Skip to comments.Lenten “Listening”: Last “Rights” for Neurology (must read)
Posted on 03/11/2006 6:09:56 PM PST by sionnsar
On June 13th, I will have been a physician for twenty five years. Twenty four of those years, exactly one half of my life, will have been spent as a neurologist. I would like, therefore, to state for the record, how grateful I am to have been allowed to practice as a neurologist, during this, the professions best of times.
When I first began my neurology residency 24 years ago, the practice of neurology was described to me in the phrase diagnose and adios. Neurologists were great at diagnosing, based on history and physical examination, where precisely a lesion in the brain might be. However we were unable to do much about most brain diseases. Now, neurology has hundreds of different drugs and treatments, and we can make a profound impact on the lives of the people who come to us for help. The number of seizure medications has increased five fold, and interventions such as seizure surgery and vagal nerve stimulation have made an enormous difference in giving our patients back their lives. Diseases such as multiple sclerosis and Parkinsons disease have numerous specific therapies including surgeries, as do various brain tumors, and a host of other illnesses.
It has been an awesome time to be a neurologist, and I have been fortunate to work in almost every part of neurology. I am board certified in five different areas of Neurology. I get to see folks with rare genetic illnesses, less rare nerve and muscle diseases, more common headaches, pain syndromes, sleep disorders, and seizures. I see little kids and the elderly. I see teenagers from broken homes with attitude problems and wealthy executives with (in my opinion) even worse attitude problems. During the course of my day, children and the adults of every sort and condition come in and out of my office. I interpret brain wave tests and sleep studies, I do pain procedures, adjust stimulators, and study nerve and muscle conduction and function. I can honestly say that I love what I do, and Im lucky to be a neurologist. Id do it again in a heartbeat.
But my kids wont be neurologists, or physicians of any kind. I have counseled them very strongly against entering medicine (they didnt want it anyway). If they were to enter medicine, neurology would be the worst field that they could possibly enter. In about 10 years, I anticipate either leaving medicine entirely or changing to be either a full time sleep physician, a high school science teacher or an urgent care physician. As it is, the next 10 years will be spent engaged in dialogue, listening and conversation about when hypothetically (there has been a slight shift from whether) it would ever be ethical for a physician to deny care (including food and water) to her patients, and the central role and ministry of a neurologist in determining which patients have such low quality of life that any care would be futile. It is anticipated, in the brave new world of the future, that neurologists will become critical to medicine in determining whose lives are worth living. We already assist in the determination of brain death and persistent vegetative state, so we are the natural specialists for this role also. As the products of the post-war Baby Boom retire, this role will become critical to the fiscal stability of health care financing, and will contribute enormously to the quality of life of society. So say the shiny newsletters that come to my home, and many of my colleagues seem enthusiastic about the important new role that will one day likely be thrust upon neurologists everywhere.
Of course nobody would be forced to do anything they thought was wrong. But insurance would look askance at a neurologist who refused to do the right thing and who continued to provide futile care. Also, naturally, refusal to do the right thing, and assist in terminating those whose quality of life failed to meet societal norms, would be considered abandonment, inappropriate intervention, or abuse and would likely be met with other sanctions from medical boards and hospital ethics committees. That has been what has happened to other specialties during my career. I recall a time, early in medical school when obstetricians and gynecologists often refused to prescribe birth control pills, especially to unmarried women. This largely is no longer an option. Indeed, in New York Obstetrics/Gynecology residents are forced to learn how to perform abortions, regardless of their religious beliefs. In 1997, the American College of Obstetrics and Gynecologists tried to make such training mandatory everywhere (though their requirements were softened by a handful of pro-life Obstetricians). As it was, changes in ACOG credentialing have made it difficult for pro-life resident training programs to remain accredited. These, together with Catholic hospital training programs, will slowly close over the next decade. However this probably will not change the United States much at this point in medical history. There are very few pro-life Obstetricians and Gynecologists in business nowadays anyway. Obstetricians figured out a long time ago, that if they began seeing a pregnant woman whose baby turned out to have Downs syndrome, they would be forced to provide an abortion or be charged with abandonment of a patient if they refused.
When I began the practice of neurology, a quarter of a century ago, I often saw children with Downs syndrome. Now, there are none. As the only neurologist who sees children in a 300 mile radius of a very rapidly growing metropolitan area, Ive not seen a single case in 2 years. Genetic testing has ensured that virtually all Downs children are aborted during pregnancy, despite the fact that many children with Downs syndrome have normal intelligence. Pro-life obstetricians have largely disappeared from US medicine. With the exception of the handful of Obstetricians and Gynecologists physicians in the American Association of Pro Life Obstetricians and Gynecologists, they are now in other walks of life. They left the practice a long time ago.
