the glory and the horror

Leave it to the Netherlands to do some crazy stuff. First it was voluntary euthanasia with rumors of involuntary euthanasia thrown in, and now it’s a game show for a kidney.

I don’t have time to go into this right now, but I will return to this topic later. This is horribly unethical and tasteless, if only from the standpoint of treating human organs strictly as a commodity on the market, not taking into account medical need.

… to Nathan and Tina! May the Lord richly bless you both as you embark on life, together.

A recent New England Journal of Medicine article from the 8 February 2007 issue tried to understand and characterize the nature of conscience as it plays a role in clinicians and their willingness to disclose information and refer to other clinicians who do not have similar moral objections. It reports that many (86% of 1144 surveyed) physicians believe they are “obligated to present all options” while a slightly smaller number (71%) believed they were obligated to “refer the patient to another clinician who does not object to the requested procedure.”

This brings up an interesting point because that leaves 14% who do NOT believe they are obligated to present all options, and 29% who would NOT refer to a willing clinician. I can imagine that the attitude of such physicians is one where they see the controversial procedure/action as such an evil, that even their referral to another clinician would be seen as being complicit in a moral evil. I’ve even considered such a position for various things.

A recent Ph.D. dissertation from a graduate student at Rice recently dealt with the issue of complicity, and in particular, his position comes down to one where complicity is defined quite broadly, but with an important factor that may not be present in the situations brought up by the survey – a “pro” stance (I haven’t read the dissertation yet, but am just paraphrasing that from some other sources)

This brings up an interesting point. If I don’t cause something to happen, but help it happen by referring the patient to someone willing to do it, yet I maintain I do not have a “pro” stance, is that complicity with a moral evil?

I’m sure you’re wondering about this, as we’re all of 5 months into 2007, but I’m referring to my intern year of my residency. I am now nearly done with what most people call the hardest year of your medical training. All in all, I’ve enjoyed it. If I had to place all of my experiences as an intern in a rigorous internal medicine training program in a major medical center with a county hospital, a VA hospital, and private hospital and only 1 call free month, I would say the positive far outweigh the negative. I have plenty of negative things to put on that scale, too. I think it’s just that there have been more than enough good things that even with the crap, it’s still come out net positive. Of course, it helps that the good things have been REALLY good.

It’s definitely been hard to be away from the wife so much. Call, when it doesn’t line up, doesn’t leave a whole lot of time to spend together, and often, we’re very tired or sleeping. I’m not exactly the best person to hang out with when I’m tired, either. Kathleen is much more patient with me than I deserve.