Monday, July 12, 2010

Removal from Dialysis or Murder?

An interview at Renal and Urology News with Dr. Lewis M. Cohen, author of the new book No Good Deed: A Story of Medicine, Murder, Accusations, and the Debate over How We Die. The book recounts the case of two nurses who were charged for murder for removing a patient from dialysis. Here's a clip:

During a series of interviews, they recounted a number of remarkable stories of inspiring deaths that followed stopping dialysis. Those were not surprising. What was surprising was this particular case, which had resulted in criminal accusations. To put it mildly, I was shocked and horrified. I became determined to understand what had happened, and in the process discovered that there were a number of similar—and sometimes much more catastrophic—cases around the country where nurses or physicians stopped life-support treatments, provided analgesics to relieve suffering, and then found themselves accused and sometimes even convicted of murder.

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Knowing the Facts

Two True/Slant journalists are having a back-and-forth about the "right to die." The first, Ethan Epstein, has just learned about the Hemlock Society and basically says that if people want to end their lives, let them go at it. What legalizing AS would do is allow doctors to kill patients.

It's a juvenile argument that anyone following the conversation could debunk any number of ways: suicide is not assisted suicide, many suffering patients don't want to end their lives violently (guns, etc.), our medical system has developed in such a way that patients are subjected to futile, life-prolonging care that they would never have agreed to had they been informed and prepared, artificial life-sustaining methods of keeping patients alive are hard to end once they are begun, and doctors provide their patients with the means (like a gun seller does, like a Henkle knife sales man does, like a hardware salesman when he sells a rope does). The patient must self-administer any lethal medication. Humans don't have a right to die, he says. Geesh. Want me to go on?

He's got no history on the issue, no life experience of it (apparently), and no knowledge of the current bioethical or political debate.

His colleague, Sahil Kapur, weighs in and debunks Epstein's "logic." It will be fun to watch this dialogue if it continues.

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Tasmanian Devils.

If you want a rational voice on end of life care and law, I can recommend some others than Wesley J. Smith who makes his money from the ultra-conservative Discovery Institute and books, blogs and articles (for the likes of National Review and First Things) on nebulous, bible-esque stuff like the "sanctity of life" and the "slippery slope" and the "culture of death" that's out to kill, you know, any body it can. The underlying groan of Smith's writing is anti-"socialist" -- whatever that means -- and yet strangely all for government telling us when and where we can die. It's an odd, potent mix of narrative that, thanks to a host of popular (but not truly populist) politicians and media celebrities, has tea party (hence, well-funded think tank) legs at the moment.

Australia has been debating assisted suicide for a while. Never one to lose a chance at the limelight, Smith's decided to weight in. From ABC News Australia:

Wesley Smith has been brought to Australia by the Right to Life lobby group to lobby in Tasmania, Queensland, Victoria, New South Wales, and Western Australia.

Mr Smith says Tasmanian politicians' backing for a private member's bill could end in a voluntary euthanasia law that will lead to a broader range of people being eligible for assisted suicide.

He says that in Belgium and the Netherlands legislation has been gradually eased to allow sick babies, people with mental illness and healthy spouses of terminally ill people to be euthanised.

Mr Smith says there can be no legislative roadblocks to restrict who would be eligible for assisted suicide.

"Once you accept the precepts of assisted suicide, that suffering is a just cause for helping someone to end their life, it's not going to remain restricted," he said.

"That's the argument I think we should have as a society."

In other words, Smith's not interested in dialogue, he's already laid out his argument and expects others -- despite the horrors of end of life care, four decades of technical advancements that have changed the definition of death, rampant futile care, and failing health systems across the globe -- like the Australian government to toe his line.

We can say that Smith has a right to his opinion here in the U.S. -- the First Amendment exists for a vital reason -- but he must adhere to facts, an area where he prefers to move quick and loose. But playing the ambassador to other countries, even at the invitation of religious groups that espouse broad imposition of ideological medicine on all citizens, is really offensive. Particularly when he purports to be an expert, touting the horrors of the Netherlands' and Belgium's laws and health care systems. From a man who still claims Terri Schiavo was murdered. His broad-strokes, black and white approach to bioethics is embarrassing. His use of the controversial subject and the politically, ideologically motivated "right to life" organizations to get the limelight is irresponsible. Take the "Made in America" sticker off that export.

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