Comments on: My "conversation" with Rush Limbaugh http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/ Health News and Advice from a Family Physician Tue, 30 Aug 2011 01:59:20 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: David Fisher, MD, MPH http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-35 David Fisher, MD, MPH Thu, 13 Aug 2009 05:23:09 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-35 Anonymous,<br />I appreciate your concerns about physician-assisted suicide (PAS). I share your concerns. I am against legalized PAS for a variety of reasons. We should not allow the intentional killing of patients, whether or not they have a terminal illness. There is a big difference between giving increasing doses of morphine for the primary purpose of treating pain at the end-of-life, and giving a prescription for a lethal dose of phenobarbitol for the express purpose of ending a patient's life. I could say a lot more about it but suffice it to say that PAS goes against medical ethics that have been held for thousands of years and upon which the patient-physician covenant is based.<br /><br />Therefore, I am concerned that mandated counseling would force doctors to offer PAS even if they don't believe in it. A "right to know" law was passed in CA that requires doctors to explain the "full range" of end-of-life options to patients with a terminal illness (defined as death likely within one year). For now that includes things like hospice and palliative care, which I support, but if PAS were legalized in CA, doctors would also have to offer this to patients even if they know that their patient would not want it or if they would not agree to perfom it. This would undermine the patient-doctor relationship significantly.<br /><br />As the current provision 1233 reads, the content of the consultation is not mandated and therefore I do not share the concern that this provision would start a slippery slope, in its current form. Anonymous,
I appreciate your concerns about physician-assisted suicide (PAS). I share your concerns. I am against legalized PAS for a variety of reasons. We should not allow the intentional killing of patients, whether or not they have a terminal illness. There is a big difference between giving increasing doses of morphine for the primary purpose of treating pain at the end-of-life, and giving a prescription for a lethal dose of phenobarbitol for the express purpose of ending a patient's life. I could say a lot more about it but suffice it to say that PAS goes against medical ethics that have been held for thousands of years and upon which the patient-physician covenant is based.

Therefore, I am concerned that mandated counseling would force doctors to offer PAS even if they don't believe in it. A "right to know" law was passed in CA that requires doctors to explain the "full range" of end-of-life options to patients with a terminal illness (defined as death likely within one year). For now that includes things like hospice and palliative care, which I support, but if PAS were legalized in CA, doctors would also have to offer this to patients even if they know that their patient would not want it or if they would not agree to perfom it. This would undermine the patient-doctor relationship significantly.

As the current provision 1233 reads, the content of the consultation is not mandated and therefore I do not share the concern that this provision would start a slippery slope, in its current form.

]]> By: Okakura http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-34 Okakura Mon, 10 Aug 2009 19:28:19 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-34 Anonymous: Physician-assisted suicide is an legislative issue that states decide, not the federal government. It is currently only legal in 2 states and has been outlawed in dozens of others.<br /><br />As for your slippery slope fears, PAS has been legal in Oregon for nearly 12 years and the number of individuals who have availed themselves of this option has remained remarkably consistent throughout: approx 36 per year. Know also that these individuals were diagnosed with an end-stage terminal illness and sought outphysician guidance and permission; <i>not</i> non-terminally ill elderly people being proactively "counseled" to off themselves by cost-cutting docs. No groundswell of death-seeking emigrants moving to Portland to die. There has been, I believe, an increased utilization of hospice services state-wide. I have no data on whether elderly suicide rates have fallen or not, although that would be interesting to know. <br /><br />While I respect your opinion, I think it is important to base fears on facts, not assumptions. America is not Holland, nor does Holland exemplify standard end-of-life pratices through the rest of Europe. Anonymous: Physician-assisted suicide is an legislative issue that states decide, not the federal government. It is currently only legal in 2 states and has been outlawed in dozens of others.

As for your slippery slope fears, PAS has been legal in Oregon for nearly 12 years and the number of individuals who have availed themselves of this option has remained remarkably consistent throughout: approx 36 per year. Know also that these individuals were diagnosed with an end-stage terminal illness and sought outphysician guidance and permission; not non-terminally ill elderly people being proactively "counseled" to off themselves by cost-cutting docs. No groundswell of death-seeking emigrants moving to Portland to die. There has been, I believe, an increased utilization of hospice services state-wide. I have no data on whether elderly suicide rates have fallen or not, although that would be interesting to know.

