Physician Assisted Dying

Share | JAMA January 19 2016 315 No 3 p 249 on the subject lists a paragraph titled Evidence Evaluating the Practice of PAD


What more can the evidence show? The morbidity and mortality of PAD is near 100%. The long term survival near zilch. We might as well be back in the days of ancient Athens when Hippocrates ranted against the charlatans, and the priests jailed him 20 years for defying their political edicts -- defining disease and directing treatments. We espouse an arrogance of modernity while in reality nothing much has changed. The question is, can we as physicians defy political dictates, correctness and greed while sustaining the Asclepian convictions and pledge of our profession. Politicians demanding PAD seems a bit like men defining women's reproductive rights, misdirected social engineering at the least. 

Heroin Addiction in New Hampture

For over a decade there has been an intense campaign to treat our patient's pain. It may have started with a successful lawsuit against a physician for not providing adequate pain relief in a suffering patient. It may have been a political thing. In any case, students are taught to always ask patients to rate their pain on a scale of 1 to 10, and meaningful use, or at least the EHR records, take up substantial space with its documentation. Doctors have seemingly lost all caution and restraint in prescribing narcotics for pain relief. We give the patient a pain delivery system affixed to their IV that gives them however much narcotic they think they need. All of this showcasing gives people the idea that any pain is a bad thing and must be eliminated.

A generation ago, two things were different: patients did not experience pain as they do today wheather due to advertising, social norms, or our preoccupation with pain management, and physicians were much more circumspect in limiting narcotics to less addicting amounts understanding that any amount is addicting and addiction is always a risk. Pain is not a bad thing, however; it is put there for a purpose. What is bad is how we interpret it. 

That is not to say we don't mitigate pain and help patients deal with it, we do and we should, but I submit, we as physicians and some of our other providers are a major root cause of the heroin epidemic. It starts with the prescription and our promotion of pain as a more important target for treatment. (And profit SIC)