Physicians who hasten death should not be called doctors

From the Economist in October 2012 was an article on physician assisted suicide.  In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state.  Several safeguards are in place to prevent this from becoming the default death pathway (only 0.2% of total Oregonian deaths).  Also, I had no idea that Holland, Switzerland, and Belgium allow assisted suicide even in non-terminally ill citizens.  So you can be suffering from, say, severe acne vulgaris, in the Netherlands and be within your rights to seek immediate death from a certified death-administering professional.  Revelatory, indeed.  And heartwarming to read about on a Sunday.

My main interest is in the doctors who are contracted to carry out these ghoulish deeds.  By physician assisted, I think what everyone has in mind some sort of benign, humane, non-invasive mode of life sapping.  You lie on a table.  Calming eastern mystic yoga music plays softly in the background.  The room smells of lilac and aloe.  A soothing voice whispers in your ear, “it’s going to be alright, peace and love await you”.  And then a white robed man with a Francis of Assisian face of compassion slowly injects painless sedatives until you pass out and then the final killing agent is administered while you are in a state of blanked nothingness.

In general, this would be a job right up the ally of a motivated, profit-oriented anesthesiologist who has become disillusioned with clinical practice.  Pumping people full of mind altering, physiology warping drugs is what they do for a living.

But I was wondering how other professions could break into the market.  A general surgeon would not seem to be such a natural fit.  At least not when it comes to death by drug.  A general surgeon looking to make a few bucks on weekends killing people would have to offer a menu of alternatives along the following lines:

  • The big red. Thoracotomy performed after induction of general anesthesia.  Aorta identified and sliced transversely.  Included in offer are free disposal of exsanguinated blood and chest closure.
  • The double tap. Bilateral neck incisions made (either under local or general anesthesia, depending on patient financial situation), both carotid arteries dissected out and tied off.  Included is immediate EEG and consult from certified neurologist to confirm brain death.
  • The gateway. Portal vein opened up after transecting the bile duct and hepatic artery.  Blood can either be suctioned off field or left inside abdomen.
  • The strangler. Incision made as for tracheostomy.  Instead of tracheostomy, surgeon occludes trachea with fingers until death ensues.  Wound closed with absorbable suture in skin lines; lovely cosmetic result guaranteed for open casket viewing.

All kidding aside, I am not one to make judgments on a man’s decision to end his own life.  It seems like a ghastly option but I’ve never been in a situation where I was suffering horribly with months to live.

On the other hand, the idea that a physician would participate in the hastening of death strikes me as intellectually incoherent.  Whoever it is that would devote himself to such a career is not, nor could ever be, called a doctor.  Those, like Kevorkian, who perform these procedures are not doctors.  They have chosen to become something else.  Arguments about the morality of what they do can certainly be fostered.  But they are not doctors anymore.  Not if the word is to have any clear, common sense meaning in the English language.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.

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  • OldeStyleLiberal

    We may be following Britain into the hellish side of socialized medicine. They have the “Liverpool Pathway” which is death by starvation and withholding of care. Next of kin may not be notified until they are next of kin.

    The problem with socialized medicine, i. e. medicine run by the state, is that it is run to the benefit of the state. Those who contribute to the state as workers are more valued than lives that do not advance the goals of the state.

    • Markus Unread

      They call that palliative care here.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      I highly suggest you read more about the Liverpool pathway. “A 2009 survey of 42 carers providing the pathway was published in the Journal of Palliative Medicine, it found that 84% were “highly satisfied” with the approach and that it enhanced patient dignity, symptom management and communication with families”

      When one is so ill as to longer be able to care for, feed, or hydrate one’s self and they are not expected to improve they have reached a point: ITS CALLED DYING. Care is not with held. feeding via NG tube and IV sugar replacement is. When you do the opposite you are not improving life, you are delaying death.

      Almost every study on end of life has shown that NG tube feeding and similar methods of prolonging death have not improved patient or caregiver pain or satisfaction rates.

