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EVERY doctor finds himself frequently in a terrible predicament. He has a patient who is dying of some extremely painful disease which is considered absolutely incurable. Yet the doctors entire energy is directed toward prolonging, and therefore intensifying, the agony of the poor sufferer. This problem has exercised the best medical brains for centuries. Nowadays, doctors have means at hand whereby they can easily and painlessly end the sufferings of the incurable. They can be put to sleep with an injection.
Of course, the problem is not as plain and easy as it seems. Recovery takes place in innumerable cases which have been declared absolutely incurable by the most experienced practitioners and specialists. Every busy doctor has seen such cases. Even cancer cases in an extreme condition may recover miraculously with or without treatment. I have described such cases in my book, Cancer, The Surgeon and the Researcher.
Dr. Roberts has written a readable and very interesting volume filled with thoughtful on Euthanasia and Suicide, Love and Sex, Crime and Punishment, etc. Much of the matter contained in the book has previously appeared in various journals such as the Nation, the New Statesman, the Spectator, etc. It will be fairest to the author if I give some extracts from this volume.
He writes: “In his Memories, Berlioz speaks of the death of his sister: from cancer of the breast, after six months of horrible suffering . . . .And not a doctor dared have the humanity to put an end to this martyrdom by letting my sister inhale a bottle of chloroform. This is done to save a patient the pain of a surgical operation which lasts a quarter of a minute: but it is not done to deliver one from a torture lasting six months . . . . The most horrible thing in the world, for us living and sentient beings, is inexorable suffering; and we must be barbarous or stupid, or both at once, not to use the sure and easy means now at our disposal to bring it to an end.
“Some time ago, in the course of an article, I referred to a letter I had just received from a patient of mine. It is so relevant that I do not hesitate to reprint it here:.
” Dear Dr. Roberts,– As I anticipated, I can no longer swallow milk. My poor starved bones are sore. I am so weak that I hope you will assure my wife that my life is now very short. I thank you for you kind attention, and I want to make one last request of you. I trust you will grant it. You know the torture I am in, and you know that in any case I can live but a very short time. Will you save me from this painful death? I am, yours gratefully,.
“This letter speaks for itself. Every doctor who has been many years in practice must have again and again been confronted by an essentially similar request. What is his reaction? It varies according to his emotional make-up. The degree of sympathy, of imagination, of courage, of law and convention abidingness each helps to determine the course taken.
It is one of the many dilemmas with which we are faced. The law of our country and the acknowledged code of our profession are in clear enough agreement. Our consciences are not always thereby set at rest. We are haunted by the reminder: De unto others as you would they should do unto you..
“What are we doctors to do in these circumstances? If we accede to our patients wish, we are, as the law stands, guilty of the crime of murder. Consequently, it is often cowardice, rather tan conscience or professional honour, that leads us to observe the established convention. I suspect, however, that very many doctors do, on occasion, allow their sympathy and their feeling of pity to override their prudence. To a humane man, the inclination to administer the merciful overdose is often almost — not infrequently, quite — irresistible.
“In its administration, there is, however, more common sense in the English law than is generally recognized. Motive is very seriously taken into account both by judges and by juries.
“In 1927, a man was tried for murder. His wife had died earlier in the year, suffering from tuberculosis and curvature of the spine. Of the five children left, one, a little girl four years old, contracted tuberculosis, and then developed gangrene in the face, after an attack of measles. The doctor expressed the opinion that the child could not possibly recover. The father — to quote the Lancet report– nursed the child with devoted care. but one morning, after sitting up all night with her, he could no longer bear to see her suffering. He drowned the child in the bath, and gave himself up to the police.
The medical evidence was such as to enable the jury to turn a Nelsonian eye to the facts, and to return a verdict of Not guilty. In the course of his summing up, Mr. Justice Branson said: It is a matter which gives food for thought when one comes to consider that, had this poor child been an animal instead of a human being, so far from there being anything blame worthy in the mans action in putting an end to its suffering, he would actually have been liable to punishment if he had not done so..
“We are all agreed about our duty to a mortally-wounded dog or cat lingering in a painful death-struggle. Law and conscience are here at one. Why these differences in the official conception of humanity and of duty?.
“We know that the effect of emotion on our bodys workings is profound and far-reaching. Without any conscious weariness on our part, and without any intervention of our will, the emotion of fear, or that of danger, leads to a physiological revolution which profoundly affects every part of us.
“The blood is hurriedly driven from all our internal organs, except the heart, lungs and brain, and dispatched to the muscles of our limbs and trunk; our stored-up reserves of starch are hurriedly converted into soluble sugar, with which the blood becomes charged; the blood itself becomes curiously modified, so that it more readily clots; the heart beats more quickly and strongly, and all feeling of fatigue disappears.
“Where is the drug, or where the surgeons tool, that can n a minute effect such a miracle as this? The series of automatic and immediate adaptations is by no means purposeless. It is exactly calculated to make efficient the essential self-preservation response to the fear-provoking situation in the primitive environment in which this machinery developed.
Whether flight or fight were expedient, it is in the muscles that the blood would be needed; and, for the work which they would be called upon to do, they would need all the fuel they could get. The advantage of the increased coagulability of the blood in case of physical injury is obvious.
“All this takes place as a spontaneous consequence of an emotion. In the light of these facts, he would be rash who would set narrow limits to the possibilities of faith or any other emotion. The success of the old charmers, who often caused such crude material objects as warts to disappear in a night, is a standing challenge to unimaginative science. At the same time, all experience goes to suggest that there are limits to the capacity of the spontaneous and unconscious forces within us.
“It is not a question of distinction between visible structural changes and what are called functional disturbances. Nothing could be more visible than a wart; and those causes which can cause a rush of blood to the face when we blush, or to the muscles when we are afraid; which can increase the beat of the heart or cause it to stop; which can lead to enlargement or atrophy of important glands; can obviously play a very important part in the restoring of health and the healing of wounds.
“Most of the diseases which attack man are, not infrequently — perhaps generally– spontaneously recovered from without external medical aid. And it appears that the defensive activities on which cure depends are for the most part regulated by what is known as the sympathetic nervous system; which, in turn, is intimately associated with the emotions. It is even s with the healing of wounds, and the joining of broken bones; and there can be no doubt that what we call states of mind may have, and generally do have, a considerable influence on the vigour of the defence of the body against bacterial attack.”.