Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
I agree with Dr. Clemmer that it would have been preferable that the project reported by Dr. Dowdy and colleagues had been reviewed by an Institutional Review Board committee. If the authors chose not to view the project as a research endeavor but rather as a clinical endeavor, one might argue that it would have benefited from review by the hospital ethics committee. Whether Dr. Dowdy and colleagues were intent on improving patient care or on performing a research study, it would have been ethically preferable to have informed the patients and/or their families that they were part of an effort to improve patient care at the end of life.
Dr. Clemmer makes a connection between an accepting attitude toward earlier deaths for terminally ill patients and an accepting attitude toward killing as occurred in the Nazi era. I believe it is important to maintain a sharp distinction between allowing patients to die of an overwhelming illness and killing. We must guard against this danger of allowing patients to die too early because of cost concerns. However, we must remember that it was the need to accept the inevitability of death and to avoid the intervention of physicians who considered themselves obliged to prolong life that first stimulated the endeavor to improve the way we approach death in the United States today. Dr. Dowdy and co-authors reported a project that is but a part of a major tidal wave of changing attitudes about acceptance of death that has been promoted by the hospice movement and endorsed by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research [1], leaders in medicine and ethics [2-4], the American Medical Association [5], the American Board of Internal Medicine [6], and the Institute of Medicine [7].
When we, as clinicians, minister to dying patients, we should guard against the hubris involved in thinking that we know when a patient will and should die. For this reason, I think we should not step over the boundary between allowing a comfortable death and actively intervening to bring about death. This would be a step on the dark side that would take us past a barrier we may not be able to handle any more wisely than others in the 20th century who thought they knew when it was right to kill.
