Physician Assisted Killing

by admin on 06/19/2011 1:50 PM

A patient with obstructive sleep apnea came in for his annual evaluation. He had been snoring for decades, but about six years ago, his wife noted that his snoring stopped abruptly in the middle of the night. She observed her husband and noted that his chest was still moving, as if he was breathing, but there was no snoring. She then put her hand over his mouth and nose and did not find any air movement. She woke her husband immediately and after a loud strider, he began breathing. She insisted he see his pulmonologist as soon as he could obtain an appointment. He was immediately scheduled for a Polysomnogram (sleep study). This confirmed the diagnosis of sleep apnea (no breath) and determined the optimal pressure to set the Continuous Positive Airway Pressure (C-PAP) device on to wear at night to assure continuous breathing while asleep. This was working fine.

As I was finishing my exam and writing his prescriptions, he casually mentioned that a friend of the family, who had sleep apnea, had respiratory failure requiring oxygen. His C-PAP was powered by oxygen pressure rather than compressed air. The friend was getting increasingly depressed over his disability and told my patient that sometimes he thought that he would just turn the machine off and end it all. Although my patient tried to joke him out of this approach, he apparently decided one night that he’d had enough. He turned off the machine and the oxygen and quietly died during the night. This is a peaceful way ending one’s life without any pain. It also is a quiet way to commit suicide with any physician accomplist.

With all the emphasis on physician-assisted suicide, it is indeed unfortunate, if not absolutely heinous, that physicians should play the role of executioner. That such a proposition can be passed by public vote underscores the lack of basic medical knowledge we have been unable to provide to the public. They don’t need an executioner to write a lethal dose of barbiturates. The patients have numerous lethal doses of medications already in their possession. Most patients now get a 90-day supply of medications. If there are any cardiac, blood pressure, narcotic, hypnotic or psychiatric medications among them, it would not even take a full bottle to do the fateful tragic deed. Whether in The Netherlands, Oregon or Europe, we should never have to worry about whether our doctor is wearing the white coat of healing or the black cloak of an executioner.

A doctor in The Netherlands confided in me during a break in a medical meeting in Amsterdam that he once admitted an elderly lady to the hospital. She said she worried about being put to death while in the hospital. The doctor I was speaking with assured her that he would watch over her to make sure that didn’t happen. The next weekend, he signed her out to a colleague. When he came back on Monday, he looked for her and couldn’t find her. The nurse said she had “died.” He quickly summoned his colleague as to what happened. He was told, “We needed the bed.” He said he now felt it was a horrible tragedy for physicians to be involved in assisted suicide. It is more often an execution and not for a medical or “relief-of-pain” reason that is commonly given. It may be just an administrative decision on allocation of beds.

Statistics in Oregon, the first state in which physicians are allowed to kill patients who request it, indicate that perhaps as many as half of these patients have not signed a valid request that they wanted to be executed. These hospital mistakes are permanent. They are not simple medication errors that the Institute of Medicine feels are so tragic. Many of them are inconsequential and can be easily reversed. Physician execution of patients can never be reversed.

Healthcare is such a private matter we may never know how many were put to death for nefarious reasons. I’ve had a number of patients complained that they were convince that a family member was killed during their last hospital stay.  A colleague confided in me that a patient he was seeing in consultation, who was in respiratory failure, was given a large dose of morphine and died during the night. The dose given would be appropriate for an otherwise healthy patient, e.g. one with herniated disc pain or a bone fracture.  Patients in lung failure need all their energy to breath and stay alive. A dose of most narcotics or sedatives will place such a patient into permanent rest. And it was not picked up in medical death chart review. Physicians are required by California law to relieve pain. Hence, it’s an easy way to quietly extinguish a life without raising any eyebrows. It also avoids prosecution.

Updated from MedInfoLine2005

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