. For everyone involved.

One line in the movie describes Dr. Kevorkian as "the last doctor you'll ever need". My thought was, does that describe me too?

And if it does, is there a problem with that?

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