Framing the deaths of children

An article at MSNBC caught my eye. The title: "Doctors hastened dying kids’ death, say parents." My initial reaction was that the doctors had done something bad. The article turned out to be more nuanced than the headline, but the opening paragraph suggested that some doctors were acting nefariously:

It's a situation too agonizing to contemplate — a child dying and in pain. Now a small but provocative study suggests that doctors may be giving fatal morphine doses to a few children dying of cancer, to end their suffering at their parents' request.
But then I thought, what if the opposite were true? And then what if the opposite headline read like this:

A provocative study suggests that some doctors are refusing to give enough pain-relieving morphine to children dying of cancer, thereby exacerbating and extending their horrific suffering.

My point is not just to be provocative. Before going further, I should disclose that I am the parent of two young (healthy) children, so this horrid situation is something that I find extremely uncomfortable to even contemplate. Nonetheless, what would I do if I had a a child who was writhing in pain, and who had only weeks or months before he would die? Would it really a bad thing to give that child more pain medication in order to lessen his pain, knowing that it would shorten his already terribly shortened life expectancy? I am amazed at how Americans make simplistic cartoons out of so many moral dilemmas. We call it "mercy killing," even when the aim is to reduce suffering. I would never criticize a parent for wanting to relieve a child's suffering by giving pain medication when that child is dying of cancer. Maybe we need a new language to meaningfully discuss this situation. How about calling it "relieving the suffering of an innocent child." Why call it "killing" at all? Why even call it euthanasia (literally, "good death")? When a child is being non-stop crushed with pain, what kind of parent enhances the pain by withholding drugs in order to attempt to display an incredibly shallow version of moral superiority to others in the community? Shouldn't the whole focus be what's best for the child? Is it better for the child to be in excruciating pain, every hour of the day, or to be given relief from the pain, even though it shortens his life? I know that many people disagree with me--they think that any wretched existence is superior to the end of one's earthly existence. Ironically, most of those people believe in an afterlife. I don't get it. When we're dealing with the family pet, everyone knows the answer. We call it being "humane" to the pet when we choose to painlessly put the pet out of its misery. But somehow, when we are being "humane" to humans, we intensify and extend their suffering. What's driving this upside-down logic? Are the critics merely having sport with doctors, most of whom are working extremely hard to give the families what they need and want? This issue is not limited to dying children, of course. Hence the moral second-guessing when sick elderly adults choose to die in far off places like Switzerland. There are many other ways to needlessly kill healthy children and to make them suffer and to deprive them of healthy minds, but we don't use the word "kill" when describing legislation that does this. You know . . . legislation that cuts medical care, closes subsidized daycare, fails to fund nutrition education centers, or allows bad schools to continue to operate. Perhaps we should use the word "kill" in those situations, since that word often provokes people to take action. But I also think that we need to jettison the "kill" language for those gut-wrenching situations where children are dying and parents are struggling to figure out what to do. We should start over when an entirely new language devoid of the word "kill," because it is the disease that is killing such children, and the parents are trying to deal with the disease. Only with a new language with a more thoughtful version of causation is worth of such situations.

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How Good Need Medical Evidence Be to Prevent Quackery?

Here is an interesting observation posted in a medical journal. It concludes:

Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

So, do we really know if parachutes are better than a placebo for surviving skydiving? Alt-Med advocates are all over this one.

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Killing antibiotics

How is it that super-germs are difficult to find in Norway? It's because Norwegians have severely cut back on the use of antibiotics. This approach has saved many lives in Norway and it could save tens of thousands of lives in the United States. What do Norwegian doctors do instead of providing antibiotics?

Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections. "We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better," says Haug. Convenience stores in downtown Oslo are stocked with an amazing and colorful array — 42 different brands at one downtown 7-Eleven — of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren't allowed to advertise, reducing patient demands for prescription drugs.
Full story can be found at MSNBC.

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Colonoscopies: a sure way to save thousands of lives every year.

Every year 50,000 Americans die of colon cancer or rectal cancer (combined, they are referred to as colorectal cancer). If Americans over 50 years of age (and those in other higher risk categories) were screened for colorectal cancer as recommended, 80% of these cancer deaths could be avoided. These numbers are staggering. To put them in perspective, about 3,000 Americans died during the 9/11 attacks, which caused this country to become apoplectic to the point where it started an entirely needless war that is currently in its seventh year. Needlessly undiagnosed colon cancer takes the lives of more than ten times as many Americans as 9/11 every year. Needlessly undiagnosed colon cancer killed enough Americans over the past twelve months to fill an entire major league baseball stadium. So where is the "war on colon cancer? My insurance company just send me a mailer reminding me of the importance of obtaining a colonoscopy, the gold standard for detecting and preventing colorectal cancer. The statistics are so stark that it would be irrational for anyone to not proceed with this procedure, even though going through with it are less than pleasant. Given that I'm 53 and I've never had such a procedure, I signed up. I started looking for information on the internet and found this highly informative video introduced by Katie Couric and featuring Dr. Jon LaPook, a gastroenterologist, who undergoes a colonoscopy on camera to demonstrate both the preparation and the procedure. After viewing this video, the entire thing looks a lot less daunting.
Watch CBS News Videos Online

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Garrison Keillor describes his stroke

What's it like to have a stroke, then get really lucky? Garrison Keillor tells it like only Garrison Keillor can tell it:

[A] neurologist shook my hand and said: "I hope you know how lucky you are." That was pretty clear as I walked down the hall, towing my IV tower, and saw the casualties of serious strokes. Here I was sashaying along, like a survivor of Pickett's Last Charge who had suffered a sprained wrist.

What's it like to get world class treatment for your stroke when you have a strong sense of social justice?

Rich or poor, young or old, we all face the injustice of life -- it ends too soon, and statistical probability is no comfort. We are all in the same boat, you and me and ex-Gov. Palin and Rep. Joe Wilson, and wealth and social status do not prevail against disease and injury. And now we must reform our health insurance system so that it reflects our common humanity. It is not decent that people avoid seeking help for want of insurance. It is not decent that people go broke trying to get well. You know it and I know it. Time to fix it.

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