Chapter XXIV: At the Bottom

Article excerpt

The Reticent Family Physician. The story of a six year old boy, his parents, and their family physician has been published in a leading Dutch medical journal. (355) The boy had some behavioral problems, and his intelligence seemed below average. He lived with his parents and attended a school for children requiring special care. Then juvenile diabetes was discovered. Patients with this type of diabetes must receive injections of insulin, otherwise they develop severe disturbances in metabolism (ketoacidosis), fall into a coma, and die. The family physician who diagnosed the diabetes did not inform the parents that the child must be treated with insulin. Instead, he asked whether their son should be treated. The parents, aware that non-treatment was tantamount to death, chose not to treat the child. The boy was not given insulin, and died.

The Trickster. (356) Dr. E, family physician at a town near Den Bosch, within a fortnight sent to our hospital two female patients, both acutely ill with pulmonary edema (an accumulation of fluid in the lungs due to heart failure, a condition which is directly life-threatening but most often responds to treatment), and both times phoned the cardiologist on duty asking her to not treat these ladies who, in his opinion, were "too old" (one was 76 and the other 72). In one of these cases he even suggested refusal of admission to the hospital. This patient overheard fragments of this conversation on the ambulance's radio, and arrived to the hospital not only suffocating from pulmonary edema, but also mortally frightened that she would be denied help.

Dr. E pretended to do everything he could to help: he called the ambulances and referred the patients to the hospital, didn't he? At the same time, behind the patients' backs, he conspired to deny them assistance and let them die.

The Healer of Mankind's Afflictions. (357) In 1973, while making his rounds at a hospital in Rotterdam, Dr. W, an internist, noticed that one of the patients was in a dimmed mental state. He then asked the nurse if the patient was suitable for euthanasia which after some hesitation, she confirmed. Dr. W then ordered that the patient's life be terminated with an appropriate intravenous injection. However, one of the doctors present protested, and euthanasia was not carried out. This woman doctor then asked what actually was wrong with the patient. Dr. W did not know the diagnosis. It turned out that there was no diagnosis: the patient had been admitted because of low-back pain, but the reason for the complaint had not yet been determined. The findings so far did not indicate any grave illness. The doctor who had protested against euthanasia checked the temperature chart for medications that could caused that patient's semi-conscious state. Indeed, it proved that he had been given rather large doses of valium (diazepam). Dr. W had forgotten that he himself (unnecessarily, for that matter) had prescribed the drug. It did not occur to him that this might have been the cause of the patient's stupefaction. The valium was stopped and the next day the patient, who had come a hair's breadth from death, could again speak and stroll the corridor.

The incident was then discussed at a staff meeting attended by the director of the hospital, Dr. S. Dr. W expressed surprise that one of the doctors considered all euthanasia inadmissible, and not for religious reasons, which Dr. W automatically accepted, but for some other reasons which he could not understand. As for the way he acted on his round, Dr. W had nothing for which to reproach himself. Admittedly, he had not known the diagnosis when he decided on euthanasia, but, after all, you can't know every patient in detail. Indeed, he had overlooked that valium was the cause of the patient's stupefaction, but to err is human and we all make mistakes. True, the patient perhaps wasn't suffering from any serious illness, but that is no obstacle to euthanasia. …