      One can make inflammatory comments all they want to rile the masses but the evidence doesn’t support the claims.

      • ColdHands

        Thank you. There have been so many horror and scare stories that you say LCS and everyone recoils. It does not automatically withdraw food or fluids at all. All it does is allow the patient to refuse food or fluids if they choose. Try looking it up and actually reading the guidelines. And you can be taken off the LCS is, as sometimes happen, patients rally or don’t pass within hours or a few days.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      “The problem with socialized medicine, i. e. medicine run by the state, is that it is run to the benefit of the state. Those who contribute to the state as workers are more valued than lives that do not advance the goals of the state”

      Yep, that’s why over 95% of those in European countries would rather have the American system….oh wait, they wouldn’t.

      • OldeStyleLiberal

        I have been to Britain a number of times between 1986 and 1999. Britain isn’t Europe but, I use their NHS as my model for state oriented socialized medicine. Toward the end of my British experience, Dr. Shipman was exposed as a mass murderer. His total killings something over 200 people. It doesn’t seem possible that this trail of bodies could be hidden for so long. Oh, wait, they weren’t hidden. Dr. Shipman’s actions didn’t arouse suspicion because his actions weren’t far enough out of line with ordinary NHS care. A man ahead of his time, the Liverpool Pathway codifies his freelance practice.

        • Payne Hertz

          You should read about serial killing doctor Michael Swango, nicknamed “Double Oh Swango” by his colleagues who joked that he must have a “license to kill” like the fictional 007 James Bond due to the high death rate they noticed on his watch.

          Massive numbers of Americans are killed and injured in this system every year yet few people involved in it seem to notice or speak out about it.

  • NorthShoreEndo

    “We can alleviate the unbearable in life better than ever before. We can do that and not eliminate life itself. As I have said many times, medicine cannot be both our healer and our killer.” – C. Everett Koop

    • Markus Unread

      “We can alleviate the unbearable in life better than ever before.”
      That is debatable, and varies widely from case to case.

  • http://www.facebook.com/profile.php?id=100000077801405 Jay B. Ham

    Sometimes when we believe we are prolonging life we are actually prolonging dying. Knowing where to draw that line in the sand is extremely subjective.

  • PatrickMonkRn

    I have no intention of, or interest in, entering into a discussion with you on this subject. However as an RN Hospice Case Manager with many years experience working directly with terminal patients and their loved ones I take exception to your fatuous comments. It is apparent that you have never been in ‘a situation with another who was suffering horribly with months to live’.
    Patrick Monk.RN. SF. Ca.

    • http://www.facebook.com/jeffrey.parks.58 Jeffrey Parks

      The valuable service of hospice care that you provide has little to do with euthanasia or physician assisted suicide. Accepting that we need health care professionals to address and manage and guide patients through end of life issues does not mean that we concommitantly buy into the spectre of physician directed death.

    • http://www.facebook.com/jill.mckenzie.18 Jill Mckenzie

      I will bet that you have engaged in the opposite of what you expressed in other situations. I always find it interesting that when I have been experiencing severe pain or someone else I know, that it is usually invalidated unless there is visual evidence of a broken bone or lot’s of blood.

  • bl

    you come off as cynical, judgemental and ignorant all at once. what kind of parallel are you trying to highlight comparing acne vulgaris to a terminal disease? pointless article.

    .disgusted medical student

    • http://www.facebook.com/jeffrey.parks.58 Jeffrey Parks

      bl-

      In the netherlands, one doesn’t need to meet any criteria for physician assisted suicide. It could be depression, despair, a terminal illness…even angst over severe facial disfigurement. One can sign up for death regardless of the clinical situation. If it sounds absurd to you to think that acne vulgaris would be a reason to kill yourself, then perhaps the whole construct of euthanasia as practiced by the Dutch ought to be the target of your disgust.

