Medical Matins

Saturday, February 4, 2012

Spiritual history

As a part of Spirituality in Medicine, I took a spiritual history from a volunteer patient. A spiritual history is added to a clinical history of a new patient. It asks:

Does the patient uses religion or spirituality to help cope with illness, or is it a stressor--and how?
Is the patient a member of a supportive spiritual community?
Does the patient have any troubling spiritual questions or concerns?
Does the patient have any spiritual beliefs that might influence medical care?

The patient I interviewed considers himself a non-denominational Christian, although he has not been to church in ten years. He told me he can't see how religion or spirituality influences bodily illness or coping with it. He can't imagine any spiritual beliefs that would influence medical care. He told me religion means spirituality with a schedule, a man-made concept and corruptible. He cast some aspersion on wealthy churches.

Titian, Christ and the Good Thief

I pressed him. I asked him to imagine he had a serious diagnosis, like terminal cancer. He speculated that he might become more active in his church. Would he be more scheduled? Yes, he guessed so. And when he thought about death, he expressed a desire for pastoral care.

A few weeks ago, a video went viral on YouTube about loving Christ without religion. My parish priest had an excellent homily that week about why this makes no sense. Religion (L. religare "to re-tie") is a human virtue born of a response to God's grace. Christ calls us to Himself; we imperfectly attempt to answer. Because we keep failing, we re-tie ourselves and regulate ourselves so that we can become perfect. Religion, briefly, is the sign of love of Christ. How can we hate it? It is our cross and discipline, so that we can "run so as to win."

Thursday, February 2, 2012

Physician-Assisted Suicide

Today I attended a Medical Bioethics Club meeting. We watched the first part of Mademoiselle and the Doctor, a documentary made about an Australian man who helps people commit suicide. He states he wants to "help to end their suffering," admitting "it's very difficult to [do this] legally...." I was internally weeping and praying through the entire twenty-minutes. It was rather horrifying, especially to see patients with no depression or terminal illness desire to end their lives. (Parenthetically: I have known women like Lisette Nigot, who do not want to age or whose bodies are deteriorating far before their minds. They are beautiful people and I want them to live!)

However, this post is not about rebutting the documentary or physician-assisted suicide (PAS). That is accomplished very elegantly elsewhere. This post is a report on the attitude of medical students toward PAS. I took notes of my peers' discussion, so everything in quotes is verbatim. I place the quotes in the form of an interview. The quotes are drawn from four second-years interested in bioethics; one is interested in OB/GYN and at least two others in internal medicine.

What is PAS?

It's "providing them assistance."

In the documentary, Ms. Nigot has no depression, terminal illness, or lack of support group in life. Nevertheless, she desires to end her life. What do you think of this?

"[I just kept thinking] 'I want to scan your brain!' "
"It's not natural." (Ironically, the student with the most liberal viewpoint said this.)

Ms. Nigot said she first thought about putting a bag over her head. What do you think of this?

It's "degrading."

Why?

She hasn't been given the options for how she could die. [?!]

Is PAS different from giving other medicine?

"[G]iving them a clot-buster for their stroke and giving them barbituates for their death...I think that's the same thing."
"[Y]ou want that [the options] to be available...it's a personal decision...it's the same with abortion...you'd want the best for them." You'd have to refer to a pro-PAS doctor.
"[D]eath is a part of life, and as physicians we want to improve their quality of life, so...." This student trailed off, assuming his point was obvious.

Some people think there are things physicians shouldn't do, regardless of people's beliefs. What do you think of this?

"I think every doctor is entitiled to their own opinion and their advice is based on their core beliefs..." but they have to be able to refer patients to someone who can do what the patient wants.
"[Y]ou can't approve or disapprove of suicide, that's an individual's choice..."
"Right."

How should we deal with patient requests for PAS?

The student who had been the most conservative and even agreed when I said "life is valuable" said that we should have "guidelines," like 'the patient have to have a terminal illness, etc.'
The liberal student: "yeah, give someone an inch, and they take a yard."

I did not speak much. I played the role of the TAC tutor, clarifying points (when I said "life is valuable" it was to make the conservative student a little more coherent) and disagreements. The discussion only lasted about forty minutes, and careened off-topic into how little information physicians have about medication toxicities (the second years take a lot more pharmacology than M1s).

But oh my goodness. Can you believe the things they said? Death by bag-over-the-head is degrading because we haven't presented the options?! Death that way is degrading because we are rational animals and it is unfitting to die in a way that dishonors a person with a social, creative, intelligent soul! Forget PAS; we say someone dies a "horrible" or "violent" or "shocking" or "tragic" death whenever this happens in all the various ways it can.

What do you make of the lack of logic on "death is a part of life"? The sameness they see between healing and PAS/abortion/contraception/etc? The remnants of sound thinking ("that's not natural" and the need for "guidelines")?

I have to go study antibiotics (we're learning all of them for an exam in two weeks, and I'm totally overwhelmed), so the post is sadly truncated. As I said: it's just a report. Discuss in the comments!

Note: here are two sources I found for the Church on PAS, but I didn't read them all the way through, so I can't recommend them. (Generally, however, the NCBC is awesome.)