Mercy Killing or Cruel Living?

It is unfortunate that since we have so much technology, we as a whole population expect more of medicine and expect everybody to expect more.  What do I mean?  Well, it seems that we all expect to live longer and if someone decides to allow nature to take its course, we ostracize them.  We think they are giving up, we want them to do everything possible, we take them to court if necessary.

Let’s take for example the case of a child born with a severe birth defect.  A hundred years ago, they did not have ultrasounds to detect birth defects.  If a child was born with any problems, it was not expected to live long.  People did what they could but they knew nature would take its course.  Today, many couples take advantage of ultrasounds and other tests to determine if there will be any birth defects.  This does not always prevent problems because they can occur at birth.  But what happens if something does go wrong at delivery or the birth defect is worse than was expected and the child becomes severely disabled?  First, the doctor would probably be sued for malpractice.  This is quite unfair in many cases because unexpected things do happen and all this creates is a rise in liability insurance and overall costs to health care.  But because of technology, everyone expects perfect outcomes.  Secondly, the severely disabled child would probably have feeding tubes and tracheostomies to keep it alive.  Why?  Because advances in technology demand it be so.  If the parents decide not to do this and allow the child to die naturally, how would the public react?  Not that it’s really any of their business, but everyone jumps in to protect a child’s interest.  The parents would probably be dragged into court, declared to be unfit parents and the child would become a ward of the state.  Is this fair?  Just because of the technology, do we have to use it?  Would we rather keep a child alive whatever the cost?  No matter that this child will have no useful life?  No matter that this child cannot interact with another person, cannot breathe on its own, cannot eat?  If we saw an animal in the same shape, do we not shoot it and put it out of its misery?  Yes, this is a human but in this condition, is it not a suffering animal as any other?  I would rather call it an animal than a vegetable.  If we force this child to live, who bears the cost of health care?  This being will require extensive medical care for maintenance as well as when infections arise, which is very frequent.   Is this really living?  Yet how do we give it a dignified death?  And as we delay the issue, the debate becomes even harder.  Technology has created an enormous burden even as it has saved many lives.

Sex Education

I was listening to the Michael Baisden show today and he had a couple listeners act as contestant in a little sex education trivia challenge hosted by some “doctor”.  I don’t know this “doctor’s” credentials but some of the answers she gave made me question her knowledge.

The answers to a couple of the questions I found to be somewhat questionable.   But one was downright wrong!  It makes me wonder how many people out there know the real answer, medical and nonmedical.  This was something I learned way back in Biology and if doctors don’t know it, then I wonder…

The question is: What does “Pap” stand for in “Pap Smear”?  I won’t give the answer yet, but does anyone know?  (Hint: The answer on the Michael Baisden show was wrong.)

Question 2:  How long does the sperm stay active in the vagina after intercourse?  I agreed with one of the contestants and I have to say I doubted the “doctor’s” answer.  I wonder where to find the real answer to this.

Question 3: What is the largest errogenous zone in the woman?  Again, I agreed with the contestants on various grounds.  The doctor had a different answer but how can you really test this question out?

Question 4: What hormone do males and females release to attract each other?  Easy, pheromones.  However, I don’t know if pheromones can really be classed as a hormone.  Yes, it is like a hormone.  However, in biology, you will learn that a hormone is a released or secreted substance that has actions on another cell or organ.  Pheromones are substances that are released and act as an attractant or repellent.  In other words, it is like a fragrance or odor.  Correct me if I am wrong, but they are not quite the same, so I have a problem with the terminology.  Perhaps I am too pedantic.

I didn’t hear all the other questions and answers but I wonder if they were accurate.  With the trouble we have in sex education, we shouldn’t propagate false information.

So, tell me, what is your sexual IQ?


I heard a story once about a woman who went to her doctor for knee pain.  She was given an NSAID.  Later, she developed high blood pressure and was given another pill.  After that, she became depressed and was given yet another pill.  Consequently, she became fatigued and was given another pill.  Finally, she went for a second opinion and he took her off everything.  She felt better.  Moral of the story: one drug caused side effects for which another drug was prescribed.

How many of us know of people who are taking 7-15 pills a day?  There is always the possibility that one or more of the drugs will interact.  It is also possible that the person is taking one pill to counteract the effects of another drug.  Unfortunately, it is too difficult to say whether the person really has a primary condition for which (s)he is being treated or whether (s)he developed the condition due to one of the drugs.  In other cases, the drug may be absolutely necessary; therefore, if (s)he develops side effects, (s)he needs to be treated for the side effect.  But how does that affect the person?  What are the consequences of taking too many pills?

Should we be like the second doctor and take ourselves off all drugs to see what happens?  Or should we just put up with the side effects and take the required pills?  Are we keeping doctors and drug companies in business by having side effects?  Are we unwilling participants in a mind game by drug companies who put out advertisements for their drugs?  How many of us have answered “yes” to questions posed in those advertisements when they ask “Do you have so-and-so symptom?”  How many of us have asked our doctors about these drugs simply because we heard of them on the TV?

I hope that if I live to be 90, I will only need an apple a day.

