My OP/ED in LA Times today

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Ken M

Mountain climber
Los Angeles, Ca
Topic Author's Original Post - Dec 28, 2014 - 09:51pm PT
Not of the quality of Callie's in the NY Times, but shows that ST folks have influence.

http://www.latimes.com/opinion/op-ed/la-oe-zamichow-murray-hippocratic-oath-death-20141228-story.html
Ed Hartouni

Trad climber
Livermore, CA
Dec 28, 2014 - 10:04pm PT
thanks for the link, Ken, the piece approaches a very important issue
nah000

climber
no/w/here
Dec 28, 2014 - 11:06pm PT
thanks for both the post and the original piece.

i appreciate your systematically dealing with difficult questions but then more importantly providing practical ways of moving beyond the status quo.

tough questions, that require thoughtful solutions... thanks for providing yours to the public discourse.
BMcC

Trad climber
Livermore
Dec 28, 2014 - 11:14pm PT
Thanks for the link to your thoughtful and well written op/ed.
Clint Cummins

Trad climber
SF Bay area, CA
Dec 29, 2014 - 01:41am PT
Good stuff.
I agree the original Hippocratic Oath refers to old technology.
And the "do no harm" version sounds good at first but doesn't hit the right spot.
It seems like the right replacement should somehow state that the doctor should act as the agent of the patient (using an economist's terminology).
I.e. try to act in the best interest of the patient. Using knowledge of treatment efficacy that the patient probably doesn't know and may not be able to understand very well.
This allows for euthanasia and non-treatment.
It can be in conflict with a "preserve life at all costs" type principle,
when the patient is near the end of their life, if the patient does not
believe in that principle (perhaps the patient believes in something like "preserve [expected] quality of life if possible").
High Fructose Corn Spirit

Gym climber
Dec 29, 2014 - 07:43am PT
+1 for the death doula.

Another excellent article, Ken.

After watching the 60 Minutes piece a couple months ago on the issue, I tweeted to the profiled anti-assist physician in the piece (his similar to Kass') perhaps it was time then for more than one type of physician?

But I like the idea of a "doula" - that works! Maybe "doula" to start and eventually in addition a more sympathetic physician type as well. Hope.



(Dr. Ira Byock was the anti-assist physician in the 60 Minutes piece.)

http://www.youtube.com/watch?v=MAHey2LjA6c
Crimpergirl

Sport climber
Boulder, Colorado!
Dec 29, 2014 - 07:50am PT
Great piece (as usual). I hope our culture changes to allow and provide the means to death with dignity for all.
Gary

Social climber
Desolation Basin, Calif.
Dec 29, 2014 - 07:51am PT
That was a good one. This was also interesting reading:
http://www.latimes.com/opinion/op-ed/la-oe-zamichow-cancer-treatment-20141026-story.html

Physicians often decline treatment in cases of terminal illness, wrote Dr. Ken Murray in “How Doctors Die,” an essay for the Zocalo Public Square website.

“What's unusual about [doctors],” Murray wrote, “is not how much treatment they get compared to most Americans, but how little.”
NutAgain!

Trad climber
South Pasadena, CA
Dec 29, 2014 - 08:34am PT
Compassionate and rational and well-reasoned.

I have a few questions/considerations though:

1. While in some cases the line may be clear, I suspect that in many cases the line is very messy and blurry, between an unchanging and uncomprising desire to end life now, versus a deeper willingness to hang in a few more days/weeks/months. This involves calling on a well of inner strength or a fear of death that may exceed what the patient was previously aware of. How is the "death doula" to know which version of the patient to honor? "Oh nonsense, you're just getting the pre-death jitters, just let me put this needle in and it will get better...." Or maybe the patient later laments that the "death doula" didn't have the fortitude to follow through? Seems like a very personal thing and hard to know a priori which intention to follow.

2. Similar case when a patient is not terminally ill yet becomes potentially so while in a hospital or as a result on an accident. Sometimes a person may state what they want as an advance medical directive according to a romantic or philosophical ideal, but when perched on the edge of finality, may recognize an error or lack of conviction in their decision. By not having a strong bias toward the sanctity of life, the medical profession or "death doulas" would not give an opportunity to reconcile the new situation and patient's discovery of their intention to live. This intention may arise at the last moment, long after legal paperwork and confirmations have been made.
MisterE

Gym climber
Bishop, CA
Dec 29, 2014 - 08:40am PT
Great article - thanks for the link and your thoughtful contributions, Ken.
crankster

Trad climber
Dec 29, 2014 - 08:53am PT
Nicely done, Ken.
MikeL

Social climber
Seattle, WA
Dec 29, 2014 - 09:12am PT
Interesting issue. At least physicians have a code of conduct or oath of office, even if a bit out-dated or in need of amendment. Most careers and jobs don’t, and hence we see all sorts of self-interested behavior that we’d rather not witness from folks. I have high regard for those “professions” that put clients and customers before themselves.

