When keeping someone alive isn’t the best choice.

Over the last few years, I’ve come to the growing realization although medicine has made tremendous technical advances we are still in a place where we have a lot to learn about the nature of diseases in general and the human body specifically. Our bodies are amazingly complex machines but there is so very much we have yet to learn about how they work.

Perhaps, coming to this conclusion is one of the reasons why I find my expectations of medical personnel to be scaled back and when I say scaled back, it isn’t a matter of me expecting people to do a bad job, more a question of realizing after all people are fallible and treating patients isn’t akin to doing a simple math problem no matter how much we may wish it so.

Everyone has good days and bad days and one of the things I try to impress on anyone when I talk to them about going to doctors, being in hospitals, etc is the people charged with care are going to make mistakes and when they inevitably do we can’t overreact. The best advocate for a patient is the patient themselves and it means educating yourself, working with your practitioner and setting up the kind of circumstances leading to success as opposed to failure.

I’m getting a little sidetracked here...

What bought this to mind was an article I read:

Ray Gosling, 70, made the confession in a television programme this week about assisted suicide, ahead of the publication of new government guidelines on the issue next week. He said he killed the unnamed man as he lay seriously ill in hospital “in the early period of AIDS” — likely to be during the 1980s.

Medical science has made some great advances but while they can prolong a life, there are many times when they cannot offer to maintain the quality of that life. After seeing a few people, people dear to me, do this dance I have come to the conclusions there are some dances a person should just sit out.

Now, we all want doctors to do their level best to help us get better, to do everything in their power to save us but, what happens when a patient won’t get better? What happens when a patient suffers from some kind of tremendous blow to their health and well being and all they can look forward to is an ongoing battle where the best prospect is not winning but losing incrementally? There is the something the Chinese called Lingchi:

In this form of execution, the condemned person was killed by using a knife to methodically remove portions of the body over an extended period of time. The term língchí derives from a classical description of ascending a mountain slowly. Lingchi was reserved for crimes viewed as especially severe, such as treason and killing one’s parents. The process involved tying the person to be executed to a wooden frame, usually in a public place. The flesh was then cut from the body in multiple slices in a process that was not specified in detail in Chinese law and therefore most likely varied.

In essence is the way medicine approaches the patient a modern day form of torture?

Someday, very soon we are going to have a discussion not about what to do to treat a patient but instead what not to do. And we are touching on that now peripherally as part of the health care debate in the sense many people who are opposing government sponsored health care would have a person believe when the government speaks about taking up the onus of medical care part and parcel of the burden will be condemning the elderly:

The republicans charge that Democratic health care reform would, in Sen. Charles Grassley’s words, “pull the plug on Grandma.” According to Sen. Jon Kyl, the bills before Congress would ration medical treatment by age. Rep. John Boehner says they promote euthanasia.

Maybe though, just maybe, it is time for all of us to ask ourselves what is truly ethical in these situations. I have seen what it means to prolong a life and there are times when it is not pretty, when it is something you would not wish upon your worst enemy let alone someone you love and care about. If the Hippocratic Corpus rests one leg on the premise of ‘Primum non nocere’ can it be there are instances where this compels a physician to do nothing aside from easing a patient’s pain and is the only thing standing in the way a threat of reprisal via litigation?

As medicine advances improve the ability to prolong a life is it time for us to distinguish the difference between whether or not it means prolonging someone’s pain?