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QJM Advance Access originally published online on August 6, 2007
QJM 2007 100(9):585-589; doi:10.1093/qjmed/hcm063
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The role of the physician in the preservation of life

F.H. Epstein

From the Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, USA

Based on the Nathan Sidel Lecture, given at Beth Israel Deaconess Medical Center, Boston, MA, April 2006 Address correspondence to Professor F.H. Epstein, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. email: fepstein@bidmc.harvard.edu

The first 150 words of the full text of this article appear below.


   Introduction
 
In the modern hospital, and in the present climate of increasing concern over medical costs, it has become fashionable to question the traditional duty of the physician to preserve life. Anguished relatives wait in the wings, expecting and fearing that death will come, and sometimes disappointed that it does not. We are urged to consider the needs of society in determining the type and amount of care we deliver. Ethicists and churchmen indicate their up-to-date orientation by proposing an action of ‘allowing to die’. Grieving relatives, wracked by the strains of a terminal illness, write powerfully about the callousness of physicians who keep patients alive. Honestly distressed doctors sometimes talk of ‘the right to die’ with the fervour of a Rousseau declaring the rights of man, and increasingly take refuge in that Orwellian phrase, ‘Comfort measures only’.

It was easier 100 years ago in the era of therapeutic nihilism. Then, . . . [Full Text of this Article]


   Life after death
 

   The patient's suffering can be relieved
 

   Death with dignity
 

   Euthanasia versus suicide
 

   The incompetent patient
 

   Dementia may be reversible
 

   Physicians are interested parties
 

   Cost of terminal care
 

   Physicians are not omniscient
 

   The median isn't the message
 

   Quality of life
 

   Useless treatment
 

   ‘Comfort care only’
 

   The attitude of the physician
 

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