Chapter XXV: The Hippocratic Physician and the Changing World

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The date was January 8, 1997, I was on the witness stand at the Palm Beach Court, (401) and Judge Joseph Davis asked me: "Doctor, can you imagine some special circumstances in which you would help a patient to end his life?" "No, Your Honor." "How so? Never?" asked the judge, and his incredulous surprise reminded me how much the world has changed.

But has it? Our hopes and fears, and the necessity to face our destiny have not changed, nor has, I deeply believe, the calling of physicians.

In this chapter I shall try to explain why the traditional clinician rejects euthanasia and physician-assisted suicide:

* His attitude had been primarily shaped by his upbringing and traditions but had been ultimately determined by medical considerations.

* As a young doctor, he had accepted the Hippocratic ethics on faith, but his life's experience, and the centuries long experience of his profession, have confirmed the soundness of this ethical code.

* Knowing how dependent and vulnerable the patients are, the traditional clinician is skeptical about the voluntariness of euthanasia.

* He would never draw fatal and irreversible conclusions from his diagnoses and prognoses because diagnoses are fallible and prognoses notoriously unreliable.

* He is worried about the future of the medical profession, and foresees the paralyzing effect of euthanasia on the professional performance of doctors and nurses, (402)

* And he is convinced that confusing the role of a healer with that of a killer must lead to disaster.

The Physician, the Patient, and "Voluntary" Euthanasia. At the time when so often the courts intervene in medical practices, it will be useful to realize how different are the images of a sick person as seen by Medicine and by the Law.

The Law sees the patient as he should be, as he has the right to be: an autonomous being, able to make independent, rational, and sovereign decisions.

The Physician sees a very different person: weakened by the disease, dimmed by the sedatives and painkillers, euphoric after some reassurance, but depressed when the news is not so good, fully dependent on the information given by the doctor, easily influenced not only by the content, but also by the way the information is presented.

In the view of the traditional clinician, if a patient is asking for death, probably the doctor induced him to make such request.

Euthanasia, Assisted Suicide, and the Uncertainties of Medicine. A high degree of certainty, or rather, a complete certainty should be required when an irreparable step is considered, and human life is at stake.

Yet the present tendency to regard medical diagnoses as certainties, and medicine as exact science, is obviously mistaken. On the contrary, the traditional clinician's view of medicine as the art of dealing with uncertainties has been right in the past and remains valid at present.

Now as in the past, 20 to 40 percent of clinical diagnoses prove wrong in confrontation with the ultimate diagnostic standard, the post-mortem findings. In spite of all precision tools which have been introduced, the accuracy of medical diagnoses has not improved in the last fifty years, which has led to the notion of necessary fallibility of medical diagnoses. (403)

An erroneous diagnosis of fatal disease remains a real possibility. In their efforts to improve a patient's condition or save his life, doctors have to rely on diagnoses that are only probable. To cause a patient's death on the grounds of a diagnosis that may prove faulty is as evil as it is mindless.

How Well Can Doctors Predict the Future? Doctors' predictions that the patients will die within so many weeks or months thrust some sick persons into such a psychologically intolerable situation that suicide or euthanasia may be seen as a way out. Death is then sought, and perhaps granted, on the grounds of a false certainty. …