Diagnostic Overkill

My husband went to the doctor for a physical mostly because he was tired of dealing with symptoms of dyspepsia.  He was young, physically active, had no other known health problems, no family history of heart disease and did not have any bad habits.  He had an EKG which showed some minor abnormality.  The doctor was unsure so he was set up for a stress test.  It came out completely normal as expected.  It should have been a relief to us but we thought the doctor went overboard, probably out of concerns about liability.  When we later changed insurance, this issue came up and we had a little difficulty getting him insured.

OK, my husband is young and it should be worth it to undergo all the tests to make sure he is healthy and will enjoy a long life.  But is it really necessary to undergo a test like an ECHO, which is expensive, just because the doctor is a little unsure?  What happened to doctors being trained to recognize signs of heart disease?  Are medical schools turning out diagnosticians or medical practitioners?

Now take the example of my 90-year-old demented great-aunt who is bedbound.  Essentially, she has reached the end of her life.  So why would the doctor want to check an ECHO to follow-up on her Congestive Heart Failure?  What difference will it make now?  So what if the test will be covered by Medicare?  The cost will eventually come back to taxpayers, who are already complaining about Medicare cutting back on reimbursements.

Another aunt, in her 80s, has had several strokes attributed to carotid artery stenosis.  She has had a couple surgeries for it and does not want any more.  She knows that she is at high risk for another stroke and the last ultrasound shows the blockage is at 80%.  Must she still have frequent ultrasounds?  Granted it is noninvasive, but is it necessary when she will not have anything done for it?

Is the concern about malpractice leading doctors to order more diagnostic tests than necessary?  If your physical exams suggest a diagnosis for which the patient does not want treatment, must you order tests to confirm your diagnosis?  Are you hoping to scare them into undergoing a treatment they do not want?

End of Life Care

When my mother was diagnosed with liver cancer I knew there was little to be done.  The tumor was too large to be surgically removed.  Also, it was invading and had already metastasized to the spleen.  I knew there were treatments for leukemias and other solid tumors like breast, lung, prostate, and colon cancer, but I was unaware of anything for hepatocellular carcinoma.  Hearing the diagnosis, I knew it was a death sentence.  I suggested Hospice but the rest of the family would not hear of it.  My mom was given 6-9 months.  She was torn between denial and giving up.  The oncologist had nothing to offer and knew of no clinical trials in the nearby area.  Finally, he referred her to an interventional radiologist, who in collaboration with another doctor, was investigating a localized chemotherapy, injected through the hepatic vein or artery.  It was meant to shrink the tumor so that perhaps surgery can be performed.

It was unclear what the consequences would be since it was so new, but it gave my parents hope.  They decided to go for it.  Prior to the treatment, her biggest complaint was itching and early satiety.  Also, her diabetes was uncontrolled with extreme fluctuations in her sugars.  After the first treatment, she had severe pain, nausea, vomiting and she went into acute renal failure.  She was left extremely weak and had to be hospitalized.  The itching persisted as well as the early satiety and poorly controlled diabetes.   But now her appetite was gone too.  Each of these symptoms had to be treated with different pills.  In addition, she developed anemia and had to have Procrit shots.  She became bloated and had edema and required oxygen.

My father became desperate and started seeking alternative therapies.  He found some herbal supplements meant for treating liver diseases and started her on these.   She gradually improved physically.  The CT scan showed that the tumor had regressed a little.  My mother became a little more hopeful and opted to have another treatment.  This time, she was hydrated prior to the procedure.  Still she developed acute renal failure and was hospitalized.  It was the same thing over again.  The repeat CT showed no change.  They continued to follow her with CT scans but she was too weak to undergo another treatment.  She continued the herbal supplements.

In the last six months of her life, she developed complications of her liver and kidney dysfunction, namely hepatic encephalopathy and hyperkalemia.  In her final days, she had severe abdominal pain and was admitted, placed on a morphine drip and passed away.  She lived 15 months after her diagnosis of hepatocellular carcinoma.  Perhaps this was not statistically significant (it is too difficult to prognosticate cancer survival), but was the cause of her prolonged survival related to the new chemotherapy or to the herbal supplements?

 I use this example to bring up the issue of end-of-life care.  As the population ages, we will be spending more and more dollars on end-of-life care.   When do we say stop?  When should doctors tell their patients to stop?  How should doctors tell their patients to stop?  According to my parents, they were told never to come back to the hospital because she would not be treated.  I have to take that with a grain of salt because what a doctor says and what a patient perceives may not always be the same thing due to different educational, experiential, and racial/ethnic backgrounds.

This case also poses the question of whether we should have treatment that is more palliative rather than curative and which causes more detrimental side effects?  How can it be considered palliative when the definition of palliative is to improve quality of life by alleviating pain and anxiety?  All it does is prolong life without thought of the quality of life.  Perhaps some may view prolongation of life as worth the cost of life.  But that is where end of life care increases the burden on the health care system.  Not to mention the fact that more and more research dollars are being spent to find these palliative therapies.  In addition, since the population that will require these treatments is relatively small, and it is difficult to induce these diseases in animals, humans are frequently the guinea pigs.  Sometimes these treatments are being used without sufficient clinical trials to provide data on its effects.  Are we willing to do this to ourselves and to our loved ones?