More recently pharmacists have been fired for refusing to fill prescriptions for birth control drugs or abortifacients. On one occasion, a pharmacist who refused to fill a University of Wisconsin students birth control pill prescription was not only fired, but was fined and ordered to take ethics classes. Although some Wisconsin lawmakers have been sympathetic to pharmacists forced to violate their religious beliefs, others feel that pharmacists have no right to personal conscience. Under the pressure of planned parenthood of Wisconsin, new legislation has been introduced, called The Patient Protection Act. This makes it even clearer that religious objections to pharmaceutical abortion will not be tolerated in Wisconsin, and (to use Planned Parenthoods words) ensures that patients will not be abandoned by pharmacists seeking to elevate personal beliefs above patient care.
Abandonment. This used to be a charge leveled against physicians and others who refused to provide care they felt was appropriate to a patient. Now a pharmacist who refuses to kill a hundred+ cell blastocyst by means of hormonal drugs is charged with abandoning a patient. If an obstetrician refuses to kill a developing baby in a mother for whom he cares, he may also be charged with abandoning his patient. So I find reassurance that neurologists would never be forced to assist in suicide or euthanasia of those whose lives are thought futile unlikely. If pharmacists and obstetricians can be charged with abandonment if they refuse to kill a developing baby, why would we escape? It is only a matter of time before dialogue becomes compulsion, and refusal to kill becomes abandonment. Catholic hospitals were forced to provide abortions long ago in Belgium, and three years ago were forced to participate in euthanasia. Currently, Catholic hospitals in California are under attack for refusing to participate in abortion, and we are engaged in listening regarding futile care.
So, I do not see myself remaining a neurologist when the boom is lowered on the Boomers, even though I have been repeatedly informed that no neurologist would ever, ever, EVER be required to violate his or her conscience. Right now we are all just listening to one another. We are all just concerned, well meaning physicians who are engaged in conversation and discernment. And its Lent! We are supposed to take stock and listen, right?
But of course, as a former Episcopalian, I know only too well where dialogue, conversation, listening and discernment can end. Lent may be about being called to listen, not simply about penitence. However listening is another of those words that has incurred a set of nasty overtones from the culture wars, much like gay for anyone who follows the Anglican troubles. Give me honest penitence any day of the week. Repentance, and amendment of life may be unpleasant, but it is, at least, something I understand.
However, I do believe that I have ten clear years. By that time, assuming the listening process has not actually resulted in repentance, penitence, and conversion of hearts, I hope to have reinvented myself into another career, and will have, God willing, provided for my childrens college education. More importantly, I hope, at least, to have changed the way folks in my community view children with learning disorders and autism. That is critical. For if I dont, I can tell you the names of at least some of the individuals whose lives will one day be deemed futile. I can see their faces. If I close my eyes and listen carefully enough I can almost hear their names . . .
Maria . . .Chad. . . Guillermo . . .John . . .Robert . . .Sarah . . .Patrick. . .Isaac. . .Alena. . .
I'm seriously at a loss for words.
For a doctor with a heart... caring and compassionate. My goodness! I scream, "Don't go!"
In one month my insurance coverage allows treatment for trigeminal neuralgia. I'm having a hard enough time to find a doctor treating me in the meantime.
What one was sent to do, do. Never should evil-doers (of any sort; legal restrictions boards, etc.) convince them otherwise.
The talent, the education, the "smarts" were all given as gifts by Our Living God. BECAUSE HE KNEW OF THE NEED BY SO MANY.
All in this world will pass away. Keep good courgage, and be that good and faithful servant.
Really? A doctor can be sanctioned if he/she refuses to provide an abortion? If so this is an outrage.
Click through and read back through her blog. All that and more.
But the handwriting is on the wall, and she's issuing the warning...
This is nothing less than shaking a fist at God. If children aren't normal or might be a burden, we kill them.
They should refuse, and be prepared to close down or be prosecuted rather than give in on a matter of core principle. It's easy for me to say that, sitting as I am in front of a keyboard, but God's Word is God's Word, period.
excellent read ping.
Don't know that I have the strength at the moment to do that.
I can only pray that God give strength for leaders who value life.
It's almost a Hitler-esque portrait we see. Be ye frail, sick, in need, elderly, not good enough physically--(and I'm in no way diminishing the attack upon the Jewish by my referring to Hitler)--you're not worth the air you breathe, according to today's applied standards.
What a disturbing picture strikes my mind. And, mind you, not for those put to death by those with no respect for life; rather, those standing in judgment with no excuse for not valuing God's creation in His own likeness.
I agree... but where are the Catholics, why are they not protesting? My wife grew up in Belgium and says it's a Catholic country -- or it was many, many years ago. (Online update as I write: 75%/97%, depending on source, still today, at least nominally.)
Europe is becoming very secular. I think it started with the french revolution.
OMG. I have not kept up on that blog! Do click through and read what she has to say about the Danish: No good deed goes unpunished: Denmarks Kristallnacht: "We should all be Danes at this moment."
This is tremendous, bookmarked!
"Lenten Listening: Last Rights for Neurology"
This is a wonderful commentary!
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"Your parallel between the weaker members of society and Jews in Hitler's Germany doesn't diminish the Nazis' assault on the them."
As a pleasant reminder, I wrote, "and I'm in no way diminishing the attack upon the Jewish by my referring to Hitler."
If I missed something, kindly point it out to me.
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