Other people's lives: reflections on medicine, ethics, and euthanasia.

Author:Fenigsen, Richard

Part Two: Medicine Versus Euthanasia

Chapter XXIV. At the Bottom

The Reticent Family Physician. The story of a six year old boy, his parents, and their family physician has been published in a leading Dutch medical journal. (355) The boy had some behavioral problems, and his intelligence seemed below average. He lived with his parents and attended a school for children requiring special care. Then juvenile diabetes was discovered. Patients with this type of diabetes must receive injections of insulin, otherwise they develop severe disturbances in metabolism (ketoacidosis), fall into a coma, and die. The family physician who diagnosed the diabetes did not inform the parents that the child must be treated with insulin. Instead, he asked whether their son should be treated. The parents, aware that non-treatment was tantamount to death, chose not to treat the child. The boy was not given insulin, and died.

The Trickster. (356) Dr. E, family physician at a town near Den Bosch, within a fortnight sent to our hospital two female patients, both acutely ill with pulmonary edema (an accumulation of fluid in the lungs due to heart failure, a condition which is directly life-threatening but most often responds to treatment), and both times phoned the cardiologist on duty asking her to not treat these ladies who, in his opinion, were "too old" (one was 76 and the other 72). In one of these cases he even suggested refusal of admission to the hospital. This patient overheard fragments of this conversation on the ambulance's radio, and arrived to the hospital not only suffocating from pulmonary edema, but also mortally frightened that she would be denied help.

Dr. E pretended to do everything he could to help: he called the ambulances and referred the patients to the hospital, didn't he? At the same time, behind the patients' backs, he conspired to deny them assistance and let them die.

The Healer of Mankind's Afflictions. (357) In 1973, while making his rounds at a hospital in Rotterdam, Dr. W, an internist, noticed that one of the patients was in a dimmed mental state. He then asked the nurse if the patient was suitable for euthanasia which after some hesitation, she confirmed. Dr. W then ordered that the patient's life be terminated with an appropriate intravenous injection. However, one of the doctors present protested, and euthanasia was not carried out. This woman doctor then asked what actually was wrong with the patient. Dr. W did not know the diagnosis. It turned out that there was no diagnosis: the patient had been admitted because of low-back pain, but the reason for the complaint had not yet been determined The findings so far did not indicate any grave illness. The doctor who had protested against euthanasia checked the temperature chart for medications that could caused that patient's semi-conscious state. Indeed, it proved that he had been given rather large doses of valium (diazepam). Dr. W had forgotten that he himself (unnecessarily, for that matter) had prescribed the drug. It did not occur to him that this might have been the cause of the patient's stupefaction. The valium was stopped and the next day the patient, who had come a hair's breadth from death, could again speak and stroll the corridor.

The incident was then discussed at a staff meeting attended by the director of the hospital, Dr. S. Dr. W expressed surprise that one of the doctors considered all euthanasia inadmissible, and not for religious reasons, which Dr. W automatically accepted, but for some other reasons which he could not understand. As for the way he acted on his round, Dr. W had nothing for which to reproach himself. Admittedly, he had not known the diagnosis when he decided on euthanasia, but, after all, you can't know every patient in detail. Indeed, he had overlooked that valium was the cause of the patient's stupefaction, but to err is human and we all make mistakes. True, the patient perhaps wasn't suffering from any serious illness, but that is no obstacle to euthanasia. Minor errors, lack of diagnosis, or the fact that there's nothing seriously wrong with the patient should not deter a doctor from doing his duty which is to help his fellow men die an easy death. It does not matter that a person could live another twenty or thirty years. Who knows what grave illnesses, how much distress and sorrow that individual would have to endure were he alive! A doctor is a person in particularly privileged position because he has the opportunity and the means to free his fellow human beings from future suffering.

