A Doctor on Euthanasia
Re “Debate Over Death: Euthanasia Issue Divides Physicians,” by Allan Parachini, March 9: As a retired physician whose practice was in the area of hematology-oncology, dealing often with patients whose cancers had become untreatable, I am more familiar than most with the theme. I have signed dozens of death certificates concerning persons with terminal, disseminated cancer. Since I am retired I have little to lose from expression of my views on this subject, which has serious medico-legal implications in the United States, unlike in Holland where the MD’s role in terminating a hopeless and depleting life is not so fraught with a charge of murder.
I have committed euthanasia several times in my medical career if part of the definition of euthanasia includes permission of a person’s death from a disease that is beyond retrieval, a person in pain, and whose continued viability is debilitating to survivors, allowing such a patient to expire because fluids, food or antibiotics needed to sustain life are withheld. Moreover, I believe that such deaths of my patients were a significant part of good medical practice.
One might divide euthanasia into two broad categories: active euthanasia, when the physician administers something to kill the patient, and passive euthanasia, when the physician does not do something to sustain the patient’s viability. There is much overlap. I have been “guilty” of the latter in several instances and I know colleagues who have done the same.
There are several requirements that must obtain for an MD to function in this way. The physician must be the primary physician, the professional in charge, at the time of decision. The physician must have a close emotional understanding with the patient. The patient and his loved ones must understand and accept the fruitlessness of further medical maneuvers. The patient and his loved ones must look on the MD as a knowledgeable physician who is speaking the truth when he says there is nothing more to be done beyond extending viability. They all, including the MD, must accept the limitations of medical expertise.
If requirements like these are met I do not believe there is a real problem concerning the physician’s role in “euthanasia.”
The problem arises because in this era of great expectations concerning medical expertise and the way that medicine is taught, equating death of a patient with medical failure, “primary” physicians are an endangered species in an arena of subspecialists.
Not one single physician spends enough time and concern gaining the respect and confidence of the patient and his or her family; not enough physicians are willing to be in charge of a medical “lost cause.” Too often, there is no single physician who is sufficiently aware of the terrible drain on human and financial resources and the impossible medical dilemma to confront these issues with the patient and his family.
CHARLES G. CRADDOCK MD
Pacific Palisades
