Dying with dignity

Reference 1 is a short report of a case from Ohio, a case about the deaths of 14 critically ill patients over a period of 4 years. Issues included consent, the use of opioid painkillers, palliative extubation and the principle of double effect - which last appears from reference 3 to date back to the times of Thomas Aquinas - more than 750 years ago, well before medicine, never mind palliative care, really got going.

I learn a little about mechanical ventilation, which involves putting tubes into airways and which can, in these circumstances at least, be rather unpleasant for the patient.

My take is that the jury, in acquitting this doctor, are a little ahead of the game. The doctor, in doing the right thing, probably exceeded his authority, thus prompting the arrival of criminal justice. 

I have not done more than glance at the other references, which has nevertheless served to remind me that dying can be a tricky business, even when the best of care is available. Hopefully, the people at reference 6 know all about it.

PS: the doctor concerned is described as DO (Doctor of Osteopathic Medicine) rather than the more usual MD (Doctor of Medicine). The story turned up by Bing seems to be: '... Both MD's and DO's attend medical school and take exams to become licensed, practicing physicians. In general, DO's tend to focus on the whole body when treating medical problems, and focus on your muscles and bones to confirm a diagnosis they make. Either type of doctor can go on to specialize in a certain area of medicine, but DO's tend to choose areas such as general internal medicine, pediatrics and family medicine that allow them to focus on holistic wellness. Both MD's and DO's can prescribe medications and treat diseases with equal competency....'. I don't think that this is a distinction that we make here in the UK.

References

Reference 1: Doc Accused of Killing 14 Patients Found Not Guilty - Harris Meyer, Medscape - 2022. To be found at https://www.medscape.com/viewarticle/972525.

Reference 2: Palliative Sedation, Compassionate Extubation, and the Principle of Double Effect: An Ethical Analysis - Jordan Potter, Steven Shields, Renée Breen - 2021. Relevant but inaccessible behind a paywall.

Reference 3: The Principle of Double Effect in Palliative Sedation - Rebecca Jane Bonello - 2020. An 86 page dissertation written under the auspices of the Department of Theology at the University of Malta.

Reference 4: Compassionate extubation for a peaceful death in the setting of a community hospital: a case-series study - V C Kok - 2015. Kok is affiliated to the Division of Palliative Medicine and Hospice Palliative Care Team, Kuang Tien General Hospital and the Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan.

Reference 5: https://en.wikipedia.org/wiki/Tracheal_intubation.

Reference 6: https://www.dignityindying.org.uk/.