DJP Update 9-28-2014 1- AMA Ethics Award Recipient Dr. Ezekiel Emanuel’s article “WHY I HOPE TO DIE AT 75”. 2- DJP Updates
The article by Dr. Ezekiel Emanuel is published in THE ATLANTIC September 17, 2014 with the title:
Why I Hope to Die at 75
H/T to Dr. Art Fougner for the alert about article in the listserv he moderates “Speaking As An Individual” and via his Twitter account: @sonodoc99
Dr. Emanuel’s article is at: http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/
You have to read his entire article to get his message. Here is one excerpt re his approach to treatment as one gets older:
“This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.) After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.
“What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections.”
Bio from article:
Ezekiel Emanuel is director of the Clinical Bioethics Department at the U.S. National Institutes of Health and heads the Department of Medical Ethics & Health Policy at the University of Pennsylvania.
Of course, AMA Delegates and the AMA Board know Dr. Emanuel well as he received the AMA Foundation’s “2013 Isaac Hays, M.D. and John Bell M.D. Award for Leadership in Medical Ethics and Professionalism” at the June 2013 Annual AMA House of Delegates.
Comments by others on Dr. Ezekiel Emanuael’s article:
@AmerMedicalAssn @DJPNEWS Dr. Emanuel stands Primum non nocere on its ear. http://t.co/4iO51DLCra
9/21/14, 8:16 AM
DJP editorial comment: I disagree with Dr. Emanuel.
Dr. Emanuel’s article is his opinion. But if the government adopts such an approach though the IPAB (Independent Payment Advisory Board) of PPACA or some other scheme yet to be devised, then we have a problem! Dr. Emanuel is a chief architect of PPACA/ACA and you already know my views on that law: http://www.intrepidresources.com/html/PEJLSMS2010.pdf
My answer to Dr. Emanuel’s view is in my 6 Commandments of Medicine: S-E-C-C + 2.
Science – Ethics — Compassion – Courage and the +2 =
Is this in the patient’s best interest?
Do I have my patient’s informed consent?
I included the 6 Commandments in my commencement speeches to graduating medical students and other medical professionals at Tulane University Health Sciences Center (May 22, 2004), LSU Health Sciences Center New Orleans (May 18, 2002), LSU Health Sciences Center Shreveport (May 29, 2004), and Oklahoma University College of Medicine (May 27, 2006).
See one of my speeches containing the 6 Commandments at:
May 18, 2002 LSU Health Sciences Center Commencement Address
Also published in Vital Speeches of the Day; 9/15/2002, Vol. 68 Issue 23, p764
These speeches were delivered during my time on the AMA Board 1996-2005 and as AMA president 2003-2004 and after.
I am 75 years old and I tell the medical students I teach at Tulane if some future government edict states people my age should be ignored and put on a gurney in the corner of the emergency department if they are in an auto accident, don’t follow the rule. Show courage and leadership and follow the 6 Commandments. I remind them it is the least they can do for a clinical professor who teaches them for free and it is the ethical act to do what is in the patient’s best interest, not the government or insurance company!
Throughout history there are people who seek to control, command, and remove liberty from others or use their view of ethics to justify their actions. America’s response has been to fight for freedom and individual self-determination. Visit Arlington National Cemetery, the National Cemetery of the Pacific in Hawaii, or the Normandy American Cemetery and Memorial for powerful reminders of the price we paid for Liberty.. Remember, LIBERTY is the absence of coercion.
As for various views of ethics and how different results can be obtained using different ethical models, see my 1998 speech: Hippocratic Oath: Discarded Relic Or Living Soul of Medicine:
Read the entire speech. Here is an excerpt about the ethical models:
Let us not go quietly into this abyss, this new Dark Age, a Dark Age of medicine. Let us stand on principle. A revival of the Hippocratic Oath with reasoned discussion of what it means is a step away from the abyss.
We must understand what ethics mean. Never accept blindly a statement that something is ethical without reviewing the analysis that led to that conclusion.
For example, consider the following different ethical models:
• Deontological: rightness is not defined in terms of their consequences; violate no rights.
• Teleological: goal or consequence oriented.
• Social utility: greatest good for the greatness number.
After selecting one of these reasoning models, was an analysis done that considered the following? Autonomy, Nonmaleficence, Beneficence, Justice.
Each of these analyses has additional choices to make in order to complete the analysis. For example, to do the justice analysis, one must decide which of the following theories one will use: Egalitarian, Communitarian, Libertarian, Utilitarian.
Thus it is obvious that it is possible to reach different conclusions as to what is ethical and what is not depending on the ethical model used.
—————- End of Excerpt———–
If Dr. Emanuel is serious about the statements in his article, it would be a good idea for him to do a legal document, an “Advance Directive” (sometimes called a “Living Will”). This gives instructions regarding medical treatment in the event an individual becomes incapacitated and is unable to instruct the doctors on treatment choices (or no treatment). Others who wish to have relatives or a trusted friend make medical decisions also execute a “Durable Power of Attorney for Healthcare”. Such a document turns comments in an article into reality.
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