  • Markus Unread

    I know you aren’t seeing our comments, Dr Parks, but I would be happy to say this to your face: By forcing a patient to suffer through the agony of a prolonged death you trap them, without hope, in a painful decaying body. You are no better than an interrogator who keeps their prisoners alive so they can continue to torture them. Worse, you get to share the patients’ agony with their families. I’m sure, as you pop your head in the dying patent’s doorway once a day (for billing purposes), that you get to “feel for” their suffering. Don’t you dare console yourself by thinking that palliative care is making their world just peachy either. At best it reduces the suffering and in the worst case it just keeps the staff from having to listen to the patient moan and wail through the pain and their failing mental state.

    “Doctors” like you are a disgrace. You are nothing more than a heartless, drug-dispensing medical-billing machine that is more than happy to prolong someone else’s suffering for your own benefit. You can hide behind your oath, but this is the real world and, for the patient and their family, death and dying is as real as it gets. I am thankful that I live in a state where we have passed a Death With Dignity law. We have the ability to take the decision about how we die out of the hands of people like you, Dr Parks.

  • Axilla

    Wow! And we wonder why general surgeons are stereotypically devoid of empathy…

  • civisisus

    And what should physicians who perfidiously prolong “life” by pushing costly, futile, vital-signs-continuation processes on exhausted, confused, frightened patients and family members be called?

    I know – let’s call them “Knowsy (nothing) Park-ers”

  • http://www.facebook.com/jeffrey.parks.58 Jeffrey Parks

    Lots of misunderstanding here. This post was written as satiric commentary on the linked Economist article about PHYSICIAN ASSISTED SUICIDE. This was not a post about palliative care or end of life issues as we face in the United States. This was a post about physicians who volunteer their services for the express purpose of ending someone’s life. To me, such an endeavor has nothing to do with the concept of “physician”, in the Hippocratic sense. To me, whether you intentionally end someone’s life via an IV cocktail or any of the absurd examples I provided is the same thing— a violation of the very essence of what it means to be a doctor. If, as a society, we want to legalize assisted suicide, then we need to create carve out an entirely new cadre of professionals who will perform these services, apart from the physician fraternity…

    I think the ad hominem, self righteous attacks on me personally are a little misplaced. But I’m a big boy. I realize that by blogging you risk being misinterpreted by the masses,. C’est la vie.

    • Markus Unread

      Joking and sarcasm about this subject – who would have guessed that you might be misunderstood? You should expect to be called out by people, in and out of the medical field, who have had to watch their loved ones suffer a long painful death. All because of an unrealistic ideal of what “life” is during an agonizing death. Self righteous is a perfect term for the pontificating against the doctors, and others, who understand that quality of life, and of death, is also part of their charter. Without that, you might as well say that your job is to keep the heart and lungs operating as long as possible. Good for you. Not necessarily good for your patients.

      Thank you, though, for addressing peoples’ comments here. In that way you have gone far and above what most doctors have done regarding this very personal and painful subject.

  • Markus Unread

    Maybe his viewpoint is because the objective of surgery is very clear cut. Get in, fix what you can as best as you can and get out. It doesn’t require the kind of contact that GP’s, nurses and hospice workers experience.

  • Suzi Q 38

    MIL died of lung cancer, with mets to the brain.
    Horrible, a lot of pain. Towards the end, she just got more and more morphine until she died. Thank goodness the doctors did not let her suffer.

    FIL decided to refuse dialysis. He had had 3 strokes, lived for 12 years dependent on others for most every basic need, and he was tired.

    I told him that he would die soon if he didn’t go to dialysis. He said, “I know.”

    His doctor called and asked me how much he should do to save his life, as he was dying. I couldn’t decide, and neither could my husband, who was his conservator. I told the doctor that while my FIL was aphasic, he was mentally competent. I told him that we loved him so we couldn’t decide.
    Would it be O.K. if you (the doctor) asked him what he wanted to do?

    The doctor was very good. He went down to the hospital and asked him.

