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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 profession’s 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 Parkinson’s 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 I’m lucky to be a neurologist. I’d do it again in a heartbeat.
But my kids won’t be neurologists, or physicians of any kind. I have counseled them very strongly against entering medicine (they didn’t 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 Down’s 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 Down’s syndrome. Now, there are none. As the only neurologist who sees children in a 300 mile radius of a very rapidly growing metropolitan area, I’ve not seen a single case in 2 years. Genetic testing has ensured that virtually all Down’s children are aborted during pregnancy, despite the fact that many children with Down’s 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 student’s 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 Parenthood’s 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 it’s 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 children’s 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 don’t, 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. . .
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I misunderstood your post by way of my own stupidity. Sincere apologies to you.
Calculated this stuff decades ago. There is not remotely enough labor and capital available to provide every elderly Boomer (am 60 myself) with "high grade medical care" (as we know it today) until death. It is simply impossible.
Triage is not just a possibility in medicine but is an everyday medical necessity. People are let die routinely. Medical resources must be allocated to those persons who will die without treatment but who will not die if given treatment. Those who may have "many years of normal life" if medically treated get way higher priority than those who may not. Goes on all the time and is part of the medical routine here in the good old USA. Check it out yourself.
They say in Holland that old folks refuse to go to a doctor because they figure that if they do they will get the final shot. In such cases the doctor will make a house call. Bye, bye, Grandma.
MUST READ ping.
Sickening. The Culture of Death goosesteps on, trampling all in its path.
Great article. This is exactly why I chose to become a bioethicist and why I have my blog and website. I'd like to help turn the tide.
despite the fact that many children with Down’s syndrome have normal intelligence.
----
? is this true?
The right to life cannot survive under socialized medicine. The logic of socialism is relentless in finding reasons to kill off the weaker half of humanity. The elderly, the sick, the disabled, the weak are portrayed as a drain on the common good. They are not contributing their share to the common welfare. They are "useless eaters" who merely consume scarce medical resources and give back little or nothing. Their lives are not worthy, the socialists will say. They have no quality of life. They are defective. They are subhuman. They will not recover. They are better off dead. They must die.
The Nazis stated matters plainly, and exterminated at least 200,000 people for the crime of being sick or handicapped:
This poster reads: "60,000 Reichsmark is what this person suffering from hereditary defects costs the community during his lifetime. Fellow German, that is your money, too. Read 'New People', the monthly magazine of the Bureau for Race Politics of the Nazi Party." [Wikipedia]
Here's a photo of the ceremony that welcomed the same thinking to this country. Former President and Mrs. Truman were present the ceremonies, to the right of LBJ, along with Lady Bird Johnson (obscured, behind LBJ), Hubert Humphrey (and many Democratic congressmen not shown here). Wilbur Mills (D., Ark.), Chairman of the powerful House Ways and Means Committee and a major player in the legislation, was also present. This was before his famous tipsy adventures with a stripper named Fanne Foxe, "The Argentine Firecracker." (Power corrupts!)
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This has nothing to do with Hitler. It's capitalism run amok. Weigh the cost vs. the benefit and that's where this comes from.
Think nothing of it, my friend. Welcome to FR.
Thanks for all the pings! How many of us realized that it has been a long time since seeing a baby with Down's? I've seen older children and teens with the condition, but I cannot remember the last time I saw a baby. Just damn : (
This doctor is one we cannot afford to lose. I understand why she will have to change professions, though. My aunt had to retire from nursing because of that hospital's policy of everyone being available to assist in an abortion. She just recently retired from accounting.
? is this true?
From the March of Dimes website:
How serious is the mental retardation?
The degree of mental retardation varies widely, from mild to moderate to severe. Most fall within the mild to moderate range, and studies suggest that, with proper intervention, fewer than 10 percent will have severe mental retardation. There is no way to predict the mental development of a child with Down syndrome based upon physical features. How serious is the mental retardation? The degree of mental retardation varies widely, from mild to moderate to severe. Most fall within the mild to moderate range, and studies suggest that, with proper intervention, fewer than 10 percent will have severe mental retardation. There is no way to predict the mental development of a child with Down syndrome based upon physical features.
Caveat emptor!
It's a good thing I didn't go the OB route.
The 'medical boards' wouldn't have liked the way I fought back, against their murderous rulings.
Thanks for the ping... :)
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I also have a precious, precious grandson who has autism. Again, the very thought that ANYONE would EVER suggest he should have been aborted brings alternating thoughts of hate and sorrow for those alleging such a thing. God help all of them.
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