Pissydoc Says…

End of Life Care

Nearly a year ago financial troubles in this country were hyped to the extent that the market crashed. Obama won his election but the nation and the world suffered because of the liberal “weaponizing” of that volatile issue. Now I fear its happening again only this time it is we, the conservatives who are embarking on a course which may ultimately harm the entire human race. Please hear me out as this is very important in regard to the ongoing debate over healthcare in this country.

My name is XXXXXXXXXXXX.  I’m an Internal Medicine physician and I’ve practiced office based, hospital based and emergency medicine for 20 years. I was very politically active in Illinois 2004-2005 when the medical malpractice crisis forced over 200 of us to move from the state. I spent days in the state capital lobbying for healthcare reform, I listened to Obama address the issue on the floor, and I sat with President Bush to discuss the issues when he visited Collinsville, IL in February of 2005. Over the last 5 years I have formed some admittedly radical ideas regarding real healthcare reform that are much different than the opinions being used to fan the flames of opposition to Obama’s plan, which I am strongly against—for other reasons. Here we go.

I do not believe the government should dictate care to anyone but I am for “ethical rationing” of healthcare and this is why.  Day in and day out I am asked to perform miracles to sustain life, usually dictated by family or the patients themselves, often knowing that nothing I do is going to help the situation. I do it anyway because, well, it’s what I do and the current atmosphere in medicine makes it difficult, if not professionally risky to say “No”.

I can’t tell you how many times I’ve seen dialysis started for patients we know are not going to be with us in 2 weeks, or cardiac bypass surgery in patients with metastatic cancer, or feeding tubes placed in chronically bedridden demented elderly nursing home patients who spend a third of the year in the hospital because of recurrent infections or inevitable bedsores. 

Just yesterday I tried, “successfully” to resuscitate a young man who was determined brain dead. I walked away, a hero in the family’s eyes knowing myself that I had done an unethical thing by stabilizing someone who might now end his days from a pneumonia or bowel obstruction after a prolonged stay in a nursing home. Luckily, he “coded” again and passed away despite our efforts.

After all of these situations I ask myself, what little girl was not able to get her chickenpox vaccine today, how many schools cut courses or activities or busing services, which family’s received their meager dinner rations at a local thrift kitchen? Do you see what I’m getting at? Now let me paint you a different, albeit extreme, picture.

Imagine a world were culturally there was no fear of death. The people accepted the natural passing of our loved ones knowing that, even though they could live to 140 years given medical advances, they shouldn’t. Instead of spending billions on cancer and cardiovascular research, those resources went to preventive medicine and to foster healthy lifestyles, providing education, solving poverty… In such a world would there be as much concern for exhausting natural resources, social injustice, fighting over land and religion… It makes you wonder.

For me, the bottom line is this: As a medical professional and father of two with family members who have died of cancer, I do not believe we need to worry about killing off our race with war or being struck down by a meteor. We physicians and the entire medical community, with our nearsighted compassion, pose a much bigger threat.

As we strive to cure all disease we create killer bacteria and exhaust resources all the while knowing we are expanding our population and specifically the portion of our population that are most resource dependent.  Just ask yourself what the world will be like when we hit an average life expectancy of 100 years. Who is going to be working? Who is going to pay taxes? What new and impressive diseases will our longevity uncover (remember prostate cancer wasn’t a big deal until our average life expectancies exceeded 70 years, because most men didn’t live long enough to get it.)

For a moment, put your emotions regarding death on the back burner and think about this. It is the well intentioned medical community, motivated by society’s fear of death that is making world finance and efforts to preserve our ecology and provide energy impossible and unsustainable. Obama is wrong to think he can dictate rationed healthcare but we physicians are wrong when we focus on treating a disease without considering the patient and society as a whole. The current conservative movement that is promoting that we should do everything for everyone regardless of age or comorbidities is especially wrong because these attitudes are contrary to the cultural change we need to instead encourage.

As much as it pains me to say, the over-the-top comments concerning hospice… by the President has shed light on an issue I believe is not only important but potentially critical for our existence in 100 years. I hope that in the future people will consider end of life decisions in a more socially responsible, less emotionally labile way. I also hope that many of my fellow physicians come to realize that just because we can do something does not always mean that we should, and that “First do no harm” applies to not only the individual but to the world as a whole. Lastly, I pray that our government leaders, political parties, and their PR services (the media) give a little more thought to the potential consequences of the positions they take on emotional issues such as end of life care.

Thank you,

XXXXXXXXXXXX, M.D.

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