Re: Bad Law, Good Ruling

Calvin Jones & the 13th Apostle posted an article from which this
excerpt is taken:

> > As a policy matter, I agree with Scalia that the problem with
> > physician-assisted suicide is that it dangerously muddles the moral
> > role of the doctor. To put it as plainly as possible: I do not think
> > doctors should have the right to help people kill themselves.


John Bigboote wrote:

> Fair enough. Doctors who swear the Hippocratic oath certainly have a reason
> to decline prescribing those medications. Unfortunately, only doctors can
> prescribe them. What we need are "death doctors" as part of the hospice
> system, who are licensed to prescribe, but are not bound by the oath to
> preserve and sustain life.
>
> For the life of me, I can't understand how anyone can feel he or she has a
> moral obligation -- or legal right -- to stop another person, whom he or she
> might never have met, from ending his or her own life when the end is
> imminent and the person is in pain. That is simply the most fucked-up, most
> self-righteous bull*** I can imagine.
>
> -jb

This was in the Boston Globe a few days ago. This doctor makes the
point that a doctor has two duties: to prolong life and to ease
suffering. He provides a cogent discussion of the tension that that
causes with terminal patients. I wonder how people who are opposed to
doctor's helping in this way when terminal patients are in great pain,
would feel if it was their close relative, or themselves, who was in
the situation.

Treating the pain by ending a life
By Dr. Mark Siegel | January 19, 2006

THE US SUPREME court ruled this week that doctors in Oregon should not
be charged with a crime for overdosing patients in the name of treating
pain and hastening death. This decision should be applauded and must
not be circumvented by new laws.

Ten years ago I assumed the care of a woman with advanced pancreatic
cancer that had spread to her spine. She was a well-known writer, and
we quickly became friends. I would travel to her apartment and visit
her for hours there, something I'd rarely done before and haven't done
since. She had a close group of friends who visited her constantly, and
an Irish nursing agency that cared for her impeccably around the clock.
At first her cancer wasn't causing her pain, though it paralyzed her
below the waist and bound her to her bed and wheelchair. Still, she
enjoyed the visits, mine and everyone else's, until the fateful day
when the cancer spread to her bones and began what was clearly an
escalating pain. I dialed up the morphine to compensate, until the day
came when the amount of morphine necessary clearly hastened her death.
I was able to predict roughly the time she would die, and her friends
said their goodbyes. I used morphine in the name of relieving
suffering, not as a murder weapon. No one who knew her seemed upset by
the trade-off, a tortured life for a peaceful death, and all thanked me
for my care at the end.

Morphine and other narcotics suppress breathing and lower blood
pressure. It is not unusual for physicians to use these drugs to
relieve suffering and thereby accelerate death in terminal cases. What
is unusual is for doctors to be prosecuted for overdosing their
patients deliberately in the name of this cause. Oregon has been the
focus of the Bush administration's attempts to criminalize the
activity, but this use of medications to knowingly end a tortured life
is not confined to Oregon. It has been part of a physician's
end-of-life role for many years, whether it is formalized in the law or
not.

Any effective physician has two fundamental roles. The first is to
prolong life. The second is to ease suffering. In most situations,
easing suffering is part of prolonging life, as when we guide a patient
through an accident or a surgery and treat pain as part of ensuring
survival. Sometimes, though, our two roles collide, and a decision must
be made as to which to prioritize. This decision is made, in part, by
considering long-term outcome as well as the wishes of the patient. It
is never a perfect situation, but we physicians have been making this
determination for eons, and we cannot be penalized or prosecuted and
still be expected to function.

In the Netherlands, active euthanasia is legal, which means that a
cancer patient who is still ambulatory and thinking clearly can ask a
doctor for a lethal injection. I am not in favor of this policy, not
because I believe that a person doesn't have a right to end his or her
life when given a terminal diagnosis, but because I question the role
of a physician in facilitating this outcome. Such a role should not be
assumed, because it is not strictly a part of relieving suffering.

But this is not the same thing as the Oregon law, which allows a
physician to participate when pain predominates, when a patient is in
agony, when reducing morphine cannot bring back quality of life. When
the only choice is pain or death, doctors routinely -- with their
patients' advance approval -- help them choose death. The US Supreme
Court is wise to acknowledge one of our fundamental roles. We are not
''Kevorkian-izing" our doomed patients when we help ease their path
from this world.

Dr. Marc Siegel, associate professor of medicine at NYU School of
Medicine, is author of ''False Alarm: The Truth About the Epidemic of
Fear" and the forthcoming ''Bird Flu: Everything You Need to Know About
the Next Pandemic."

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