Sunday, February 25, 2007

Hippocrates: Do's & Dont's

During my media appearances and in response to the postings on this blog, I am frequently asked how physicians can reconcile their role as healers with participation in physician-assisted suicide and/or lethal injection. Frequently, the Oath of Hippocrates is cited as “the governing” document.

The oath is, and always was, ceremonial only--just like traffic signs in the city of New York, that functions only as general guideline.

The modern version of Hippocratic Oath, written in 1964 by Louis Lasagna, then Academic Dean of the School of Medicine at Tufts University states that a physician
“…will apply for the benefit of the sick, all measures (that) are required, avoiding those twin traps of overt treatment and therapeutic nihilism…” Clearly, in cases of chronic debilitating, and frequently fatal diseases, usually associated with intractable pain, one should not over treat and concentrate only on proper pain control and patients comfort.

The modern version of the Oath also states that “…it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play God…” The recently reintroduced Compassionate Choices Act of 2007 (California AB374) specifically addresses physicians’ responsibility and respect for patients’ right to self-determination and the right-to-die with dignity. More importantly, the modern Hippocratic Oath recognizes the concept of medical futility.

Similar safeguards should be in place when taking person’s life by lethal injection. A recent article published in the Lancet (Volume 365, Page 1412, April 16, 2005) is a study of post-mortem blood tests that in 43% of reviewed cases, thiopental levels (a drug used to put people to sleep) in the subjects were too low to prevent awareness, pain and suffering.

Double trained in Anesthesiology and Pain Management, I bring over 30 years of academic and clinical experience Attending Anesthesiologist to the argument.

A Diplomate of the American Academy of Pain Management, Associate in Medicine of the American College of Legal Medicine, and a Diplomate and Distinguished Fellow of the American College of Ethical Physicians, I am more than qualified to represent an alternative viewpoint that an Anesthesiologists participation in the preparation and administration of the legal injection is needed to protect the condemned from undue pain and suffering, and their right-to-die with dignity.

An earlier, “classical”, version of the Oath was translated from Greek and interpreted by Ludwig Edelstein in 1943. It is by far more conservative and discriminatory against women than the current one. It starts with a “mini-oath and covenant” of allegiance to
:”...Apollo Physician and Asclepius and Hygiea and Panacea and all of the gods and goddesses…”; and promises to teach the art of healing free, but to men only: “…and to regard his offsprings as equal to my brothers in male lineage and to teach them this art-if they desire to learn it without fee or covenant…”

The “classical” version weighs in on some other “hot” health/ethical/legal issues of our society: “…I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and holiness I will guard my life and my art…”

Obviously, the questions of how physicians can reconcile their role as healers with participation in physician-assisted suicide and/or lethal injection, are probably asked by the conservatives who obviously prefer the “classical” version of the Oath.

And if physicians were even close to practicing their art in “purity and holiness” why are there so many lawsuits and investigations by the Medical Boards?

“…May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”

Be Well!


Anonymous said...

Dr. Steve Miles researched the Oath in its historical context and is of the opinion that the reference to not giving a deadly drug had nothing to do with physician aid in dying, but rather was an admonition to doctors not to use their position of trust to gain access to those in power for the purposes of assassinating them. It appears that during the time the Oath was apparently “written” (the first copies weren’t found until hundreds of years latter) there was a lot of political upheaval in Greece and it was not uncommon for politicians to eliminate their competition. Miles points out that many physicians were servants of the state, very much like soldiers, and could be given orders to poison the enemy.

Anonymous said...

Considering the idealistic times in which the Oath was probably written I would subscribe to the theory that a physician had an obligation to dignify the departure of his patient (euthanasia).

The clause about not harming the patient, might as well mean that the physician had an obligation to protect his patient from disgrace and dishonor (such as a death in paralysis or slow deterioration).

Let's remind ourselves that Honor and Prestige were big in Ancient Greece (just think of Menelaus who instigated the Trojan War just to avange his name). I am convinced that in that culture a death from a dibilitating disease was not seen as very honorable nor respectable. Thus, a physician (who was also a friend) had a moral obligation to his patient to give him a deadly drug upon request and free him from shame.

Hippocrates himself once remarked that "Life is short, the art long, opportunity fleeting, experience fallacious, judgement difficult." Does he not mean that human life is rather worthless but the art that one leaves behind, one's personal fable, is what is left of us?