Harriet S.MeyerMD, Contributing EditorDavid H.MorseMS, Journal Review EditorRobertHoganMD, adviser for new media
Edmund D. Pellegrino, in his chapter "Ethical Issues in Palliative Care," offers two very important orienting thoughts for the physician caring for a patient with terminal illness. He notes that (in Western culture especially), "The dying person intrudes on everyone else's pursuit of business or pleasure. In the modern world, dying is an obscenity, an experience to be avoided at all costs. . . . " And he reminds us that "The vulnerability of the patient and the inequality in knowledge, physical stamina, and power between patient and physician must always be a moral brake on doing harm so that good may come of it." Although we, as doctors, know these things intellectually, especially if we've had the good fortune to be exposed to a rigorous ethics course, the book is replete with examples and adjurations against our tendency to forget them as we go about our daily lives in practice, particularly when a crisis occurs and we are in the heat of battle with a medical emergency. Several of the authors acknowledge that our behavior at such times is wholly understandable, trained as we are to think of disease as "the enemy."
PsychiatryHandbook of Psychiatry in Palliative Medicine. JAMA. 2001;285(4):469-470. doi:10.1001/jama.285.4.469-JBK0124-4-1