Thursday, November 17, 2011

Genuine compassion in dying

As I've noted in an earlier post, I strongly oppose active euthanasia and physician-assisted suicide. The medical profession should never participate in killing. Killing is the antithesis of medical care. Physicians should never participate in capital punishment, active euthanasia, or abortion, or in any act which intentionally ends a person's life.

There is a long ugly history of medical homicide, and it was (and is) invariably justified as necessary for the relief of suffering. The German T4 program comes to mind, and even Joseph Mengele's sadistic experiments at Auschwitz were justified at the time as being necessary to advance medical science.

But there is no excuse, then or now. Medical killing is killing, not medical.

What then is the ethical role of a physician in the care of people who are dying? Do people have to suffer? There is in fact much that physicians appropriately do to alleviate suffering.

First, patients have autonomy over a broad range of options for medical care. Patients may decline medical treatments in most situations, and there are many situations, such as treatment of a severe infection in the terminal states of cancer or connection to a ventilator at the end of life, when refusal of heroic medical intervention is ethically appropriate by universal agreement. There is no ethical requirement to continue heroic medical care which is merely prolonging the process of dying.

For patients who are experiencing pain or anxiety, there is an enormous armamentarium of narcotics and tranquilizers and even procedures that doctors can use to alleviate suffering. All pain of dying persons can be controlled, with competent and conscientious medical care. Hospices do this especially well, but pain can be relieved in intensive care units, on hospital wards, and at home. The euthanasia proponents' argument that physician-assisted suicide killing is necessary to alleviate pain is a lie.

Some unnecessary confusion arises when large doses of narcotics are necessary, because the narcotics may hasten death. It is agreed by all ethicists, including those who are most strongly pro-life, that administration to terminally ill people of large doses of medications necessary to alleviate pain is entirely ethical, even if the medication (unintentionally) accelerates the process of death. The intention is to alleviate pain, not to kill, and that is entirely ethical.

There are many more things that can be done to ease suffering. Most people want loved ones to be with them, and modification of visiting rules can allow the person dying in a hospital to be with their family. Spiritual support is also very helpful for many dying people.

The issue of feeding tubes is perhaps the most contentious issue we routinely face. Is it ethical to withdraw (or never place) feeding tubes for people who are terminally ill? I believe that it is not ethical to remove feeding tubes. Here's why.

There are two kinds of care provided in medicine. One kind of care is extraordinary care, which includes surgery, the administration of drugs such as antibiotics and medications to support blood pressure, and ventilatory support on a respirator.

The other kind of care is ordinary care, which is the provision of nourishment, hygiene, clothing, and shelter.

There is no obligation to provide extraordinary care if it is against the patient's wishes, or if the care is merely prolonging the dying process. Under the appropriate circumstances, it is perfectly ethical to withdraw support of a ventilator if the respiratory support is serving merely to prolong death. I have done it hundreds of times.

There is, however, an obligation to provide people with nourishment, shelter and clothing. These are basic necessities we all need. Starving someone to death is very different from discontinuing a drug or disconnecting a ventilator. Starving someone to death is morally equivalent to leaving them without clothing and shelter to freeze to death or letting them lay in their waste. It is never ethical. There are rare exceptions to this, such as when, in the last hours or days of a terminal illness, the ingestion of food and water causes pain, and it is ethical to withhold it under that circumstance.

What about the patient's autonomy? Doesn't he (or his proxy) have the right to refuse even ordinary care?

No. Patient autonomy is not unlimited. If a person comes into my office and asks me to perform an operation that they do not need, I am under no obligation to do so. In fact, performing an unnecessary operation or providing any sort of unnecessary care is unethical regardless of whether the patient requests it. Doctors are not under any obligation to do unethical things just because a patient requests it. Autonomy has limits.