    I will never forget how kind he was, asking me what we wanted him to do.

  • US Expat

    Writing satirically about this painful subject is risky business. Doing so is a little like making weapons jokes to security officers in airports — with predictable results.

  • http://www.facebook.com/shirie.leng Shirie Leng

    Wow. I’m kind of surprised Kevin accepted this post. Setting aside the offensive nature of it’s jokes, this writer has a very limited view of the role of the physician. It is our job not only to heal the sick but to attend to the dying. I am all for an adult discussion of PAS, but this is not it.

  • http://www.facebook.com/jeffrey.parks.58 Jeffrey Parks

    I think many of the commenters are talking past the content of the post. Why is monstrous to delve deeper into the actual content of what it means to be an advocate for physician assisted suicide? I think it’s important to determine what exactly it is that people are objecting to in the post. Is it the fact that I question the role of a physician in providing the materials/instructions in hastening someone’s death? Or is it merely the grotesque examples I have provided? I think that if you want to be an apologist for physician assisted suicide, you should say so. If you think that doctors ought to provide direction on how to end your life, then say so. If you think euthanasia and physician assisted suicide ought to fall under the rubric of palliative care medicine, then say so. Only understand that by doing so you accept the unpleasantness of what it actually means, in real practice, to end someone’s life. If the end result is the same, why should it matter what the means are that one chooses to implement such an end. What is truly the difference between overdosing someone on morphine vs. “performing bilateral carotid occlusion surgery”?

    It’s an uncomfortable post, I grant you that. I appreciate that Kevin had the balls to put it up (he chooses all my posts, I dont submit anything to this blog). I would just try to reiterate once again that I am not satirizing palliative care or hospice medicine.

    I just don’t think docs have any business attending to the sordid business of providing the means of death. I’m sorry that such a thought was so controversial

    • Suzi Q 38

      No problem Dr Parks,
      I clearly understand. There is a “fine line” with controlling or hastening the destiny of death and prolonging life.
      I understand why Kevin accepted this post.
      It is controversial, to say the least.
      Why should you be sorry?
      You have an opinion, and are allowed to share it.
      It is just that not everyone will agree.
      I know what you mean. You don’t like the idea of Kevorkians running around giving us the “death sleep juice,” but you undertand and believe in palliative and hospice care.
      I get it.

      We all may have to face this unless we are fortunate to have a quick death. Too bad that I can’t orchestrate my death if God gave me a clue as to when and where it would be.
      Some people are not lucky. Some people are facing years in a bed, not able to move, in pain, suffering. Their family members suffering helplessly with them at their beside. What if they want to choose their fate? what if they begged you to help if you could, aside from what their family thought?
      We euthanize dogs at the animal shelter in order to ease their future suffering. God forbid that we would let a dog or cat suffer. There are religious rules to consider, also.

      Interesting topic.

  • Docbart

    I think your thinking is really rigid. Who says that our role as physicians is to keep people alive even when they are competent and want an end to suffering with no hope of recovery? When we can’t heal them, isn’t our role to comfort our patients? We do this for animals. Why shouldn’t we have the same compassion for our human patients?
    Your condemnation of our medical colleagues who practice PAS also shows tremendous hubris. Why does your ethical system trump theirs? Why are you the only one who has the patient’s best interest at heart? Who are you to say that they are mercenaries and you are the idealist? A little humility would serve you well.

  • Payne Hertz

    No one should have veto power over a person’s moral right to end their own suffering at the time and manner of their choosing.

    It should be the patient’s choice when and how they end their lives.

    To force a person to endure the torture of an agonizing death against their will is barbaric. Such a perverse form of tyranny as this has no place in a free society.

    Since most people accrue the majority of their lifetime medical expenses at the end of life, there is a huge financial incentive for the medical system to block people’s right to die in order to milk them for everything they’re worth by prolonging their deaths as long as possible.

    There should be no physician involvement required for suicide except where both the patient and the doctor agree to it. People should be free to obtain and use whatever substance is necessary to hasten death without consulting a doctor.

