Do No Harm? Should Patients Still Trust Their Doctors?

h/t Zenit

Medical Journals Show Increasing Support for Euthanasia

By Denise J. Hunnell, MD
WASHINGTON, D.C., AUG. 22, 2012 (Zenit.org).- Primum non nocere. First do no harm. This edict has been part of medical ethics since the time of the ancient Greek physician, Hippocrates, in the fifth century B.C.  It is found in the Hippocratic Corpus, a collection of medical writing attributed to Hippocrates. The original Hippocratic oath includes:
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
For millennia the physician has been charged with being an advocate for the patient. Part of the impetus for the original Hippocratic oath was to ensure that doctors would not be paid by an enemy to give poison instead of medicine. Patients should be able to come to their doctor when they are sick and weakened, and have no fear that their vulnerability will be exploited.
Unfortunately, the sacred trust of the doctor-patient relationship is being strained by a new ethical model. Physicians are being urged to place the "greater good" above the needs of their individual patients. A disregard for the sanctity of human life as well as a utilitarian philosophy that judges the value of a patient to society is becoming more mainstream in the medical profession. This is evidenced by the increasing number of articles in respected medical journals that call for approval of assisted suicide and euthanasia, euphemistically called "assisted dying."
The British Medical Journal (BMJ), a publication distributed to the members of the British Medical Association, devoted much of its June 14, 2012, issue to endorsing voluntary euthanasia and physician assisted suicide. Raymond Tallis, emeritus professor of geriatric medicine at the University of Manchester, argues in this issue that respect for patient desires and autonomy renders irrelevant any opinion on the matter by the Royal College of Physicians or the British Medical Association. Therefore, all opposition to euthanasia is merely inappropriate paternalism and should be dropped.
In this same issue, Tess McPherson relates the difficult last days of her mother, Ann McPherson, and uses this painful experience as a call for legalized physician assisted suicide and euthanasia. Rather than seeking better pain control, she argues that death is the best option for those suffering at the end of their lives.
Finally, Fiona Goodlee, editor in chief of the BMJ, rounds out the arguments by declaring that legalization of assisted dying is not a medical decision, but rather a societal question. She argues that the role of the physician is compatible with providing euthanasia or assisted suicide and if society wants it, they should get it.
Amid these scholarly endorsements of euthanasia come the claims of British physician Patrick Pullicino that the National Health Service (NHS) is effectively killing 130,000 patients every year when doctors place these patients on the Liverpool Care Protocol (LCP) and deny them nutrition and hydration. According to the Daily Mail:
Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an 'assisted death pathway rather than a care pathway'.
He cited 'pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients' as factors.
Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated.
The medical literature from the United States also shows an increasing acceptance of physician assisted suicide and euthanasia. The July 12, 2012, issue of the New England Journal of Medicine (NEJM) included an article by Dr. Lisa Soleymani Lehmann and Julian Prokopetz that suggested physician opposition to assisted dying was an unreasonable barrier to patients seeking lethal medications. They recommended that all patients who met the legal criteria for assisted suicide as outlined in the state laws of Oregon, Washington, and Montana should be able to obtain the drugs necessary for suicide without a physician's prescription or approval.
Perhaps the most chilling example is the enthusiastic endorsement in the Journal of the American Medical Association (JAMA) for the book Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, by Drs. Franklin Miller and Robert Truog. This book seeks to do away with two core principles of medical care. The first is that a physician cannot intentionally cause the death of his patient. The second is that donors of vital organs for transplantation must be dead before the organs are harvested.
Catholic health care ethics, in accordance with natural law, holds that when the burden of life-sustaining extraordinary care such as a ventilator is greater than the benefit it provides, such care can be withdrawn. This is not seen as causing the death of the patient, but rather allowing the patient to die from his underlying illness. Miller and Truog disagree and assert that such an act directly causes the death of the patient. They then begin their descent down the slippery slope by claiming that if causing death by withdrawing life-sustaining care is acceptable, then active voluntary euthanasia by lethal injection should also be acceptable. Further, if voluntary euthanasia by injection is acceptable, then voluntary euthanasia by removal of vital organs to be used for transplantation should be equally acceptable. This radical argument could be disregarded as fringe thinking had it not been so prominently and positively recommended in JAMA.
It is reasonable to say that the notion that physicians should not kill their patients is still widespread among medical professionals. Indeed, several of the aforementioned authors take their colleagues to task for opposing euthanasia and physician assisted suicide. The growing numbers of prestigious medical journals that are routinely publishing support for all forms of "assisted dying" are, however, a clear indication that this approach to end of life "care" is making significant inroads in mainstream medical ethics. The foundational principles of health care that date back to Hippocrates are in jeopardy.
This has serious implications for patients. No longer can a patient assume that his physician has his best medical interests at heart. Now physicians are being urged to consider the cost to society of a patient's care and judge whether a patient is worthy of such expense. Instead of seeking to provide comfort and authentic compassion at the end of life, there is increased support for hastening death as an expedient solution to suffering.
It is now incumbent upon every patient to explore the ethical principles of his doctor. Does he uphold the sanctity of life from conception to natural death? Does he understand that treatments can be deemed burdensome, but human life is never burdensome? Does he view nutrition and hydration as ordinary care as long as a patient can derive a benefit from it? Does he reject all justifications for intentionally causing the death of his patients?
If your physician does not answer unequivocally "yes" to each of these questions, can you really trust him with your life?
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Denise Hunnell, MD, is a Fellow of HLI America, an educational initiative of Human Life International. She writes for HLI America’s Truth and Charity Forum.

