Thursday, June 9, 2005

The Oncologist: Fear of Death; NEJM on the law, Schiavo, and PVS

The current issue of the Oncologist has a pretty interesting article from Mass Gen about the fear of death & facing, as providers, our patients' existential suffering.

This week's NEJM has 2 articles about EOL ethics and conflicts, both clearly in response to the Terri Schiavo tragedy/debacle. The first is a brief piece about the role of the legal system in EOL decision making (the author's opinion that the law should have as minor a role as possible).

A quote: Resort to the courts by warring family members to try to narrow the acceptable range of end-of-life choices on religious grounds is more worrisome. The clinical options at issue in the Schiavo litigation — removing the feeding tube and allowing a patient with a devastating brain injury to die or continuing tube feedings and embarking on an almost certainly futile therapeutic course — were both within the range allowed by ethics and law. To their credit, the judges who heard the case declined to narrow this range. The escalation of a family dispute through fiery religious references represented an attempt to reduce the latitude allowed by law. A Florida bishop's op-ed piece invoked "the passion of Terry Schiavo," and some insisted that, to God, stopping tube feedings is murder. The attempt failed, but the incendiary language set a new standard for family divisiveness at the end of life.

The other piece is a Dutch perspective on persistent vegetative states.

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