Monday, January 8, 2007
Updates on Past Posts: NOLA MD, Teen with Hodgkins, Italian Right to Die
Dateline: New Orleans, LA
Old Pallimed Post #1 Post #2 post #3
The Times-Picayune reports that Dr. Anna Pou, and nurses Cheri Landry and Lori Budo have still not been formally charged with a crime. The story revolves around Hurricane Katrina and the actions at Memorial Hospital in NOLA. The three (sometimes referred to as the Memorial Three) were arrested by the Attorney General because of suspicion of committing euthanasia on 4 patients under their care during the few days after Katrina. CNN was denied access to some of the court documents in another event. Not much is actually happening in this case, and some are trying to get the case to move along so the nurses and doctors can have their day in court to clear their name or be prosecuted. But some newspaper editorials in NOLA have insinuated the AG is dragging his feet. Nothing much new since mid December.
Dateline: Chincoteague, VA
Old Pallimed Post
Abraham Cherrix is back in the news, and sadly his health and family are not doing as well as they had expected. He was given court approval to seek alternative treatments, including the Hoxsey method in Tijuana, Mexico. He is followed by a Mississippi physician who is a specialist in alternative medicine (particularly immunotherapy although the ACS states this is now the 4th modality of cancer treatment so I am not sure how alternative this is...) and radiation medicine. He has swollen lymph nodes in his axilla and is likely going to receive more radiation. And also very sadly the parents have split, which news outlets attribute to the stress of Abraham's illness. This is a grim reality of how much illness, goals of care, hopes, fears, emotions, etc. can infect family dynamics. And then you throw on top of that the magnifying glass of the media and the courts. That is incredible pressure. There is also a bill being introduced called "Abraham's Law," which basically states a terminally ill mature child (under 18) can make a joint decision with the parents to pursue non-standard treatments and not be accused of medical neglect. Some are protesting saying that this will weaken child protection laws and clog the courts with cases trying to define 'terminally-ill' or 'life-threatening' (Ask any palliative medicine consult team if they have ever had a controversy with other medical staff/patients/family in defining someone as terminally ill..it is very common!)
One nice silver lining for a often-maligned discipline, social workers. The same social services that first reported the case for suspicion of neglect (a good thing to at least look into) were also the same social services that came to the mother's aid when she was separated and was having difficulty with her bills and emotional support. Social workers are really great people. They are not baby stealers. (A social worker once told me that and it has stuck with me.)
Dateline: Rome, Italy
Old Pallimed Post
Piergiorgio Welby died on December 20th after a doctor removed him from his ventilator. The The physician, Dr. Mario Riccio, had a long conversation with the patient, during which time he found him to be competent and able to make this decision. Dr. Riccio also rightly clarified:
"This must not be mistaken for euthanasia. It is a suspension of therapies;But despite his clarification, the Associated Press still managed to muddy the issue, by contrasting his statements with how long you could be prosecuted for assisted suicide and about how law makers felt about euthanasia. Again, three different issues with very important differences that are often confused for one another.
refusing treatment is a right. Quite frankly, in Italian hospitals
therapies are suspended all the time, and this does not lead to any intervention
from magistrates or to problems of conscience."
When the people took his coffin through the streets, apparently the Roman Catholic Church kept the doors closed denying him a religious ceremony, because he 'sought to end his own life.' there is some explanation of possible investigation and prosecution of the physician involved. Apparently most of the Italian public supported the patients right to withdraw his ventilator.


4 Responses to “Updates on Past Posts: NOLA MD, Teen with Hodgkins, Italian Right to Die”
January 08, 2007
Thanks for the follow-ups. Do you have a sense of how well a 'mature minor' is defined?
I'll also add that the confusion between assisted suicide, euthanasia, and withdrawal of life-prolonging treatments is not just promulgated by the ignorant. Proponents of assisted death frequently conflate the practices and argue that they are morally and practically identical (this is the exact same argument that opponents of all three practices make as well).
While we're updating, Art Buchwald is alive and kicking--he was on NPR a few weeks ago if I remember correctly. I think his book about his non-stop hospice party is coming out soon.
Drew
January 09, 2007
I'll second that about even the professionals getting it wrong. I'm pretty familiar with the "Death with Dignity (aka Physician Assisted Suicide or PAS) law here in Oregon (done some research in the area, manuscript not yet ready for publication alas), and it is NOT the same as euthanasia -- for one thing, in PAS the provider prescribes the medications but does not administer. The person has to self administer the drugs (which is why it is in pill form). And, unlike withdrawal of life-prolonging treatment, there is an active aspect to it--some people would say that withdrawal of treatment is "letting nature take it's course" while PAS is actively speeding up the process.
Nonetheless, I've been to more than one conference presentation where the two terms were used interchangeably (and I've sat and gnashed my teeth). There have been efforts to change the name of the law here, but so far no good.
If you want to know more about the Oregon Law, check here: http://www.oregon.gov/DHS/ph/pas/faqs.shtml#whatis
Off topic, if the link works correctly, yes, I now have a blog and no, there aren't any posts in it yet. Grant writing, data analysis and coursework are all taking precedent I'm afraid.
January 09, 2007
Thanks for the comments Marachne. We look forward to seeing your blog once it is up and running. You will soon find that blogging is a nice escape that sort of keeps you on target given your topic of choice.
I am glad that someone else out there gets the distinction. You need to have your definitions in order to have a rational discussion about these complex issues. It is point #1.
January 10, 2007
Marachne thanks for the comments. I agree that withdrawal of life prolonging treatment is essentially 'letting nature take its course' and frequently an appropriate, moral thing to do (sometimes it is, even, the best medical care for a daying patient). There are some very earnest, thoughtful people who disagree, which is fine, and it's a worthwhile topic of debate to be sure (altho in the U.S. from a medicolegal sense the debate is essentially over). However to conflate withdrawal with giving someone an apnea-inducing dose of pentobarbitol is down-right dishonest and gets me all fired up too. Looking forward to your blog.
--Drew
Post a Comment