Winslade_When the Patient Decides to Die

Winslade_When the Patient Decides to Die - WHEN THE PATIENT...

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Unformatted text preview: WHEN THE PATIENT DECIDES TO DIE By William J. Winslade, Phil, all}. Readers are invited to submit their re- sponses to the ethical questions posed in this column, excerpts of which will be published in the next issue of Biomedical inquiry. What follows is a summary of an actual case. it did not occur in Texas. 79~yearnold woman with Parkinson’s disease became psychotic after being treated with . excessive amounts of 1; Dope, an antiparkinsonian drug. Her family brought in a new physician, a specialist in geriatrics, who discovered the pro— per dosage level; the patient regained her intellectual capacity (with minimal cognitive and memory problems) but remained severely disabled by “fro zen” limbs and inability to control her bowels and bladder. The patient was a proud, tenacious, and dignified matriarch whose 81-year«old husband andqchildren deferred to her. She had spent more than two years in a nursing home. After she recovered from the drugninduced psychosis, she became increasingly unwilling to remain in the nursing home. But she did not desire to return to her horse or the homes of her children. For her, the burdens of living were too great, and the quality of her life was too low. She wanted to die. She was not suffering from a ter— minal illness. Nor was she physically able to obtain any means to take her own life. Her sister, who had recently died of cancer, had been able to hasten death with a large dosage of barbitu- ates. This patient wanted similar assis- tance. However, she sensed that her geriatrician would neither assist her in committing suicide nor perform euthanasia. She liked and respected her - physician and did not want to rupture her relationship with him. She sought the assistance of a psychiatrist whom she thought would provide the drugs. The psychiatrist, however, diagnosed her as depressed and prescribed antidepressants. The patient refused the psychiatrist’s recommended treatment. The geriatri- cian later agreed with his-fpatient that she was not clinically depressed and that antidepressant drugs were not indi cated. Her depression was understand- able and rational in her circumstances. Her geriatrician learned of his patient’s desire to die and talked with ' her about it. She correctly sensed that he was unwilling to condone or faciliu tats her desire to die. But he did not condemn or abandon his patient. in— stead he tried to understand her feel— ings, to appreciate her plight, and to offer to help within the limits of his own uuncnnv professional integrity. To help assess the situation, he asked me to ioin him as a consultant. I talked at length with the physician, the patient, and her family both individ- ually and as a group. It became clear that the patient was rational, reflective, responsive, and inuactably firm about her desire to die. She examined her life and decided that it was no longer worth living. Her husband and children reluctantly and sadly accepted her decision. 1 explained to them the legal implications and ethical aspects of assisted suicide. Her physician stated that he woaid not facilitate her suicide but that he felt strong loyalty to his patient and respect for her autonomy. He did not intend to abandon her or transfer her to someone else. She Checked out of the nursing home and died, presumably with the assistance of her family, three days later . Her physician was asked lay the family to sign her death certificate. If he testified that she died of natural causes, no autopsy would he performed and no inquest would be held. if he indicated a suspicion that her death was caused, say, by a drug overdose, then an autopsy and inquest would follow. Yet the physician realized that his medical license could be clouded, if notieopardized, by a fraudulently prepared death certificate. if you were her physician, what would you have done at various stages of her care? Would you have signed the death certificate, and if so, how? What values are most compelling for you as a physician in this situation? Have you been confronted with similar choices? How have you dealt with them? We welcome your responses. William Wins/ado is professor of medical jurisprudence and psychiatry a! the Institute for the Medical Humanities. Send your response in Biomedical inquiry, Office of Public Affairs, The University of Texas Medical Branch at Galveston. ...
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