A Soldier's View of Torture, Just War Principles

H/T to Zenit

Britain's Most Senior Ranking General Considers the Evils of War

By Edward Pentin

ROME, AUG. 2, 2012 (Zenit.org).- "My view is absolutely clear: torture is wrong and shouldn't be allowed, and people who torture should be apprehended, with the full force of law applied."

Speaking from his residence in London on July 20, Britain's most senior ranking general, Field Marshal the Lord Guthrie of Craigiebank, believes any use of torture is "very damaging" and does "more harm than good."

He also believes people "tend to tell you what you want to hear when being tortured" and it can seriously damage the reputation of countries such as the United States who pride themselves on upholding human rights.

The subject of torture was just one of several topics addressed by the 73-year-old veteran soldier who is a convert to Catholicism and a member of the Knights of Malta.

Before retiring in 2001, Lord Guthrie had served as a soldier in places such as Malaysia, Borneo, Yemen, Oman, Kenya and Northern Ireland. He was head of the British army during the Balkans War and then made head of Britain's armed forces between 1997 until 2001. He also served as a troop commander in Britain's special forces, the SAS, and headed the elite regiment from 2000 to 2009, before being raised to the rank of Field Marshal by Queen Elizabeth II in June of this year.

But throughout his distinguished military career, faith was always important and "hugely helpful" to him. "It gave you a spiritual, moral, and ethical background, and maybe a confidence which you may not have had otherwise," he explains. "But being in the military is not easy because you do have to make some terrible decisions sometimes."

Raised an Anglican, he married a Catholic but he wasn't received into the Church until he was in his 40s, relatively late because he wanted to be "absolutely sure" he was doing it for the right reasons.

"My father had become a Catholic when he was 68, and we were always that way inclined," he tells me. "We went to Church and all that, and it seemed to me that I would probably end up there." He was also influenced by friends who were priests and army chaplains, as well as a monk from the English Benedictine Abbey at Ampleforth.