  • Michael Cutting

    I can appreciate your view. However it seems very black or white when medicine is usually anything but. I can think of a number of treatments, many pharmacological, which hasten death because they are designed merely improve the quality of the remaining life.

    I think individual choice and the opportunity to have dignity in life and death are more important factors than what we may believe. It doesn’t mean we have to agree with the decision or help with it, merely accept it and move on. A true doctor provides the best care their patient chooses.

  • bill10526

    Dr. Kevorkian was a hero to me. He answered those who begged for his services like the man who did not want to drown in his spittle. He had mail bags full of pleas to help Uncle Fred, Aunt Ester, my husband George, or my wife Ruth. He had criteria to weed out temporary depression, and true to his profession, he helped human beings cope with their anguish.

  • http://www.facebook.com/jeffrey.parks.58 Jeffrey Parks

    The Dutch accept mental suffering as sufficient reason for euthanasia requests. This means that they have state sanctioned assisted suicide for non terminally ill citizens. So, by theory, anything causing “severe mental anguish”, whether from physical malady/psychological trauma or whatever, would qualify one for PAS.

    • Molly_Rn

      What do you have against the Dutch?

    • Cory Ingram, M.D.

      Holland had 4 cases of euthanasia in 2012 for persons with mild dementia. The reason they were allowed euthanasia was their fear of future suffering. There is also a movement for euthanasia for a completed life for persons over 70 who feel their life is complete. The Dutch have slipped down the slippery slope from the 1990′s when Prof. Heleen Dupuis would argue that the Dutch would never slip down the slippery slope because they could set limits as a society. Clearly, as a society, the limits have have taken on a new form and many would consider this a major slide down the slippery slope.

  • Rebekah Peterson

    What about the doctors who do nothing to sustain life? Yes, I got that this was written as a sarcastic approach. And before 3 years ago, I wouldn’t have believed that families would have to fight the medical establishment for basic care for infants. But my son was born with Trisomy 18, in many places a death sentence. His doctors have been wonderfully supportive, but not all are. I have watched as an emergency court order was needed to force a hospital to give a newborn lasix for her wet lungs. “She was going to die anyway” was their reasoning. Yes, she did pass away, but after several months with her loving family, instead of only 3 days in the NICU. As an advocacy group, we know the statistics and outcomes. We know that many of our children can’t live. But when we have to fight those who should be helping us, I don’t think they should be given the title of “doctor” either.

  • Molly_Rn

    Your
    satire is not satirical. You come across as an arrogant, judgmental
    know-it-all. I am glad that I will not have you to deal with when I am facing
    death. I cannot imagine having to deal with your self-righteous sanctimonious
    BS on top of dying.

  • petromccrum

    You need to see the “REAL” side of suffering. You obviously have not; so who are you to judge. I give these individuals my support and thanks.

  • http://www.facebook.com/people/Irene-Gibson/1081147295 Irene Gibson

    Well, Kevin, you certainly stirred up a debate on the EOL subject….essentially defensive of a patient’s right to end of life choices. All the responses reassure me about medical care these days. Thank you.

  • http://www.facebook.com/jill.mckenzie.18 Jill Mckenzie

    I recently heard of an incident where a Doctor(?) was involved with making decisions about a relative that may have introduced too much conflict and stressors which resulted in perhaps a quicker ending to his life than he actually wanted. He was an 89 year old vet..living with his second wife who was declining as he was but..I heard a comment that it was for the best and I shuddered…

  • Don’t lie

    Some blog posts are always going to be way over the heads of many if not most readers. Blogging is often personal. You need to have put in the time to understand a particular blogger – never do you have to agree. After all, it’s not about you now is it. I also think some of you think you can control a blogger’s thoughts by “acting out” in response. What you don’t understand, is that’s not going to happen. My response to you would be to GET YOUR OWN BLOG. Also, please stop the whining!

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