While I respect your opinion, I think it is important to base fears on facts, not assumptions. America is not Holland, nor does Holland exemplify standard end-of-life pratices through the rest of Europe.

]]> By: Anonymous http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-28 Anonymous Sun, 02 Aug 2009 22:29:24 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-28 Hi Dave, <br /><br />I remain extremely wary of the "end of life conversation" clause in the new health care legislation. While the paper may state that end of life conversations will be optional, I feel that this is only a thin edge of a very thick wedge. Obama has been quoted stating that it is the older generation that is sapping medicare, and that "tough decisions" need to be made. One also has only to observe the global culture of death/assisted suicide (now practically mainstream in Europe) to wonder just how soon it will become mainstream here in the US. I am grateful for your explanation that our government is not currently pushing suicide coaching, I do think it's only a matter of time before it will mandate assisted suicide coaching. Of course doctors should be paid for time spent counceling patients, but what may happen in the future needs to be discussed in explicit terms. I would feel comfortable with wording that guarentees at no time will assisted suicide become a part of the tax payer subsidised government health plan; even for those who may request it. Hi Dave,

I remain extremely wary of the "end of life conversation" clause in the new health care legislation. While the paper may state that end of life conversations will be optional, I feel that this is only a thin edge of a very thick wedge. Obama has been quoted stating that it is the older generation that is sapping medicare, and that "tough decisions" need to be made. One also has only to observe the global culture of death/assisted suicide (now practically mainstream in Europe) to wonder just how soon it will become mainstream here in the US. I am grateful for your explanation that our government is not currently pushing suicide coaching, I do think it's only a matter of time before it will mandate assisted suicide coaching. Of course doctors should be paid for time spent counceling patients, but what may happen in the future needs to be discussed in explicit terms. I would feel comfortable with wording that guarentees at no time will assisted suicide become a part of the tax payer subsidised government health plan; even for those who may request it.

]]> By: Vince Morris http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-26 Vince Morris Sat, 01 Aug 2009 12:30:39 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-26 Good stuff, David. Keep it up. Good stuff, David. Keep it up.

]]> By: Steve Smith http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-23 Steve Smith Fri, 31 Jul 2009 17:16:56 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-23 Bravo, Dr. Fisher! What you attempted to articulate on the radio and have eloquently said in your blog in absolutely on-target. Thank you for advocating and educating others on behalf of hospice and palliative medicine physicians -- online and in the media. <br /><br />Steve Smith<br />Executive Director, CEO<br />American Academy of Hospice and Palliaitve Medicine<br />Glenview, IL Bravo, Dr. Fisher! What you attempted to articulate on the radio and have eloquently said in your blog in absolutely on-target. Thank you for advocating and educating others on behalf of hospice and palliative medicine physicians — online and in the media.

Steve Smith
Executive Director, CEO
American Academy of Hospice and Palliaitve Medicine
Glenview, IL

]]> By: rmw http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-22 rmw Fri, 31 Jul 2009 11:36:15 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-22 Printing this and taking it to doctor's offices today. Keep up the good work. Printing this and taking it to doctor's offices today. Keep up the good work.

]]> By: judygold http://doctorfisher.com/2009/07/my-conversation-with-rush-limbaugh/comment-page-1/#comment-21 judygold Fri, 31 Jul 2009 04:47:58 +0000 http://drdave.socialmediawisdom.com/?p=31#comment-21 Dr. Fisher,<br />Thanks for trying to talk some sense into Rush, even though he chose not to listen. My son told me about a similar rant when Ann Coulter filled in for Bill O'Reilly several weeks ago. I tried to contact Fox News to get a transcript of the show, so I could find out exactly what was said, but have been unsuccessful so far. Those of us in hospice or palliative care need to just keep getting the word out and trying to correct misconceptions. Keep up the good work.<br /><br />Judy RN CHPN<br />Texas Dr. Fisher,
Thanks for trying to talk some sense into Rush, even though he chose not to listen. My son told me about a similar rant when Ann Coulter filled in for Bill O'Reilly several weeks ago. I tried to contact Fox News to get a transcript of the show, so I could find out exactly what was said, but have been unsuccessful so far. Those of us in hospice or palliative care need to just keep getting the word out and trying to correct misconceptions. Keep up the good work.

Judy RN CHPN
Texas

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