New and wholly evil medical ethic embraced by the AMA in 2012:“Physicians also have a long-recognized obligation to patients in general to promote public health and access to care. This obligation requires physicians to be prudent stewards of the shared societal resources with which they are entrusted. Managing health care resources responsibly for the benefit of all patients is compatible with physicians’ primary obligation to serve the interests of individual patients.…physicians should … participate in efforts to resolve persistent disagreement about whether a costly intervention is worthwhile, which may include consulting other physicians, an ethics committee, or other appropriate resource.”
As this New Year begins, the story of a life I saved last night reminds me of the awesome responsibility and privilege entrusted to us as physicians and individuals. A life saved from two other physicians. Mrs. B is a 92 year old independent woman who lives alone, still drives and who her daughter says is a “little demented”. She is alive and thriving this morning because this one doctor decided to serve her needs and not those of a collective society and its “shared societal resources”. She is alive this morning because this one doctor decided to stand up to two other doctors who thought it was “time to stop” and not worry about the social ramifications of the “collegial relationship”. Mrs. B. is alive today because this doctor did a very simple thing; one that is only simple after years of training and when dedicated to the most important ethic in life and medicine: an individual’s needs come first, their life is important and should not be thrown away. This one doctor encountered a 92 year old “demented” woman placed on death’s doorstep by a doctor’s orders and said “STOP”! This episode shows that we need not let evil work when good can intervene and we need not be forced to serve a collective when we should serve the individual first.
7:05 p.m. 12/31/12 This neurosurgeon receives a phone call from a local emergency room doctor: Mrs. B. has a very large subdural hematoma and is in a deep coma. This neurosurgeon orders medication to lower the patient’s intracranial pressure and other measures to preserve her life. This neurosurgeon gets dressed, and drives across town on a new years eve dodging busy traffic where some drivers are barely under control.
7:10 The emergency room doctor receives a call from a radiologist who advises that the hemorrhage is large and there is “herniation”.
7:15 The E.R. doctor calls the patient’s daughter and wrongly advises her that the situation is hopeless and hears the daughter say “she wouldn’t want to live like that”.
7:30 The E.R. doctor orders the ventilator removed and the patient extubated (breathing tube removed).
7:35 This neurosurgeon arrives to examine the patient and sees the respiratory therapist turn off the ventilator and about to remove the patient’s endotracheal tube. The patient is off the machine and breathing. The patient is waking up from a coma – better than when she first arrived in the E.R as she responds to the initial resuscitation attempts and measures ordered by this neurosurgeon on the phone.
7:35:01 This doctor says STOP!
7:40 This neurosurgeon berates the E.R. doctor and tells him he needs to adjust his approach to patient care. This neurosurgeon tells him not to give up so easily, stick to his specialty and give life a chance!
7:45-8:45 This doctor organizes a short-staffed O.R. team at a small community hospital on a holiday evening unfamiliar with emergency brain surgery and personally assists in setting up the room and moving the team along.
8:45-10:30 This doctor performs major brain surgery, removes the blood clot, stops the bleeding and sends the patient to the ICU for care.
7 a.m. 1/1/2013, Mrs. B. is opening her eyes and following the nurses commands.
As medicine and society as a whole proceeds into a new mentality of serving “the collective” at the expense of the individual, it is tempting to grow cynical, throw in the towel and let evil grow. It is tempting to walk away from doing what is right and join in the crowd of people – going along to get along. As doctors, it is tempting to follow the new and wholly evil ethic approved in 2012 by the AMA that says that doctors must be “prudent stewards of shared societal resources” and allow individuals to die who appear to be “too costly”. This new ethic is one that must be rejected but it is sadly infiltrating the hearts and minds of doctors and nurses. It is far too easy to look at a 92 year old, demented lady who is gasping her last breaths and let “nature take its course”. It would be easy for a neurosurgeon to walk in on a scene of a woman’s life who is being abandoned and turn around and walk out the door. This is the new Obamacare ethic that is invading medicine like a cancer: adopting death as the first and quickest option and not doing what we entered medicine to do: save lives! Try when others would stop. Give life a chance, even if it is a small chance, to survive! This ethic is being indoctrinated into our young doctors and our older doctors are being berated and coerced into following it with “incentives”, “bundled payments”, “accountable care organizations” and the proliferation of the “palliative care team”. Doctors are being told to spend less on patients as all payment for their services and total patient care are “bundled” into one payment. The more money they allow to be spent on their patient, the less money they will receive from the “Accountable Care Organization” (ACO) or similar entity. The employed doctors are especially vulnerable as their “utilization” is reviewed quarterly and “over-utilizers” are simply fired. These are not doctors that any patient can trust.
These lessons apply more than in medicine. They apply throughout America where we are all being subjected to serving “the common good’ and “the state” at the expense of the individual. Of course what is good for “all” is defined by a small group of the arrogant elite who never suffer the consequences of the rules that really are met for “the little people” (the true 99%). The individual is being cast aside so we can all be forced into being “prudent stewards of shared societal resources”. It is time to reject this wholly evil approach to society being promoted by the progressives and arrogant elitists amongst us. We need not think we have no say in the matter. This is America, the land of the great experiment where a Constitution was created in 1791 that did not grant rights to people, but protected those natural rights we have that are part of us and cannot be separated. Those inalienable natural rights to life, liberty, property and the pursuit of happiness.
For those who might be discouraged about your ability to make a difference. For those who think “doing the right thing” doesn’t matter anymore. For those who are too afraid to offend your friends and colleagues by standing up for what is right and teaching them the right thing to do (with shame if necessary). For those who are concerned about burdening society with spending that is “too costly” or for actions that might be “futile”. For those who are being misled to think it is “selfish” to act in your own best interests or to serve and protect the interests of a single individual. For those who think there is no point in being good. Remember life and your natural rights. Remember Mrs. B.