Notes in the Margin - 12 October 2024
Assisted Suicide, Interprofessional Teams, Whistleblowers, and more
Notes from a Family Meeting is a newsletter where I hope to join the curious conversations that hang about the intersections of health and the human condition. Poems and medical journals alike will join us in our explorations. If you want to come along with me, subscribe and every new edition of the newsletter goes directly to your inbox.
Every so often, I’ll share things I’ve been reading with a few words of mine scribbled in the margins. If you have something to share, please do! The comment section is open.
Should doctors prescribe death? Resisting the expansion of assisted suicide
Peter Jaggard and Richard Sams offer a response to Thaddeus Pope and Lisa Brodoff regarding the use of voluntarily stopping eating and drinking (VSED) as a bridge to assisted suicide. Pope and Brodoff offer a response. Unfortunately, Eric Widera’s and my response is left unaddressed.
The algorithm and the Hippocratic Oath
Ronald Dworkin traces a history of how physicians became scientists and lost their grounding in the humanities. He recommends restoring that education to them with the hope of a better future for healthcare. I’m less hopeful: tacking on some additional classes will likely just co-opt the humanities to the efficiency agenda of modern medicine, as I’ve shared. The beginning of a proper response, I think, is to consider what kind of clinician we want and need, and then discern ways to form that clinician: through reading, yes, but also in considering all the many ways the hidden curriculum is operative throughout education and onward into a career.
GeriPal: Intentionally Interprofessional Teams
Team work is hard work. Alex Smith and Eric Widera tackle this topic with a group who recently published a textbook on the topic in palliative care. A great conversation about the nuances of an understudied topic.
Searching for Medicine’s Soul: Carl Elliott on Whistleblowers
In The Occasional Human Sacrifice (which I haven’t yet read), Carl Elliott documents several stories of research misconduct through the eyes of the whistleblowers who brought them to light (including himself). In this podcast, Aaron Rothstein interviews him about his own experience as a whistleblower, and his reflections on the moral climate of research ethics.
5 Personal Rules for Reading Disagreeable Books
has some helpful advice for learning from people with whom we disagree. He writes specifically about books, but the advice applies to any form of disagreement. Part of what makes this challenging, I think, is that reading a list makes it seem easy, but the virtues necessary to sustain productive, gracious disagreement are not easy to cultivate - e.g., patience, generosity of spirit, humility, to name a few. The way you cultivate them, though, is to do work where you most need them. So jump in!From the Archives
Here's something, only a little dusty, that new readers may not have seen.
Too often, clinicians understand “goals of care” conversations to be a euphemism for conversations about end of life care planning and in particular about code status. That shapes how they approach these conversations. Instead, if you have a broader appreciation for what goals of care entail, you can discover more helpful tools for navigating the time spent discerning them.
Beyond Asking: Building the Goals of Care
Thanks for sharing!
Your response to Pope and Brodoff was good.
Something to consider when looking at their arguments is that the nearer-term 'source code' (the older code is in the eugenics movement) for the pro-MAID movement is a combination of two things: Quite radical views of individualism (I'm reminded of the Sovereign Citizens movement for some reason) and an early mix of people with and without medical training affected by the deaths of loved ones to illness or who assisted/caused their death (e.g., Humphry, Seguin, Nitschke, et al.). Sometimes these things are in tension, and the VSED gambit reads to me like an attempt to bridge them.
This paper notes that some people exploring suicide options feel like it's more legitimate if it's supported by a clinician and the responsibility is shared. https://www.tandfonline.com/doi/full/10.1080/01459740.2016.1255610#d1e502
This is also an intersting read on medical sects... https://www.jstor.org/stable/27505750