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Interesting though processes

My ex boss, in Family Practice, is a hard core Catholic. We went head to head over religion, atheism, catholicism, politics and the list goes on. Most all the time it was good fun although we never really came to any agreements. The other night, in the ER, I saw a patient who I used to take care of in FP for 10 years. He has Hep C, endstage liver cirrhosis, portal hypertension, esophageal varices (which had bled twice), hyperammonemia and hepatic encephalopathy. He uses marijuana regularly. His visit to the ER was because of lower leg swelling. The workup led to nothing new and I sent him home. His mother pulled me aside and told me that my ex boss had told this patient to absolutely not smoke dope. I told her that at this point in his life he may smoke as much dope as he wants. I talked to my boss about the Hippocratic Oath—first do no harm and relieve pain and suffering—His response to me more than once, has been “suffering is part of life”. How can he reconcile this with the oath? If dope makes this patient comfortable, then is it not our responsibility to encourage that (in view of the fact that he is terminally ill). My ex’s “suffering” comment comes from his catholic/christian beliefs and, as I see it, directly contradicts his medical oath but he could never see this. This was a source of conflict for us both for years.
So after our visit in the ER I told the patients mother to ignore my ex’s advice and let him smoke dope if he wanted to. Doing “no harm“ by limiting what helps him is wrong; “relieving pain and suffering“ means marijuana if life is terminal. In my experience, I believe religion gets in the way of sound medical practice.

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Permalink Reply by unholyroller on January 17, 2009 at 12:25am

I have to agree with you, Charles. I've told patients and families the same thing for years. Grandma(pa, Whomever) is dying. Let them have anything they want. As for the very catholic/christian saw about "the more you suffer the greater your reward in heaven" bullshit..I've always thought that this was just a way to appease the poor, ignorant masses while robbing them blind, keeping them ignorant and feeding their superstition to better the church's own position and amass wealth and land.

You can still see this phylosophy at work in any 3rd world country that is largely catholic....or any catholic-run healthcare facility in this country when the church fathers keep telling the poor that birth control is a sin. Yeah, suffering occurs, but that dosen't mean it can't be relieved. Next time someone pulls this on you, ask them why "god" created coca bushes. Or doctors. Or birth control meds. Or medicine of any kind........maybe they should stop taking/prescribing HTN meds....insulin....chemotherapy........you get the picture. I love making them sputter.

Permalink Reply by Dr. Thoss on January 17, 2009 at 7:20am

So often we hear, "What's the harm if someone has religious beliefs? It doesn't hurt anyone else!" Wow. This is a great example showing how it does harm others. Here, one person's screwed up view of life (drawn from religious teachings) quite naturally leads him to IMPOSE that view on the lives of others.
So, pharmacists refusing to fill certain prescriptions on their religious grounds follows quite naturally.
Great story

Permalink Reply by Ro on January 17, 2009 at 8:10am

I agree...and I think this also crosses back over into the realm of assisted suicide which the religious vehemently oppose...I almost half expected to read that your ex boss compared the pt's suffering to that of Jesus on the cross or something. I know you said you were in trauma too...don't you LOVE the "praise god" when the patient lives, or "you killed my...." when the patient doesn't live directed at us? Know what...please foreward all medical malpractice suits to your cloudly supervisor. To borrow a line from Hitchens..."Religion Poisons Everything"

Permalink Reply by Sentient Biped on January 17, 2009 at 12:41pm

This may be a little off from your topic, but when I see cars in our clinic parking lot with the "Marriage=(male sign)+(female sign) bumper stickers, it gives me pause. I think about the fact that some of the people who I am caring for do not accept my humanity. THis is because of their religion and prejudices.

These are people who actively campaign against people like me. All that I can say is that as more and more time passes, they know me better and appreciate the care that i give, and eventually their views may soften. Medicine is a place where people with drastically opposing views interact on a regular basis, and must remain professional and caring.

As best we can, in medicine, we need to check our prejudices, religions, politics, at the door and recognize that we are practicing expert, evidence-based medicine. It doesnt mean that we'll agree on all of the specifics, but we need to be open to diverse points of view in the grey zones. In our group, we have been told that our DEA licenses are at risk if we support or promote use of any illegal drug, including pot, so I don't promote or recommend it to patients. But my personal view is that if someone who is terminally ill wants to smoke pot, what is the harm in it.

Our hospice group does use a lot of morphine and methadone, and uses marinol when appropriate. Also a lot of ativan. So hopefully we are giving very good, compassionate care at end of life, including use of opiates, psychoactive agents, and other drugs. Medicine is not just about treating disease, it's also about reducing suffering. If marijuana ever falls off the totally-forbidden list, I'm sure it will be added as well.

What a ramble. If it doesnt show, I'm sympathetic to your point of view.

Permalink Reply by Charles Cusumano on January 18, 2009 at 6:47am