Notes in the Margin - 16 August 2025
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.
An account of how the euthanasia program is going in Canada from
. This is horrifying in its content and also in the stultifying bureaucratization of the whole thing.Conscious of Conscience: Moral Distress as a Trigger for Deeper Reflection on Harm
I appreciated working on this essay with Joyce Meza-Venegas and Ryan Slauer inspired by Dr. Meza-Venegas’s experience as an intern. All clinicians have had similar experiences. Where can we find resources to feel, articulate, and reflect upon a morally distressing experience in healthcare?
GeriPal podcast: Death Anxiety
In this existential space, "anxiety" isn't how we think of it in psychiatric terms, but rather it's a motivating force; it ranges from concern to terror. It can show up in innumerable, unexpected ways, as Dani Chammas and Keri Brenner observe. Their discussion reminds me: in our culture, if we must die, we want to die "with as little dying as possible.”
Don’t Tinker with AI in the Classroom
From
. This also applies to clinicians who are tinkering with AI in the clinical encounter. We’d never abide them tinkering with medications or surgeries outside of a research setting, so we shouldn’t allow it for AI.Donor Organs are Too Rare. We Need a New Definition of Death.
"In its initial report the committee noted that ‘there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.’" If we move the line now, why not move the line in the future, and again, and again? It's worrisome that the push for a re-definition of death is to meet demand for a scarce resource. Defining death is worth doing for its own sake, but not so we can gerrymander our way to increasing organ supply. What a massive conflict of interest.
Doctors Sometimes Fake CPR - and They Should
"Slow codes aren’t an anomaly; they’re a symptom of a deeper dysfunction in how we manage death and dying in America." I agree. The answer, however, isn’t to double-down on deception. We need to have ongoing conversations about what it means to be dying. Dying is more than a physiological process. It's a social role co-constructed by everyone within a culture. Part of the fallout of living and practicing medicine within a pluralistic society is people are going to disagree with you about constitutes dying. We're not just talking about success rates of CPR. Some individuals, families, and cultures really have very little concept of "dying" apart from what happens after CPR fails. Their script is literally, do everything to sustain life, including CPR. If that doesn't work, then it's over. The bedside is no place to adjudicate metaphysical disputes. But articles like this one don't help either. They merely argue that a clinician's only recourse in the face of such metaphysical discordance is deception. I don't think that's right either.
Canada’s euthanasia regime is the logical outcome of a deep commitment to liberalism without any constraint. It is first and foremost a political instrument, not a health care program. But as Hemingway wrote about bankruptcy, things have happened slowly, then all at once. Canada didn’t embrace euthanasia overnight, although it was legalized in a series of discrete steps. Rather, this philosophy was already at work in routine decisions about health care, as I’ve argued.
AI Mimicry and Human Dignity: Chatbot Use as a Violation of Self-Respect
These authors argue, as I understand it, that we accord others respect when we treat them like moral agents. When we treat something that isn’t a moral agent as if it were one, we implicitly disrespect ourselves because the object can’t offer the reciprocal regard due moral agents. While I don’t track with everything they write, this is something worth considering as chatbot use becomes more prevalent: what are we owed in our engagement with our tools? How are these companies respecting (or disrespecting) their customers through tool creation and deployment?
From the Archives
Here's something, only a little dusty, that new readers may not have seen.
There may eventually be some validity to the concern that robots are becoming too much like humans. But there’s real validity to the concern that humans are becoming too much like robots when the machine sets the standard.
Remaining Human: Avoiding the Uncanny Valley
“‘It must be nice sometimes to have no feelings. I envy you.’
Unrestrained liberalism leads us to illiberal places.
Some MAID doctors reasoning that life has no value, and concluding that because of this they must be the ones end *other people's* lives, implying that they place a higher value on their own lives... From The Atlantic piece:
"Yet Reggler feels duty bound to move beyond his personal discomfort. As he explained it, “Once you accept that people ought to have autonomy—once you accept that life is not sacred and something that can only be taken by God, a being I don’t believe in—then, if you’re in that work, some of us have to go forward and say, ‘We’ll do it.’"
On stultification:
"In a fully developed bureaucracy there is nobody left with whom one could argue, to whom one could present grievances, on whom the pressures of power could be exerted."
- Hannah Arendt, ‘Reflections on Violence’, 1969
https://www.nybooks.com/articles/2013/07/11/hannah-arendt-reflections-violence/