Intentional death by starvation when done at the request of a patient is suicide, and no physician is under any obligation to facilitate suicide. In fact, physicians are under an obligation to prevent suicide if possible. If an 18 year-old comes into an emergency room declaring that he wants to kill himself because his girlfriend left him, doctors are under an obligation to stop him. He will be admitted to a locked psychiatric ward involuntarily to protect him, if necessary.

So what happens in real life when I am asked by a patient (or a family) to remove a feeding tube and allow a person to starve to death? I meet with the patient/family, tell them that I ethically cannot do that, and I explain why. Actually, most patients/family end up agreeing with me; it's very common that they feel pressure from the others on the medical staff to withdraw feedings, and many are relieved to hear that they don't have to.

For those patients/families who do wish to discontinue feedings, the hospital assigns another physician to write the order.

The bottom line is that there is no reason for anyone who is dying to suffer. In my professional life I have seen thousands of people die, and the vast majority have passed with dignity and in comfort. A very important part of my job is to alleviate their suffering, and provision of ordinary human needs-- nourishment, hygiene, clothing and shelter-- is part of the alleviation of suffering.

There is never any role for killing.


  1. I'm glad I live in a country (the Netherlands) where physicians are allowed to assist a person in suicide.

    You probably think it's up to your imaginary god to decide when we check out. Good for you, but other people should have the freedom to decide on their own.

  2. @troy:

    You do have the freedom to decide on your own. Rope is cheap, and there are lots of bridges. You can even save up sleeping pills. You've got lots of choices.

    Why do you involve the medical profession in your suicide plans?

  3. Medical professionals are much less likely to make suicide messy and painful, because they have legal access to certain drugs and know how to properly administer them.

    You, Egnor, don't have to assist anybody if you don't want to, but why would you forbid your less superstitious colleagues from helping out?

    Typical example of religion making good people do bad stuff.

  4. Doctor Egnor, I doubt that any of your patients who read your blog would bother asking you about assisted suicide because they will know you’re true position, “I won’t help you, but feel free to jump off a bridge.”


  5. Euthanasia is a very slippery way of dealing with end of life issues, as much as abortions are with dealing with start of live issues.

    Once accepted as the normal way of doing things, they both can lead to unforeseen consequences.

    How many abortions are used in lieu of contraception?

    How many assisted suicide will result in planned euthanasia of the old and disabled?

    Of course, if we believe that we are the accidental result of blind material forces and not much better than other animals, it does not matter and free for all is king.

    I know we are more, much much more than that!

  6. Dr. Egnor, when my time comes, I hope to be taken care by doctors such as you.

    1-I don't want artificial life support.

    2-I don't want to suffer and/or starve to death.

    3-I don't want to be killed.

    3-I wish someone will be there, holding my hand, when I depart to meet my Creator.

  7. How many assisted suicide will result in planned euthanasia of the old and disabled?

    I hope you're trolling and you don't actually believe what you're writing.

    3-I wish someone will be there, holding my hand, when I depart to meet my Creator.

    Unfortunately it won't happen, because your creator is imaginary.

  8. troy said...

    " I'm glad I live in a country (the Netherlands) where physicians are allowed to assist a person in suicide."

    Ah this explains much of your brain washing.

    Hey troy, mortification at the whim of your "doctor" awaits you.

    Good luck if you don't approve, you will be sent off to meet your maker anyway if the "physician" decides your quality of life is "insufficient" - whether you agree or not.

    And please spare us the standard line of bull shit that no such thing ever happens, because we all know it happens everyday. Especially the murder of the elderly by "mortification" under the "care" of your so-called "doctors". Doctors of death that is. Hitler would be proud.

    " You probably think it's up to your imaginary god to decide when we check out."

    Why are atheists such utterly incompetent thinkers?

    Ok so, which "imaginary god" would that be? And please, don't be shy, I want logical scientific proof of the "imaginary" part.
    You have none, never have and never will and if you had a brain you'd know what that implies for your inane world-view.

    So it appears clear that if the theists and deists are merely "imagining", rather than logically deducing and inferring, a power & intelligence sufficient for the creation of the universe and its laws, that atheists are necessarily "imagining" there is no such power.

