Pamela Winnick Getting Action Against "Dr Death"
Regular readers of Secondhand Smoke will recall the trouble that author Pamela Winnick and her family were having with a few physicians they named collectively "Dr. Death," who kept trying to pressure them into "pulling the plug" on her father. Here is the latest update from Pamela, reported here with her permission:
"Wes, you'll be happy to know that I just got a call from the head of ethics at [name omitted] Hospital re my piece in the WSJ. He's conducting a full investigation. The residents in question are being identified, reprimanded--and possibly fired. He's very serious about this and said they violated hospital policy. My father is within days of dying now, but it's the right way.
Thanks for all your help. pam"
Our sympathies to Pamela's family and our gratitude to them for defending the value of her father's life. There is a huge difference between dying when one's time has come, and being pushed out of the lifeboat.
posted by Wesley J. Smith @ 4:25 PM
3 Comments
3 Comments:
I am really glad to see that the hospital is responding appropriately to these incidents. I wonder whether they would have done so without the opinion article in the Wall Street Journal.
Also, what if the residents who might be fired aren't really the source of the problem? What if the problem is the overall philosophy of the higher-ups at that hospital permeating down to the residents? It would be easy for the high muckety-mucks to sacrifice a few peons at the altar of public opinion without addressing the real problem.
Finally, what are they teaching in medical school about ethics? It's not going to do any good to fire a few residents if medical schools are pumping out doctors with such a degraded view of ethics.
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The "chasing" sounds odd. The actions of the residents go beyond anything I have seen or heard about. I suspect a local - meaning the treatment team including residents, fellows, and the attending - influence with a prejudice toward low/no interference in patients with a terminal condition. The upper level residents and fellows would be the place I'd look. Someone taught the phrase, "Your father wants to die."
However, the doctors were not suggesting "precipitating" anyone's death. The disease is/was killing Mr. Winnick. The blood clot is symptomatic of changes due to the cancer. It is true that it was a miracle that Mr. Winnick was able to come off the ventilator and that he had no heart or brain damage due to the blood clot.
The original article told us that these conversations were in the ICU, while the author's father was still unconscious. If there is no advance directive, how could the treating team know how far to go in the face of a patient with terminal cancer and a blood clot (I assume in the lungs) and before the patient has regained consciousness without asking?
Many people consider death during the unconsciousness due to a pulmonary embolism or pneumonia preferable to pain and air hunger or liver failure, kidney failure, bleeding disorders as the clotting factors are used up, and the other problems that I can imagine down the line.
Especially in these days of autonomy and accusations that doctors are patronizing, it is/was appropriate to hold a family meeting in the ICU to discuss the attitude toward accelerated treatment, if needed. The possible treatments are interventional, possibly painful and require multiple departments and people: surgical intervention for a tracheostomy tube for the ventilator, permanent placement of a gastric feeding tube, cardiac compression or shocking in the event of heart attack, addition of pacemaker, dialysis, or parenteral feedings [high-tech IV solutions that require constant monitoring and adjusting and which cause liver damage in the long-term].
This is not a sound-bite issue. I'll put more at my blog.
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