**makTHRAX**

It does, if the patient signs a DNR, the doctors do not attempt to revive the patient if they begin to fade away, no matter what the family says. If the patient is unconcious, then it is a whole different story.

thx,
makTHRAX

Mad Kally

winstonjen,

I'm a hospice RN. Didn't we have this discussion before?

winstonjen

Yes, a similar one.

Some doctors do not give morphine to patients who are nearly dead, and they give the pitiful excuse, "They might get addicted to it."

Mad Kally

Actually that is quite rare. We also have a hospice doctor. If necessary we will go over the family physicians head. We don't just leave people with intractable or out of control pain.

winstonjen

That's a relief to hear. I suppose I just heard stories about crackpot quack doctors that believe that suffering in itself is a virtue.

Mad Kally

While I was being trained for hospice, the director told us "If you ever leave a patient at home with OOC pain (out of control) don't even bother coming back to the office."

winstonjen

Now that's a good director. Surely preserving a patient's happiness and well-being take precedence over preserving life. Palliative care is for the dying - it's established that they won't get better. Therefore, there should be no limit to the amount of painkillers used.

Arrowman

I agree. I think on issues such as euthanasia, the AMA should butt out. Well, not entirely, because it is their profession that will have to deal with the outcomes of any legislative change, and they can validly contribute to the public debate, but I think there have been times that the AMA President or somesuch has made a public pronouncement (usually anti-euthanasia) that I think goes well beyond their brief. Why should the medical profession as a whole have a "position" on such a subject?

(It's like the RSL having a position on the national anthem or the republic - I mean, what gives Bruce Ruxton the right to speak on behalf of all ex-servicepeople?)

That's an unjustified generalisation/slur. In my experience the medical profession honours "DNR" signs and has been known to administer de facto euthanasia (ie heavy dose of painkiller) quite readily. If you want to assert that even some doctors "hook patients on life support against their will to make more money" you'd better have some pretty good evidence!

I think you'll find that the testimonies of Kally and others will be the rule, not the exception.

Well, to me the Oath is just an ancient ceremonial recitation, preserved by the medical profession only as such - and because some members of that profession just love to feel "special" and part of an ancient tradition that sets them apart from the rest of society. Same reason barristers wear wigs and gowns.

The medical profession (like others) is governed by legislation and regulation, not the Oath (and given its archaic and ambiguous wording, how could it be?). I've seen the words "First, do no harm" posed as an argument against euthanasia. I'd dismiss such argument as irrelevant (not to mention, one could also argue that maintaining life using technology unknown to Hippocrates, is in fact "doing harm"). I doubt that anyone in the medical or legal professions sees the Oath as some sort of guideline which should be referred to in preference to the legislation and ethical regulations etc.

Perhaps we could replace the Oath with a clearer, more modern version - but what would be the point? At the end of the day, it's the legislation/regulation that counts. Not to mention - can you imagine the uproar from the conservative parts of the profession?

(Noting dangin's comments about the revised oath taken by first years - yes, I do think it is valuable for newbies to be aware of the tradition and importance of their profession, and the first year oath referred to by dangin might well be a valuable exercise.)

By the same token, however, this also leads me to disagree with your words as quoted above. Because I think the Oath is simply a ritual, I would not be too bothered about "Following a part of an Oath is like not following it at all" or similar things. I'd prefer to critique the medical profession and the way it's managed (by itself, and by the government) on other grounds than just compliance with the Oath.

OK - now spell "beer".

PS Note how throughout this entire post I have carefully avoided having to type "Hippocratic"

Mad Kally

DNR (do not resusitate) or no-codes are always respected here in the US. There is no limit to the amount of morphine a patient can handle. That means that what a good dose is for them could kill two of us or more. It's a fact that morphine and other narcotics slow respirations.

Before I worked in Hospice I was an oncology nurse. We did something called a slow walk on rare occasions. Don't ask me for any details about that, if you get my drift.

Arrowman

Kally, my ex-wife is an RN. The Australian experience is similar and, as I said, I believe humane treatment of patients is the rule and not the exception.