How Doctors Should View Death | Big Think

How Doctors Should View Death

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Our health care system right now prizes efficiency, rather than embedding an ethics committee throughout a patient's treatment. The challenge of being a medical ethicist is bringing "airy" concepts into clinical practice. Sometimes the solutions to ethical issues become established via legal precedent.

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MATT MCCARTHY:

Matt McCarthy, MD, graduated from Harvard Medical School and went on to complete his internal medicine residency at Columbia University Medical Center. He is the author of two national bestsellers, "The Real Doctor Will See You Shortly" and "Odd Man Out." His newest book, "Superbugs," is on-sale now.

McCarthy is also an assistant professor of medicine at Weill Cornell and a staff physician at New York-Presbyterian Hospital.

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TRANSCRIPT:

MATT MCCARTHY: When I graduated from residency training, I had finished four years in medical school, three years of internal medicine residency, and three years of subspecialty training in infectious diseases. I took a job as a staff physician at a hospital in Manhattan. And it was a teaching hospital. And I suddenly found myself surrounded by every morning on rounds medical students, interns, residents, a pharmacist, a social worker, all of these people who are turning to me to make medical decisions, which I felt reasonably comfortable with.

But it was a patient who I met who challenged me with an ethical issue that made me recognize how out of my own depth I was at handling these things. And that patient was a 24-year-old woman. I'll call her Sarah. And she had end stage anorexia nervosa. And she weighed 35--she was 24 years old, and she weighed 35 kilograms. She was the size of a fifth grader. And her heart was barely pumping, and her electrolytes were a mess. And there were all of these issues that were essentially just on the verge of death. And when I went to see her with my medical team, she said to me,"I have just one request. I would like a palliative care consult. I want you to help me die."

And as I was standing before her, I said, "No, no, no. There's a lot of things we can do for you. But that's not one of them. We're going to get you through this." In fact, that's a phrase that I say to a lot of patients-- we're going to get you through this. And as I was saying these words, I felt the glare of the medical students and residents around me. And I recognized I wasn't being my best self, my best doctor self that I had dreamed of being. It just didn't feel right that I was telling this woman, "No." And I ended up reaching out to our ethics committee. And that started a long and winding process of me getting involved in medical ethics where I learned just how many ethical issues doctors were facing. And it led to a clinical research career where what I study now are the ethical issues doctors face where they don't ask for help or they don't ask for an ethicist.

Part of that is because our health care system right now prizes efficiency. And itis often inefficient to say, time out, we need to talk to a clinical ethicist and make the right decision. ButI've come to recognize how important that can be. When you join the world of medical ethics, you learn about a whole new vocabulary of terms that were never exposed to medical students like me, things like beneficence and non-maleficence and autonomy and justice. And they're very theoretical and airy concepts. And the challenge of being an ethicist is to bring those concepts into clinical practice. And so the first thing you do, if you're going to be a medical ethicist, when you're called in for a case, when I goto see an ethics consultation, is you figure out, what are the facts. And there is a saying in our hospital that good facts make for good ethics.

And often that is the big stumbling point. Doctors may be disagreeing about something or a patient and a doctor or disagreeing, and that leads to an ethics consultation. And in a third of the cases at least, we find out that there is a fundamental disagreement on the facts of the case. The other thing that's very helpful to know are legal precedents. So a hypothetical would be a 12-year-old boy needs surgery for a tumor in his liver, and he's going to require a blood transfusion during that surgery. But his parents are Jehovah's Witnesses. And they say, "No blood transfusion!" And the surgeon says, "I'm not taking this kid to the ER unless I can transfuse him bec...

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