GESTIÓN EN SALUD PÚBLICA: Managing miracle expectations in clinical medicine

lunes, 30 de abril de 2018

Managing miracle expectations in clinical medicine

Managing miracle expectations in clinical medicine

Bioedge

Managing miracle expectations in clinical medicine

by Xavier Symons | 28 Apr 2018 |

Despite the increasingly atheistic nature of Western countries, many people still believe in miracles. In particular, statistics indicate that many people still believe in medical miracles. What’s more, the cases of terminally ill British infants Charlie Gard and Alfie Evans arguably are examples of parents “holding out for a miracle”.

How then, should hospital ethicists respond to miracle invocations by surrogate decision makers?

A new article in the American Journal of Bioethics attempts to provide guidelines for hospital ethicists in their interactions with religious (particularly, Christian) surrogate decision makers. Three American medical researchers -- Trevor M. Bibler (Baylor), Myrick C. Shinall Jr. (Vanderbilt) and Devan Stahl (Michigan State) -- offer “a taxonomy of miracle invocations”, ranging from more personal, authentic invocations of the divine to invocations motivated by a distrust and a loss of faith in the healthcare team treating a patient. They argue that, regardless of what the motivation of the miracle invocation is, clinical ethicists need to exercise show “empathy” and “epistemic humility” when engaging with decision makers:

The model of inquiry we promote paints the ethicist as an open-minded and active collaborator in another’s search for truth...Some ethicists may reject this portrait, but patients’ moral systems often include religious beliefs to which the ethicist must respond—or risk ignoring moral, spiritual, and existential distress...The ethicist’s ability to clarify seemingly opaque concepts, promote precise communication, and elucidate values seems especially important when religious concepts orient a patient’s worldview.

Several commentators respond to the target article, with some suggesting that it falls outside of the role of the ethicist to explore and “shore up” the moral worldview of surrogate decision makers. Some believe that it is the role of chaplains and pastoral care workers to interact with patients at this level.

“Die, my dear Doctor! That's the last thing I shall do,” said the 19th Century British foreign secretary Viscount Palmerston, not long before he slipped his cable. For all of us, dying is the last and perhaps most significant moment of life. Which is why recording the exact cause of death is a matter that calls for scrupulous accuracy – not just for epidemiological purposes, but also as part of our personal and social history.

But our disturbing lead story today – that Flemish doctors under-report euthanasia by a mind-boggling 550% -- throws all this to the winds. The most common practice, at least according to the latest research into the topic, is that most Flemish physicians who practice euthanasia lie on the death certificate.

Perhaps their offence is more understandable than jurisdictions which require doctors to lie. In many, like Oregon, they are told to record the patient’s underlying disease as the cause of death – as if JFK died of Addison’s disease rather than an assassin’s bullet.

Perhaps we should keep in mind the wise words of the author of a study on death certificates: “Death certificates are really important. We owe it to our patients to be able to accurately record why they die” — and thus to “help the living.”