The April 18 article in the series "As They Lay Dying" revealed an alarming new attitude of some members of the medical profession in a prominent Washington teaching hospital. What, in fact, are our medical schools teaching doctors? Where has the purpose of this once beautiful profession gone?
The doctor is a "physiological mechanic" whose job happens to be to do his best to "fix" bad parts at the request of patient and family. Even the auto mechanic on the corner will do all he can to keep the old family wheels working. Where does the medical mechanic have the right to disregard discussions with family or to "pressure" the body in need of fixing to decide under duress--which is a decision made under pain or drugged confusion-- to yield to death and give up hope?
Dr. William Knaus, co-director of the intensive care unit at the George Washington University Hospital, acknowledged that one of his patients remembered very little about the conversation Knaus had with him regarding the decision whether or not to continue treatment. Presenting a man in pain with the offer of earlier death to escape the present hurt is hardly the job of the "physiological mechanic." The role of the physician is to practice his trade and not to play God. The job is to heal and provide opportunity for life and that one last chance--it may be there.
It is not for the doctor to decide whether he believes a family can understand a medical problem sufficiently to make a decision. It is the job of the physician to make certain the family does understand. Further, by what authority do doctors such as D. Joshua Cutler (letters, May 2) dare to "question the wisdom of letting them" (families or patients) decide. So long as there exist people who neither ask to be relieved of the "burden" of making life-or-death decisions nor wish doctors to do so, the physician has the responsibility to provide complete and unending opportunity for life.
If we allow physicians to assume the new extended power to which some of them already believe they are entitled, we are opening the doors to poor medicine and relieving the physician of responsibility in case something goes wrong.
Knaus may be a good "physiological mechanic," but he must not attempt supremacy over human beings and violate the purpose of medicine, technological advancement, or the ancient Hippocratic oath. No human being--in this case, a doctor--can acquire sufficient skills "to balance uncertainty versus the indiscriminate application of technology." We have awesome technology as well as fine medicine and chemistry. Civilization grows by utilizing these assets wherever possible--not by chosen application of them. No doctor will ever be able to rationalize to an intelligent public, "It wasn't us making the decision. God was making the decision. We were just responding."
To the doctors of the new perspective: if you are just responding, then respond as defined by the Hippocratic oath and an inner desire to "fix" the body, no matter how impossible that may seem. After all, do people not go to hospitals seeking life?
To members of the sleeping public: dare to question and demand explanations. You have not only the right but the wisdom to decide for yourselves and your families. Don't waste your time with any doctor who will not give you his.