Dr. Rosen:      There is an increasing emphases of Doctors assisted killing their patients. Is it appropriate for the messenger of healing to assist patients in terminating their lives?

Dr. Milton:      That is a very disturbing question. And our professional organizations seem to be advocating this.

Dr. Ruth:        I would never have thought that when I went to medical school such a subject would ever be considered.

Dr. Michelle:   I would not and could not be involved in such a travesty.

Dr. Sam:         It beats anything that I could have ever imagined.

Dr. Patricia:   It certainly makes me feel uneasy with my own professional colleagues.

Dr. Edwards:  Let’s think about this a moment. What do you think will be the ultimate outcome of this?

Dr. Sam:         I know a lawyer with Merkel Cell CA in his thigh that invaded his femur when it became very painful. He told his wife let’s move to our vacation home in Oregon so I can put an end to this suffering.

Dr. Edwards:  But dying is not a painful proposition. We have plenty of drugs now to let everyone die in comfort. Why not let nature take its course?

Dr. Rosen:       I don’t think the general public believes that. It’s not been so long since many people didn’t want to be around a dying person. Some were so petrified they sent them off to the hospital to die. And after they died, they left the bed unable to even touch their loved ones.

Dr. Edwards:  Then we went through the long ethical dilemma. How to let our patients die? We couldn’t even let our terminal patients die in peace. When the heart stopped, we pounded on their chests, frequently breaking ribs. If they survived, they would really have severe pain from fractured ribs. The respiratory therapists were always nearby with their ventilators waiting for the doctors to intubate the dying patient so they could hook them up to breath for them.

Dr. Rosen:      Then we had a real ethical problem. Can we ever turn off the ventilator? Isn’t that called Mercy killing? Isn’t that criminal? A felony?

Dr: Yancy:      But the hospitals loved it, especially while the ventilators were running and collecting revenue by the minute, by the hour, by the day . . . by the month . . . by the . . .   until the court allowed the doctor to turn off the ventilator.

Dr. Rosen:      That could take a week or more after the patient had effectively died.

Dr. Yancy:      You can see why hospitals love it. At $500 an hours, the weeks, months, etc. was a gold mine for the hospitals.

Dr. Edwards:  Remember the Karen Quinlan fiasco? When they finally got the court order to turn off the ventilator, Karen kept on breathing.

Dr. Rosen:      Which goes to show you what actually happens when lawyers and courts practice medicine. Doctors no longer provide appropriate care. They are unable to make appropriate medical decisions—like checking for spontaneous breathing when making rounds.

Dr. Edwards:  Maybe Karen was able to breathe on her own six months earlier on her year-long expensive life-support ventilator care.

Dr. Milton:      Can we explore that possibility a little more? Let’s assume that without the court interference, and the doctors would have followed normal quality of care, they might have found that she could have been breathing on her own 200 days earlier without life support. Now just take the cost of daily life support in your hospital. We know it’s quite variable. To be in the ICU costs several thousand dollars a day. Then add on the charge for life support which will also be several thousand dollars a day. Looks like the 200 days could add up to more than half a million dollars saved in hospital charges. Before long, you’re talking real money.

Dr. Rosen:      Some physicians felt collecting an ICU treatment charge every day was gouging the system. And when they addressed it, the hospitals did not understand why. I remember once when I was managing a patient on life support who also had an infection, the infectious disease doctor suggested that we both continue to see the patient every day but only put a charge in every other day.

Dr. Milton:      When the hospital administrator heard this, I bet he thought you were stupid. Wasn’t the name of the game to charge whatever the traffic will bear?

Dr. Rosen:      That’s what the hospital thought and how the hospital practices. It is unfortunate that the lay public doesn’t believe that doctors are cost conscious.

Dr. Milton:      That’s because some doctors do gouge the patients.

Dr. Rosen:      How do the new staff members view this?

Dr. Ruth:        I think most of them go with the flow. They don’t want to make waves early in their careers .

Dr. Rosen:      Most of them have government sponsored debt. So they have become slaves to the government. So the next generation of physicians will no longer be independent. They will practice by whatever rule they think will prevail and get their student loans paid. They no longer will be a servant to their patients.

Dr. Michelle:   How sad.

Dr. Rosen:      But they may think they have the patient’s best interest at heart, even to the point of Mercy Killing.

Dr. Ruth:        Tragic!

Dr. Rosen:      And that’s why it’s hard to have an ethical discussion about doctors being an accomplice to the patient’s suicide vs murder.

Dr. Yancy:      I caution patients who are on Beta Blockers for their high blood pressure what could happen if they over dose on this medication. They already have low blood pressure on the medication and their heart rate goes down to the 40s.  I tell them if they took 5 or 6 of  these as they are about to retire, their heart rate could go down into the 30s and their BP could drop into the 60s. Then if they took twice that many when they turned off their bedside lamp, their pulse would continue downward and their blood pressure would drop even further. Then the brain and kidneys would not be perfused and they would sleep  very soundly. They may then not awaken in the morning. If that is their intent, be sure to tell your wife that you love her and that you’re not feeling well and will retire early.

Dr. Rosen:      You’ve just outlined why Doctors never have to put a needle in the patient’s vein and inject anything lethal to assist in a suicide. Let the patient do it on his own and keep your white coat on. Never wear the black coat of the executioner.

Dr. Edwards:  Yes, let’s not be an accomplice to killing.

Dr Yancy:       Beta Blockers give your patients a peaceful painless death.

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