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A matter of trust

If we are seriously debating euthanasia, is it any wonder that so many patients are suspicious of hospital doctors?
Martin Cullen | 15 November 2012
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I am an intensive care doctor in a Sydney hospital. I spend my days and nights amid flickering lights and beeping monitors in a small ward with desperately ill patients. Some of them have just been operated on. Some have just had a stroke or a heart attack. Some have just arrived after car accidents.

Patient’s lives are entrusted to me and my team on the assumption that we will do everything possible to keep them from dying. Behind the scenes, medical and nursing staff work very hard, often without sufficient resources, to ensure that they stay alive and well.  

What I find discouraging is that we are increasingly rewarded with hostility. I never cease to marvel how deeply some families of my patients distrust the medical profession. Between me and them is a wall of suspicion. I know how used car salesmen must feel.

Why? Why is the confidence of the public melting away?

One reason is doctors who disgrace the profession with intolerable behaviour, both on and off the field. They are a very small percentage of my colleagues, but they do exist.

Another reason is “medical mishaps”. The media exaggerates these constantly, making hospitals appear to be impersonal bureaucracies which make people sick instead of nursing them to health. Unfortunately, under-resourced and overworked staff sometimes mistreat patients or give faulty diagnoses. It’s a fact.

Then there are the long waits in emergency departments and poor communication between doctors and patients. Being a member of the public and facing the public hospital system can seem overwhelming and discouraging.

But another factor is at work, one which strikes at the heart of the medical profession: the possibility of euthanasia. Doctors exist to keep people alive, not to kill them.

I first noticed this shadow over my relationships with patients and their families in the late 1990s. For a few months voluntary euthanasia was legal in the Northern Territory. During that time four people were killed by Australia’s best-known euthanasia activist, Dr Philip Nitschke.

Thereafter, I began to hear anecdotes of elderly folk who were sick but refused to enter a hospital because they feared being euthanased. It was a perfectly predictable response to ongoing stories about legalised euthanasia in places like the Netherlands and Belgium and surreptitious euthanasia in Australia. Other doctors are killing their patients – can I really trust you?  

Maybe it carries on from the argument at the other end of life, in the womb. If an obstetrician does abortions, how can he be trusted with delivering a baby?

No longer do families assume that their loved one will be cared for. Families feel they need to be advocates for their sick relative. They aggressively question all of my suggestions for care. I really can’t blame them. In the Netherlands, where euthanasia has been legalised, non-voluntary euthanasia, aka murder, is no longer unknown.

Unfortunately, I have witnessed the pro-euthanasia attitude of some doctors. They believe strongly that the lives of some patients are not worth living. This is an arrogant disrespect for human dignity.

I recall a young man admitted to our intensive care unit with pneumonia. This is usually a readily reversible disease process with the right interventions. But our patient had terrible cerebral palsy and couldn’t communicate. All he could do was roll around on the floor. Some staff told me that they were trying to get the family to consider not intubating him as it was “futile.”

But when I spoke with his elderly parents, I formed a completely different impression. They described a son who was loved, who was normally quite happy and cheerful, but who depended on them for activities of daily living. So I intubated him and put him on life support. He went home two weeks later.

How could I not give him the treatment that I would give anyone else of his age? Why should he be treated differently just because he had cerebral palsy? Why were some staff quick to believe that his life was worthless, even though he was precious to his family?

Thankfully though, medical and nursing staff can be patient advocates. I remember vividly another incident. A young man with a terrible brain injury came in from his group home with life-threatening pneumonia. He was clearly well-loved by the staff at the group home and normally he was not a problem. Unfortunately his own parents, who visited him only several times a year, wanted him to die. The doctors and nurses were shocked and pushed them to reconsider. After many discussions the family members gradually changed their minds. It was comforting to know that some staff really value life and its sacredness.

But nowadays when I bring bad news to families and tell them that death is imminent and that we can do no more, I expect resistance and hostility. Just a few weeks ago I was treating an elderly woman who was very sick. Her family told me that they believed that their father had been euthanased years before.  They weren’t going to let us doctors take their mother, too. They looked at me as if I were a murderer. It was very unsettling for me.

Consequently I have great distaste for Philip Nitschke and his ghouls who chatter about freedom and autonomy, about good deaths and easy get-aways. They have appropriated the word “compassion” to allow them to kill without compunction. But com-passion means “to suffer with”. A compassionate doctors walks with a patient. What a miserable message to give dying patients: let us give you a needle. I am suffering and all you can do is kill me, they think. Where’s the mercy in that?

When the pro-euthanasia lobby irresponsibly bleat about killing as the answer to suffering, we doctors in the hospital system suffer the consequences.

Several weeks ago I accompanied an elderly patient. We spoke about the fact that he would soon be with his beloved wife who had died years before. I assured him that we would walk up to the gates with him -- and after that, he was in God’s hands. His final days with his son were full of trust and fruitful.

I can’t imagine what a Nitschke end-of-life session would entail. Trust? I think the family would be left cold and empty.

Please, Philip, shut up. You are making my job so much harder.

Martin Cullen is an intensive care specialist in a Sydney hospital. 

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