I also liked very much the article pointed to at the same URL that Gary noted and quoted. I’ve gone through one of those radiation and chemo cancer treatments that was very difficult. At the high point, I told my wife that if I had to go through it again, I might not do so. She said, “. . . like hell you won’t.” (Cancer treatments can leave challenging lingering effects. When people ask about the cancer, all I think of is the effects of the treatment.)

It seems to me that issues about quality of life is something that climbers would perhaps understand better than most groups of people.
SC seagoat

Trad climber
In What Time Zone Am I?
Dec 29, 2014 - 09:24am PT
A profoundly important subject.
When I was undergoing chemo I met a number of women who had exhausted just about all the treatment options. They were down to options that may have prolonged their lives by a few weeks to months but with ugly side effects.
Most of them said "nope, I'm over it" As they declined they were given all the pain meds they needed. However, prior to that stage, they got to live the remainder of their days with a level of robustness that they would have been robbed of otherwise.
We have incredible medical technology to continue the beating of the heart and rising of the lungs. Is that life? Especially when a patient wants something else and is horribly suffering.

Thank goodness for Oregon and Washington state. May more follow.

Susan

Ken, your article was very moving and provocative. Excellent read!
BrassNuts

Trad climber
Save your a_s, reach for the brass...
Dec 29, 2014 - 09:51am PT
Nice piece on a tough topic that I think about frequently. I like the concept of a doula or agent, this makes good sense to me.
rgold

Trad climber
Poughkeepsie, NY
Dec 29, 2014 - 10:20am PT
Thanks for an interesting and relevant discussion Ken.

I find myself able to sympathize with multiple positions on both sides of the issue. On the one hand, the Hippocratic oath stands as a bulwark against a potentially chaotic patchwork of ad hoc decisions, with potentially as many "wrong" ones as we get now from an abundance of caution.

On the other hand, modern society with its miraculous medical interventions now holds out a possibility never existed and seems to me to be quite novel, namely that, having lost the physical control we have when relatively healthy, we might still be able to control how we die. That's what it's about: our ability to control the circumstances of our death after we have lost control of our life.

I and almost everyone I know want to have this control; we fill out living wills and sign DNR's, much of which, in my experience, is to no avail. The combination of inertia, bureaucracy, good intentions, yes, the Hippocratic oath, and I think in some cases institutionalized greed, together conspire, much of the time, to prolong life in spite any of the expressed wishes of the now-helpless patient.

My suspicion is that the death doulas (OMG, don't let Sarah Palin get a hold of that notion) are almost a cute trick to circumvent the Hippocratic Oath obstruction; there are many other obstacles, and maybe there should be.

Relatively undaddressed in your piece are the quality of life issues that many people worry about. What if your condition is not terminal so much as vegetative, what if you are not faced with imminent pain, but rather a long cognitive and physical decline?
Ken M

Mountain climber
Los Angeles, Ca
Topic Author's Reply - Dec 29, 2014 - 10:51am PT
Thanks for all the thoughtful comments. I really appreciate it.

As you might imagine, the Op/Ed format is very limiting in terms of length, and is a major constraint in limiting the development of associated ideas. I suppose that is what books are for?? :)

The main goal of the article was to get people thinking about the issues involved with this, not really a specific prescription for system construction.

For most on this forum, the issues involved have had more to do with our parents, and what we've seen happen to them. Hopefully, we can think about how that has gone wrong, and what we can to to right that when it comes time for our own generation, or those approaching the brink.

Gorgeous George

Trad climber
Los Angeles, California
Dec 29, 2014 - 11:17am PT
Your piece was both thoughtful and provocative.

But I would like to see the discussion amplified to include a discussion of how much harm Doctors actually cause by unduly resorting to prescribed medication, including anti-biotics, for everything that ails their patients.

Yes, assisted suicide for terminally ill people is an important societal question, but I believe part of the reason the costs of medical care have skyrocketed out control (and out of reach for most people) is because Doctors are prone to needlessly prescribing too much medicine, and thereby doing the bidding of the pharmaceutical industry.
Ken M

Mountain climber
Los Angeles, Ca
Topic Author's Reply - Dec 29, 2014 - 11:25am PT
George,

I totally agree with you that overuse is a huge problem, and needs wide discussion.

One of the lead organizations taking this on is the Lown Institute:

http://lowninstitute.org/

One of their directors, Shannon Brownlee, has written several books on the subject, findable on Amazon.
rottingjohnny

Sport climber
mammoth lakes ca
Dec 29, 2014 - 11:35am PT
I believe assisted dying is a practical and compassionate procedure...I wonder if this discussion is taboo for a regressive society that thinks prolonged suffering , as long as someone else is doing the suffering , is a noble pursuit... ?
BLUEBLOCR

Social climber
joshua tree
Dec 29, 2014 - 11:37am PT
Congrates on a respectable write!!


This is the original version of the Hippocratic Oath:

I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.

I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.

With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.

Further, I will comport myself and use my knowledge in a godly manner.

I will not cut for the stone, but will commit that affair entirely to the surgeons.

Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.

Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.

If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate![4]
wiki

What part did you want to change?
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