Hospice and Palliative Care Medicine:
Is It Losing Its Soul?
Physicians, until more recent times, have been guided by their twofold oath to “do good” and “never to do harm” to individuals in their care. In this way, the public’s trust in doctors and the medical profession was justly earned. Life, itself, was viewed as a great good, even life plagued by difficulties. Taking a life, for any reason, was taboo. Profound respect for the sanctity of life has always been the core principle of medicine. Is Hospice and Palliative Care Medicine losing its soul?
The New Bioethics: A Seismic Shift from the Sanctity of Life Ethic
There are changes being wrought by many elite academicians, including physicians, philosophers, and lawyers, who profess that only certain lives are worth saving. What doctors once were trained to think of as an unassailable good—protection of every human life entrusted to their care—is being rejected.
In a clear rejection of the sanctity of life ethic, this new viewpoint—utilitarian bioethics—presents a quality of life approach that divides human life into two categories: “wanted” and “unwanted.” According to the new bioethics, when applied to certain people, “do no harm” implies further life is harmful and, therefore, killing them is beneficent. In hospice and palliative care settings, the administration of intentionally larger doses of analgesia, beyond what is necessary to diminish pain, is sometimes done to intentionally end patients’ lives. This is not a secret within the medical profession.
The arguments employed to justify killing patients encompass a seismic shift in medical ethics. Notice what is happening here: the medical profession (and society, too) is slowly turning away from the traditional sanctity of life ethic toward an arbitrary quality of life ethic.
Guardrails for Good Medical Care in Hospice and Palliative Care
The guardrails for good medical care begin and end with physicians’ commitment to treat individual patients according to their needs and the refusal to become agents of the government or other third parties interested in cutting costs and preserving resources. Physicians should be committed to doing the very best for each patient they encounter and directing patient care in cooperation with their patients. This traditional approach was and is based on recognizing the equal moral worth of every human life.
By Ralph A. Capone, MD, FACP. Dr. Capone is board-certified in Hospice and Palliative Care
Medicine and Internal Medicine. He also teaches Catholic Bioethics at St Vincent College in
Latrobe, PA.
Persistent Vegetative State
In the 1980s, bioethicists, courts, state legislatures, and physicians began to use the dehumanizing “persistent vegetative state” (PVS) diagnoses to justify denying food and fluids to unresponsive patients.
The Multi-Society Task Force on the medical aspects of PVS (MSTF) defines PVS as a vegetative state that lasts more than one month.1 The diagnosis of PVS is based on lack of evidence that the patient has awareness of self and environment. According to researchers Dr. Joseph Giacino and Nicholas Schiff this bleak diagnosis is often wrong. They discovered apparently “vegetative” people whose minds still imagine, recognize, and respond. The first “vegetative” patient Schiff saw was the victim of a stroke who had no sign of consciousness. Three years later, he met her again and was shocked to find her able to talk to him.2
Some patients who have a PVS diagnosis are mentally alert and able to communicate by blinking or through aids such as computers. Other patients retain some measure of awareness even though they do not exhibit evidence of it. Some who have recovered recall things that were said or done to them while no one knew they were aware.
Their inability to satisfy our longing for response does not justify abandonment or imposed death.
CASE IN POINT
A psychologist at Putney’s Royal Hospital for Neuro-disability told John Cornwell, a writer for the Times (London), this amusing story: “Young man with motorbike head injury in a coma. His mum, a keen evangelical, comes every day with friends to sing “Onward, Christian Soldiers” by his bedside. She’s hoping to stimulate his brain into action.
It works: he comes round, but he can’t speak. So, they fit him up with one of those Stephen Hawking-type laptops, and the first words he speaks are: ‘For God’s sake, Mum, shut it!’” Cornwell commented, “That’s about as funny as it gets on a brain-injury ward, but there’s a serious take-home message. Even minimally aware patients can retain emotions, personality, and a capacity to suffer—and, as the young biker showed, attitude.”3