Death by bedsores

The September 15 issue of The Lancet has a fascinating article by Arthur Caplan, who is now at the Division of Medical Ethics at New York University Medical Center. Caplan tells the story of “Harold Brennan” (a pseudonym), an 88 year old man who had lived an independent life until a series of ministrokes left him helpless and bedridden. He was in a community hospital where, despite apparently good care, he developed bedsores. He experienced great pain whenever he was moved and decided he no longer wanted to be turned. When told that this would lead to worsening infections and death his resolve was all the stronger. A psychiatric consultant assessed him as angry but not depressed and competent to make decisions. The nurses were horrified. How could they stand by and not provide the most basic form of nursing care? The hospital tried to get Mr. Brennan’s daughter to come to…

Massachusetts Death with Dignity Ballot Initiative

My home state of Massachusetts has an initiative on the November ballot that would establish a “death with dignity” law closely modeled on the existing laws in Oregon and Washington. Surveys suggest that a majority of the public support the law, but influential groups including the Catholic Church and the Massachusetts Medical Society oppose it. Today I had the privilege of meeting with a group of elderly men at a community center to tell them about the initiative, summarize the essence of the pro and con positions, and then lead them in discussion. In other words, something like a focus group. The heart of the discussion was a spirited exchange between two of the participants. One who I’ll call “Skeptic,” opposed the initiative. Human nature being imperfect, he anticipated that some doctors would “specialize” in certifying that patients met the criteria for receiving a lethal prescription without the kind of careful…

Is it OK for GP’s to have sex with their patients?

For anyone interested in the ethics of doctor-patient sex and the relationship between ethics and law, the recent 5-1 decision of the Supreme Court of Pennsylvania in Thierfelder v Wolfert makes fascinating reading. (If the details interest you, make sure to read Justice Todd’s dissent – in my view she got the issue right!) In 1996 David and Joanne Thierfelder became patients of Dr. Irwin Wolfert, a family physician. He treated them both for conditions that included low libido. In 2002 Ms. Thierfelder told Dr. Wolfert that he had “cured” her problems and was her “hero.” They began a sexual relationship that lasted for a year. She became more anxious and depressed and finally ended the relationship in January 2003. She told her husband about the affair two months later, and together they brought malpractice action against Dr. Wolfert. Dr. Wolfert argued that as a general practitioner he should not be…

No Treatment as the Treatment of Choice

In the October 3 issue of JAMA, Allen Detsky and Amol Verma offered “A New Model for Medical Education: Celebrating Restraint.” Restraint in medical practice is decidedly un-American. Not surprisingly, the authors are Canadian! Detsky and Verma are concerned with both quality and cost. Here’s the essence of their argument: …we suggest complementing health care cost control initiatives by transforming the current approach used in medical education that primarily rewards meticulousness of clinical investigation to one that also celebrates appropriate restraint…Clinical teachers who are role models could embrace a new approach. They could emphasize teaching restraint, both to improve health care quality and to acknowledge the professional duty of resource stewardship. The worship of obscure diagnoses is a longstanding part of US medical culture. It’s exemplified by the “zebra joke,” which I first heard as a medical student in the early 1960s: Two senior physicians are walking alongside a wall. On…