Monday, April 7, 2008

Doctor Power

At a recent international conference, I happened to be seated next to one of the presenters shortly after his erudite talk. His talk presented a scholarly and highly nuanced analysis and decision framework based on his understanding of the relevant philosophical and ethical literatures around death and dying. What was most intriguing for me was the part of his framework identifying who should be making these end-of life decisions.

Let's just say that the word doctor appeared much more often than words like patient, family, next of kin, spouse, or parent.

I engaged this distinguished ethicist and philosopher about his clear conclusion that, in most of his presented stages of decision-making, the doctor held full sway. I raised the concern of “doctor power” in light of how euthanasia in the Netherlands (and many other places, I’m sure) is often recommended (and carried out) by doctors without the permission of the patient -- or anyone else, for that matter.

Let’s just say he squirmed a little, and insisted that something got lost in the translation (he delivered his presentation in Italian, I heard the translated English version).

I don’t think so.

Let me be clear: Many physicians are a blessing to their patients, as they should be. However, only the truly naïve will believe that there are no doctors for whom euthanasia is an accepted, justifiable, and ethical practice.

In this day and age where the medical profession pretty much sees the “do no harm” part of the Hippocratic Oath as a quaint throw-back to a bygone era, and where, increasingly, medical decisions are economic decisions above all else, is it unreasonable to suppose that doctors everywhere, including in the US, sometimes act on their conviction that euthanasia is permissible without anyone’s permission?

Well, no. 

Doctor Power is here to stay. Remember Dr. Hootan Roozrokh?

No? Well, here’s what the Los Angeles Times story reported a little more than a year ago:

SAN LUIS OBISPO -- No one in the courtroom Wednesday suggested that Ruben Navarro could have avoided death for long.

But whether the severely retarded, comatose 25-year-old was nudged into it by an  impatient transplant surgeon is at the core of a legal proceeding unprecedented in the  United States.

Dr. Hootan Roozrokh, 34, has been charged with three felonies in Navarro's 2006 death. His case is being watched intently by medical professionals and ethicists across the country who fear that a conviction will discourage prospective organ donors and their families. . . .

At issue was whether Roozrokh, a San Francisco specialist on leave from Kaiser Permanente, improperly administered massive doses of morphine and Ativan, an antianxiety drug, in order to speed Navarro's death.

Doctor Power. Pure and simple.

Roozroh decided. Ruben died.

Ruben had been pumped so full of morphine and Ativan that when he finally succumbed, his organs were useless for transplantation.

Want to read about Hospital Power? Check out Annie’s story. I’ll have more to say about Annie later.

Maybe it’s time to find out how really well you know your doctor.

Couldn’t hurt to check……….



Deborah said...

When we select a family doctor or specialist, we measure our satisfaction based on the convenience of office hours, how available the doctor is for emergency visits, how pleasant the office staff is and how much time the doctor takes with us when we have the flu. We need to add another criterion: whether or not the doctor will let us live.

Dr. Mark Mostert said...

Thanks, Deborah, for chiming in. Yes, for better or worse, we probably need to do that - aggressively, deliberately, and in our own best interests.