I know a doctor who murdered a patient.
Chances are, so do you, but you probably have never been confronted with the fact. Over the years my family and I have been blessed to be in the care of many fine general practice physicians, but none have been finer — or smarter, more compassionate, and as available — as Kent. Long ago he gave up pediatrics and cross-trained in another specialty because “I couldn’t stand to have one more kid die on me.” When a seven-year-old leukemia patient lost her battle for life, her father punched Kent several times, severely, before he was pulled off him. He had not fought back or even raised his arms to deflect the blows. “I felt like I had it coming,” he told me.
We had a lot of contact, professional and otherwise, so his call late on a business day was not unusual, but his rambling narrative and slurred speech were. He was not quite incoherent. I can be as slow on the uptake as anyone so it was a few minutes before I even dared to guess what he was talking about and asked, “Have you been drinking?”
“Where are you?”
“Home. Knocked off early.”
“Have another drink,” I said, “a big one. Go to bed. Don’t talk to anyone about this, not even your wife. If you want to talk tomorrow, call me, but we won’t talk on the phone. We’ll pick a place.”
We never spoke of it again.
While he talked in a reflexively roundabout way I had deciphered that his patient was in her 90s, had no next of kin, and was riddled with cancer. The maximum permissible dose of morphine rendered her unconscious for brief periods, becoming ever shorter. She awoke screaming in agony. He administered an overdose.
Decades ago William F. Buckley, Jr., learned of the harrowing distress of a member of his household staff. Her sister, trapped in Cuba, was dying of cancer. Painkillers were almost impossible to obtain. He wrote that he forged a script for morphine using schoolboy Latin, although he never publicly revealed how he got the prescription pad or transmitted the medication to Castro’s destitute fiefdom, thus hastening a peaceful death.
If you can confidently condemn Kent and Bill, perhaps you occupy a higher moral ground than I do. Kent committed murder. Bill did something much less grave, although he broke the law in several different ways. I am cognizant of all the arguments: moral, philosophical, religious, legal. The nattering and harrumphing about slippery slopes — “Next stop, Auschwitz!” — be damned. I honor them for their courage, and their compassion.
The moral issues abundant in these situations are stark. Less so are those exposed by the treatment of Hazel Fenton at the hands of her tireless healers in Great Britain’s National Health Service. Mrs. Fenton, a resident of East Sussex, is an 80-year-old retired private school housemother who was admitted to Conquest Hospital earlier this year suffering from pneumonia. As far as I can determine, she had no more serious underlying condition. Her medical staff quickly decided that she was terminal, and withdrew antibiotics, nutrition, and hydration, a process that has been known to mask signs of improvement. A nurse asked her daughter what she planned to do with the body.
These actions were taken under the auspices of the widely-used Liverpool Care Pathway (LCP) program, which boldly proclaims itself England’s “National End of Life Care Programme” on its web site. Its stated purpose is simply to improve care for the dying, but apparently it does not have a mandate to expedite the process, although medical practitioners can decide whether actual treatment of the patient is beneficial. Initially intended for terminal cancer patients, it has been such a jolly good success that it is now extended to inconvenient patients with other conditions, such as Mrs. Fenton.
Her daughter, Christine Ball, is a caregiver herself. She acknowledged the seriousness of her mother’s illness but insisted that she was not necessarily terminal and that she be treated, to no avail. The obdurate Mrs. Fenton, never having been made aware of the fact that she was dying, actually started to improve while being slowly euthanized, and told her daughter that she was “feeling better.” After four more days of battling with hospital bureaucrats, Mrs. Ball finally persuaded them to take her mother off the “programme” and begin treating and nourishing her; this despite the fact that the LCP’s guidelines provide for “daily reviews” of the patient’s condition “whenever possible.” A “review” of Mrs. Fenton’s status apparently would not have been “possible” but for the presence of her meddlesome daughter. She must have been, as they say on that side of The Pond, “a real bother.”
The latest is that Mrs. Fenton is recovering and being cared for at a nursing home near her daughter’s residence, and does not want to die, although I find no indication that she has ever been encouraged to express an opinion in the matter.
The middle ground can be elusive. The moral case against what Kent and Bill did is easily made. There is simply no argument available justifying what was done to Mrs. Fenton.
Or is there? We are living longer. The exponential increase in medical and other technology beggars belief. Is it all boiling down to economics, supply and demand, cost-benefit analysis and, eventually, rationing? Is there a moral imperative to provide everyone with the best of everything?
An old friend, a rabbi, recently spoke to his congregation in favor of health care reform. He believes that the constellation of things to which we are all entitled includes the highest quality diagnostic care. A recent episode of "House" came to mind. Dr. House quickly rattled off a series of tests he wanted performed on his patient. A real physician who practices in the area of New Jersey where the show is set observed that House had just spent $93,000.00 in eight seconds.
We all want the best for ourselves, our loved ones, perhaps even our friends. If you’re a real humanitarian, you want the best for everyone, right? But it’s not there. How can anyone seriously think that it ever will be under any circumstances? Obamacare will not make it so. It will not solve the moral quandary of health care rationing or how best to treat the dying, especially those in agony. It will not allocate our limited resources more efficiently and humanely than any other socialist plan. It will not cause the scales to fall from the eyes of the cohort of physicians now contemplating early retirement. It will not build the machines that enable our system to function.
The version of health care reform now before the Senate is a grotesque pastiche cynically cobbled together to get votes. It will not treat our Mrs. Fentons as human beings.
Stay tuned. There may be an ice floe in your future.