Justice

Turning to just war tradition, a subject on which he wrote a book ("Just War - The Just War Tradition: Ethics in Modern Warfare by Charles Guthrie and Michael Quinlan" – published by Bloomsbury 2007), Lord Guthrie says Christians came "slightly late" to it, because, he suspects, most were probably pacifists, and outside the structures of the Roman Empire until Emperor Constantine became a Christian. From then on, they were forced to take responsibilities. "Suddenly we found we had to make decisions, and that wasn't easy, " he says, "but the philosophers and thinkers of the day had to wrestle with these problems."

But he is grateful for the Christian just war tradition as he is a firm believer in the need for principles in war. "People do behave very badly in armed conflict sometimes, but it does seem to me to be absolutely right that you have a moral compass which sets standards," he says. "There are certain parts of the tradition you really do have to think very, very carefully about before you move away from them."

He is particularly keen that military commanders have very good reasons to go to war, and that they be fully prepared for the consequences. "It's not good enough just because you want to punish somebody or revenge," he says. "You've got to actually think: what are the consequences going to be? Are you going to make things better?"

"Of course, war is evil," he continues. "War is a horrible thing, a disastrous thing, but sometimes there are things which are even worse, like genocide, the completely uncontrolled killing of innocent women and children." Moreover, he dismisses talk of martyrdom as a credible form of defense and resistance.

"I think it's crazy," he says. "If you had Attila the Hun coming and you had a country of 100,000 people, do you think it's a good idea to stand by and watch 100,000 people killed? That doesn't make any sense at all in the real world. I'm very suspicious of that, it just doesn't work, never has worked and I don't see why it should. But you don't want to go to war; you want to think very, very carefully about what it actually means."

Some military theorists, most notably the 19th century Prussian tactician Carl von Clausewitz, have argued that to win a war, maximum force, or "absolute war," must be used. That being the case, can a war ever be just if such a tactic is used? "You want to get the war over as quickly as possible," Lord Guthrie answers. "You don't want to kill any more people than you have to, and you want to protect people who are not actively engaged in the war, like women and children and non-combatants. But what is a non-combatant? Is, for instance, somebody working in a munitions factory? … You get into very difficult areas; these things aren't black and white at all."

Asked if the allied bombing of Dresden in the Second World War, in which thousands of civilians were killed, was just, he answers: "Dresden will always be very controversial. I think nowadays more and more of us think it wasn't right because we were winning the war anyhow. But if you had been involved, you might take a rather different view and I think it would be very wrong of us to condemn everybody who was involved." He also points out that London was indiscriminately bombed as well, resulting in the loss of over 40,000 lives.

Questions today

Turning to topical issues, the Field Marshal believes a pre-emptive strike on Iran to prevent them from acquiring nuclear weapons "would be completely wrong" at the moment because it would make the situation worse. Similarly, he is firmly opposed to military intervention in Syria at the current time, believing it would further destabilise a country in a "very dangerous region."

Regarding the war in Afghanistan, the veteran soldier says he has "a problem" with the military operation as "people didn't really think of the consequences." But he believes the initial reasons for the intervention – to allow UK and US special forces to destroy the Al Qaeda camps -- were "perfectly lawful" and "morally right."

"I think that was achieved brilliantly," he said. "I would then question – and we come to unforeseen consequences again – should we not have just come home then?"

He frequently mentions the problem of unpredictability in war, and especially the difficulty of preparing for the aftermath of a conflict. "You've got to think: what are the consequences of what I'm going to do, and have a plan," he says. "It is difficult because soldiers are quite good at winning battles, but who is actually going to pick up the pieces? Soldiers aren't ideally trained to be policemen, civil lawyers, prison officers. Why should they be able to do it, really? And yet they're the only people around."

He says this was particularly true of the 1991 Iraq War when many argued the coalition forces should have marched onto Baghdad and ousted Saddam Hussein's regime. "It would have caused logistic problems … which I dare say could have been got round. But I think there were people in the United States who really didn't want to go on, and I can see why," he says.

"But of course by not going on, the second Iraq War became more likely."

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Edward Pentin is a freelance journalist and can be reached at pentinzenit@gmail.com