    This is not hard.

    So who's the smarter? The fool that pretends to himself that there is no such power because he doesn't want there to be, or the guy that simply "puts 2 and 2 together" and gets 4 and accepts the answer?

    Atheists all fit into the 1st group; i.e. the fools.

  9. I was going to reply to Anonymous but Gary H. has just nailed him.

    Good work Gary H.!

  10. Dear Gary H.,

    You are insane and your comparisons with the nazis are slanderous and disgusting.

  11. Dear blind little coward Gary H.,

    It is extremely sad to see what religion has done to you. You are completely deluded and you have persecution complex, and your rants make no sense.

    I'll pray for you.

  12. Gary H, replying to my request for evidence that people were euthanized against their will:

    ""Some 2,636 Dutch people were killed by euthanasia during this time"

    You're sure everyone of these was perfectly "reasonable"? We're just supposed to blindly trust your doctors of death?"

    Gary, I know you're not the sharpest tool in the shed, but I would have thought that even you must realize that quoting the number of people that were euthanized is not evidence that they were killed against their will. So either you are even more stupid I thought, or you are a dishonest sleazebag. Probably both.

  13. Also, "your doctors of death" reminds me of Sarah Palin's death panels.

  14. troy and anon = dumb and dumber

    It is tragic to witness what atheism has done to you both - denial denial denial, nothing but denial of reality.

    It's right under your noses but denial has claimed your murky minds and you are blind to it.

    2,636 kills in one year.
    In a country with less than 17 million.
    A rise of about 13% from the previous year.

    "Doctors of death" is the only proper term.

    Now they have included "loneliness, loss of autonomy and depression" as other viable reasons for "assisted suicide".

    They have also included infants in their legalized killings of course. Infanticide? Sure! Why not?

    So who's next?

    Ah! Hitlerian eugenics! Isn't life wonderful!

    All through history "prophets" and intelligent men - those that foresaw evil coming, those that warned of impending war & destruction - have been deeply disdained and hated by fools like yourselves ...
    ...just before the shit hit the fan of course.

    So, thank you for these comments!

    They only confirm the beliefs of all the intelligent persons watching the world go down the toilet -due to atheist Darwinian ideology- while blind fools like you pretend it isn't happening and can't happen.

    Truly pathetic.

  15. Gary,

    You're obviously insane, but I'm still curious why you would deny people the right to a dignified death. You still haven't shown any evidence that people were killed against their will, despite repeated requests. I assume you don't have this evidence or you would have shown it by now. Your religion has turned you into a ghoul. Too bad. Hopefully other people will learn and try not to become an insensitive godbot like you.

  16. "1-I don't want artificial life support.
    2-I don't want to suffer and/or starve to death.
    3-I don't want to be killed.
    3-I wish someone will be there, holding my hand, when I depart to meet my Creator."

    Hmm.. you dont want to suffer huh? Dont want artificial life support..ok. So lets just say they take you off of the life support. Or maybe you dont even need it, but your life and whats left of it, will be painful, to yourself and to the people that care about you. Maybe hanging in there for months, shitting yourself, having to be fed like a baby, taking up hospital resources, etc.

    Many people would like to have the option of not having to endure the rest of their lives like that, or not wanting their children's last memory of them as such. And Egnor, its pretty difficult for a hospital bed-ridden patient to go jump off a bridge.

    Gary H. - you seem very angry and hostile. You resort to name calling very quickly, as if you were in high school. I thought religious people were supposed to be kinder than that. 'turn the other cheek' so they say..

  17. "Doctors of death" is the only proper term.

    "Paranoid moron" is the only proper term.

    They have also included infants in their legalized killings of course. Infanticide? Sure! Why not?

    [citation needed]

    atheist Darwinian ideology

    What kind of idiot says "atheist Darwinian ideology"? It sounds like a parody of fundamentalism.