…’If you get through this,’ I whispered to Mr. Smith, ‘I hope you can forgive me.’
I have never been able to balance satisfactorily in my own mind the twin pillars of modern medical ethics: patient autonomy and the physician’s obligation to do the best for his patient. As a doctor, when do you let your patient make a bad decision? When, if ever, do you draw the line? What if a decision could cost your patient’s life? How hard do you push him to change his mind? At the same time, it is his life. Who are you to tell him how to live it?” (New York Times)
In this troubling essay, the physician seems to justify an invasive outright violation of a competent patient’s clearly expressed directives because the patient is grateful several weeks later. The physician asserts that no one really wants to die, and agrees enthusiastically with a colleague, in a travesty of a competency assessment, that if the patient had expressed a wish not to have heroic measures, his thinking wasn’t straight. This style of medicine is pitiful in its singleminded, vain and ultimately of course pointless quest to cheat death at all costs. The pride physicians like this take in their seeming omnipotence and omniscience make me ashamed of my profession. I am surprised that the author was so un-self-conscious as to have no embarrassment at having portrayed himself in this light. There are any number of vignettes most of us can describe — or which you can see on ER every week — that describe the subtleties of medical decision-making in the face of ethical dilemmas… but this is not one.
