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May 1998
Volume 62 |
Number 5
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| Letters to the
Editor |
OB Anesthesia Coast to Coast
In the interest of historical accuracy, it is submitted
that the first Department of Obstetric Anesthesia was not established
in the Pacific northwest, as suggested in the "Letters to the
Editor" column (ASA
NEWSLETTER, December
1997), but rather in the Atlantic northeast. On July 14, 1952,
such a department was initiated at the then Providence Lying-In
Hospital, Providence, Rhode Island.1
At a symposium on the "High Risk Mother and Fetus," chaired
by Yusef Barcohana, M.D., held at the now Women and Infants Hospital
on April 18, 1998, this continuous, uninterrupted 24-hour-a-day,
365-day-a-year obstetric anesthesia service to the community and
to the region was recognized. It would appear from communications
to the NEWSLETTER, that a controversy has arisen as to
the claim of priority. I would conclude with this quotation by
John C. Warren:2
"It is not my intention to enter into any investigation
on this point, as it will perhaps be hereafter examined and settled
by some competent tribunal."
Herbert Ebner, M.D.
Grand Cayman, British West Indies
References:
- Ebner H. An evaluation of spinal anesthesia in obstetrics.
Anesth Analg. 1959; 38:378-387.
- Warren JC. Etherization; with surgical remarks. Boston, MA:
William D. Ticknor & Co; 1848; page v.
'Out of the Box' Thinking - Hurrah!
Accolades and kudos for our new editor, Mark J. Lema,
M.D., Ph.D., on his synopsis (ASA
NEWSLETTER, March
1998) of Stephen R. Covey's landmark book for all successful
leaders [The Seven Habits of Highly Effective Leaders].
As a major respected profession in society, physicians are expected
to be knowledgeable in the healing arts and apply caring and empathy
to their practices for society. Today, however, the speed of change
demands new skills. We are challenged more than ever before by
the explosion of all bodies of knowledge, the rapid processing
of databases by computers plus the instantaneous movement of information
around the world at the speed of light (fiber) by the Internet.
Staying focused has never been more challenging, more difficult
or more frustrating. We live in a blizzard of data with a paucity
of wisdom! So, how can physicians stay focused on their vocation
plus continue to make personal contributions to society daily?
My answer: read "outside of the box" of medicine.
For example, we already know the desirability of balanced
nutrition and its contribution to the body's overall physiologic
and psychological status. Why not apply the same concept to our
reading? Why not nurture our mind with a balanced reading style
that opens our thoughts to new options for enhanced problem-solving?
Such a habit forces us to address old "problems" with new and
often creative ideas for relationship building and cultural interdependence
(Covey). Personally, for 15 years, I have channeled 15-30 percent
of my reading time beyond anesthesiology and medicine. Such diversity
has sharpened all dialogue with nonanesthesiologists, given me
a bigger picture of what "response-ableness" to society means
and set my context for embracing and adapting more rapidly to
change.
I applaud the efforts of our specialty and the timely
communications of this NEWSLETTER. ASA and its NEWSLETTER
continue to serve as a "written role model" for anticipating change,
future forecasting, sharing knowledge outside the house of medicine
and fostering a broader context for continuous problem-solving.
Our competitive, global and explosively changing daily life will
only accelerate with the wonders of new technologies. The habit
of reading beyond medicine will certainly make us better care-givers.
Maybe as a bonus such "out of the box" reading and thinking will
also make us as physicians more approachable and more fun in our
dialogue with nonmedicine types!
Robert W. Vaughan, M.D.
Chapel Hill, North Carolina
Physician-Assisted Suicide: Let Us Address the Cause
Physician-assisted suicide (PAS) [ASA
NEWSLETTER, March
1998] is a social and philosophical issue that obviously does
not lend itself to a simple right or wrong answer. Perhaps when
confronted with this kind of dilemma, we should do what we do
best: address the cause or primary issue. The big question should
be, why do people need help with dying? Is it due to ignorance
or powerlessness, or is it an indirect call for attention to their
continuing problems? Many terminally ill patients choose the option
of PAS due to pain, suffering or fear of abandonment, all of which
are within the office of the physician to mitigate. Are we really
fulfilling that role in modern-day practice?
History has been remarkable for its ability to repeat
itself. We can therefore draw on the age-old wisdom of Hippocrates
to guide us and not "give a deadly drug to anybody if asked for
it." But modern history has been more remarkable for its ability
to present us with situations where the beacon light of the past
cannot simply guide us to our journey's end. The great physician
Hippocrates did not have to grapple with chronic diseases and
a mountain of the life-sustaining modalities technologically available
to us today in an abyss of adequate pain control or emotional
support. Physicians are supposed to heal and comfort. What if
we cannot or do not? Who suffers?
If Hippocrates were a modern-day physician, I suspect
that the kind-hearted practitioner would not have denied his patients
the option of dying with dignity if some established standards
or reasonable criteria are met. Are we really not harming our
patients by our masterly inactivity? Who benefits when we continue
to deliver service against our patients' best wishes? As a profession,
if we can address the problem of pain control and fear of abandonment,
perhaps PAS would not be as topical an issue as it is today. Let
us give hospice or palliative care the prominence it deserves.
Medical heroism or advances come in different forms. As fellows
at the Vanderbilt Pain Control Program, some of us rotated through
hospice as part of our training, and that rotation did change
some of our naive perspectives with regard to the dying.
Until we address the factors prompting PAS, we, as physicians,
cannot and must not run away from it. Who certifies a person dead?
Who decides that no further therapy would help? Who decides on
the competence of an individual to make the decision to end life?
Dying is a serious and important issue, and involvement with dying
has been part of our role. We cannot abdicate this role at this
epoch of personal freedom. Neither should we play second fiddle
and relegate the decision-making to others.
Ike Eriator, M.D.
Jackson, Mississippi
Editor's Note: In response to Dr. Eriator's letter,
I have four comments in rebuttal.
First, Hippocrates and his disciples were dealing with
both acute and chronic illness and death just like today's physicians.
They encountered diseases without known cures just like today's
physicians (Hanta, Ebola, HIV), and they tried to cure, care
and comfort without intentionally terminating the patient's
life, unlike some of today's physicians.
Second, your editorial confuses the concepts of active
euthanasia, withdrawal of life support, failure to treat and
physician-assisted suicide without drawing distinction among
these very different actions.
Third, in answer to your three questions in the last
paragraph, physicians certify the death of a person (legally);
physicians, patients, family members and third-party payers
decide when no further therapy would help; and Kant would argue
that an individual's decision to end one's life is both illogical
and contradictory because free will cannot logically decide
to limit its freedom unless under duress (suffering). It is
a decision against autonomy rather than the ultimate autonomous
decision.
Finally, regarding "abdicating," I do not recall undergoing
any coronation as "the decision-maker of when people die." I
thought that job was left for God.
- M.J.L.
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