Matters of life and death
In a new book, A Miracle and a Privilege, Dr Francis Moore, 81, of Harvard Medical School, discusses a lifetime of grappling with the issue of when to help a patient die. An excerpt: Doctors of our generation are not newcomer to this question. Going back to my internship days, I can remember many patients in pain, sometimes in coma or delirious, with late, hopeless cancer. For many of them, we wrote an order for heavy medication – morphine by the clock. This was not talked about openly and little was written about it. It was essential, not controversial The best way to bring the problem into focus is to describe two patients whom I cared for. The first, formerly a nurse, had sustained a fractured pelvis in an automobile accident. A few day later her lungs seemed to fill up, her urine stopped, her heart developed dangerous rhythm disturbances. So there she was: in coma, on dialysis, on a breathing machine, her heartbeat maintained with an electrical device. One day after rounds, my secretary said the husband and son of the patient wanted to see me. They told me their wife and mother was obviously going to die, she was a nurse and had told her family that she never wanted this kind of terrible death, being maintained by machines. I told them that while I respected their view, there was nothing intrinsically lethal about her situation. The kidney failure she had was just the kind for which the artificial kidney was most effective. While possibly a bit reassured, they were disappointed. Here was the head surgeon, seemingly determined to keep everybody alive, no matter what When patients start to get very sick, they often seem to fall apart all at once. The reverse is also true. Within a few days, the patient’s pacemaker could be removed, and she awoke from her coma. About six months later I was again in my office. The door opened and in walked a gloriously fit woman. After some cheery words of appreciation, the father and son asked to speak...
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