The Impatient Chest Physician. Can a doctor kill a sick person out of impatience, in a fit of anger? It seems improbable; and yet it has happened. The chest physician told the interviewer: "At the hospital where I previously worked, I had a patient, a very young man, who clung to life. He did not even want to talk about his bad situation.... This patient had a kind of lung cancer that carries a very bad prognosis. No surgery is being done in these cases because when the cancer is diagnosed it had already spread. The treatment is chemotherapy and radiation, and can be quite successful; and this patient did reasonably well. And then," the chest physician continued, "I suddenly said to myself: 'now it becomes too crazy, I cannot go on with that, now [I must do] active euthanasia!' I gave him an I.V. drip with such drugs that he died." (358)

Euthanasia at a Nursing Home. Dancing with Mister D., (359) the book written by Dr. Bert Kiezer, physician at a nursing home in Amsterdam, had become a bestseller in Holland and was most enthusiastically greeted by reviewers when published in Great Britain and the U.S.: "Moving and profound"; "the most remarkable feature of this book is the moral integrity of the writer"; "A delicate, moving and strangely enjoyable book."

A number of the nursing home's residents asked Dr. Keizer to put an end to their lives, and he obliged. He administered lethal drinks to Mr. B, an AIDs patient; (360) to Mrs. P who had lung cancer, but still was in rather good shape; (361) and to Miss Van D who had multiple sclerosis. (362) He administered lethal injections to Mr. B whose lung cancer was suspected from the X-rays, but not quite confirmed; (363) to Mr. van den B who was moderately disabled due to Parkinson disease; (364) and to Mr. U, a stroke patient who did not actually ask for death but had once, when he still was healthy, signed a euthanasia declaration. (365) Also, when Mrs. M almost choked on her own vomit, Dr. Keizer did not try to free her airways but finished her with an injection of morphine. (366)

There also was Mrs. M with a brain tumor. She never asked for euthanasia and did not know what was being done to her. She received from Dr. Keizer a lethal injection because her husband insisted on it. (367) The names in the book were changed, but I am sure the facts have been truthfully rendered.

Dr. Keizer is not quite your typical physician. He hated studying medicine (368) and now hates his work: "lately ... I start my days with more revulsion than usual," he writes. (369) It is the patients, their sores, their looks, their utterances, and most of all, their physiological functions that cause his deep disgust. (370) Unlike genuine physicians who don't notice the unappetizing side of their work and focus on quite different aspects of the matter, Dr. Keizer remains fixed on the offensive sights, sounds, and smells.

He is also totally devoid of manual dexterity which is the distinguishing feature of a physician. His hands are "riddled with cuts and wounds" which expose him to terrible infections. (371) Every medical procedure he performs goes wrong, with most unpleasant effects for himself. (372) He doubts whether he is a doctor at all. (373) Quite obviously, Dr. Keizer is one of these sad cases, an individual who practices medicine, but should never have entered the profession.

Not that it matters: for this doctor rejects medicine. He unreservedly accepts all devastating accusations with which the Dutch media have showered medicine in the last thirty years, and adds some of his own. Medicine is a nonsensical and cruel hoax. (374) It cannot do anything for people, least of all save anybody's life. (375) Diagnosing diseases is useless: "as if it matters whether your strangler is called Joe or Alexander." (376) Medical interventions are scientifically groundless. (377) "The medical repertoire is ... full of crap." (378) Medical treatment is humbug. (379) All medicines are "useless shit." (380) Three surgical operations are mentioned in the book: one did not remove the tumor and left the patient to slowly die, (381) the other blinded the patient, (382)while in the third, the surgeon "finished the patient off in twenty minutes"; (383) the latter outcome provoked Dr. Keizer's hearty laugh. All attempts to treat a sick person are transgressions of patient's privacy, bouts of medical violence, (384) or idiotic farces. (385)

We begin to understand now why Dr. Keizer performed euthanasia on Mr. B, even though the diagnosis of lung cancer was still in doubt. (386) What did it matter? Diagnosing diseases makes no sense anyway. (387)

But Dr. Keizer disavows greater things than medicine. He disavows Life. Life is not worth the trouble. (388) Worse still, it is a situation in which we are trapped, a train on which we keep riding only because we are too cowardly to jump off. (389) What a relief to hear that you've got a deadly disease! (390)

If Life itself is rejected, what are Dr. Keizer's values? Telling the Truth. More precisely, the doctor's duty (and privilege) to tell his patients that they are going to die. (391) And Dr. Kiezer is convinced that patients, whether they want it or not, have a duty to receive this information.

He also likes to tell his patients little jokes on the subject of their deaths, (392) or to express mock concern: "In a month or so, we'll be stuck here with a hundred thirty...

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