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Recent Newspaper & Online Columns by Kate Scannell MD

Grappling with 'miracles' of modern medicine

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 08/18/2012

Every doctor, it seems, has at least one story about a patient who, against all known odds, defied expectations and escaped -- "miraculously" -- from death's certain grasp.

One of mine involves a young man dying with multiple complications of AIDS during the early '80s. For days, his motionless body had been unresponsive to physical and verbal stimuli. He had ceased breathing and was ventilator-dependent. His blood pressure required chemical support to encourage blood flow. And one day, his heart just stopped beating. Honoring his previously expressed wishes, we disconnected the ventilator, the intravenous drips and the heart monitor, which had flat-lined. He didn't flinch when his breathing tube was extracted. After performing the ritual examination to determine death, I joined family members who comforted one another at his bedside, telling stories involving the patient, which made them laugh and cry.

About 10 minutes later, I informed the family that I needed to leave but would return within the hour. Before departing, I took the patient's cold hand in mine, while also checking for a pulse (none), and I placed my other hand over his heart (no beating and no response to the physical stimuli I covertly applied).

Approximately 30 minutes later, I returned to the patient's bedside. His cadaveric body had turned yet a deeper shade of gray, and his family was preparing to leave. We all said our final goodbyes and headed for the exit. And that's when, with our backs all turned, we heard him ask: "Where's everyone going?" Well, we were going into shock. And he proceeded to live several more months.

In general, we doctors don't like to speak publicly about such "cases." In fact, as someone who has written extensively about doctoring, I have not until now written about this patient. I didn't even include his story in the book I published -- "Death of the Good Doctor" -- that chronicles my experiences caring for AIDS patients within that same hospital during the early epidemic.

Over the years, I've often speculated about my death-defying patient. Using my medical mind, I can't explain what happened. Still, I'd be among the first to admit the inadequacy of science to fully account for human reality. Once, when my inexplicably enlivened patient subsequently returned to visit the AIDS ward, I asked how he viewed his Lazarus experience. He said only that "it was clearly not my time" and that "God works in mysterious ways."

This patient came swiftly to mind as I read a new study in the current issue of the Journal of Medical Ethics. In it, British researchers asked whether doctors -- against their professional judgment -- should be obligated to provide intensive medical care to terminally ill children when parents demanded it, based on their religious beliefs in divine intervention or miraculous recovery.

To determine the scope of this issue, the researchers reviewed 203 instances in which doctors had determined that, in the best interests of the child, medical interventions should be withheld or withdrawn. In the end, parents intractably disagreed with doctors in only 17 cases, 11 of which involved their "explicit religious claims that intensive care should not be stopped due to expectation of divine intervention and complete cure."

Religious-based disagreements between parents and doctors over the medical care of children in ICUs are as old as ... well, as pediatric ICUs. But what really makes the new study noteworthy is the authors' forceful conclusion: that it is high time to "facilitate rapid default access to courts" when doctors and parents so disagreed.

Already within a week of its publication, this study has grabbed many headlines. The public is interested because it concerns their rights as current and future patients and parents. They want to be seen and treated by doctors not as diseases but as whole persons -- whose humanity incorporates physical, emotional and spiritual dimensions.
Doctors care about this issue because it deeply matters how their judgments and actions affect the lives of vulnerable patients and families. When they feel coerced into delivering useless or harmful care, it can feel professionally corrupting and morally disturbing. Doctors also wish to be seen and treated as whole persons.

Talk about using the courts to settle disagreements about medical care seems to be gaining steam. In the U.S., we're also witnessing resurgent interest in devising hospital "futility" or "nonbeneficial treatment" policies that delineate a mechanism by which final decision-making authority is granted to doctors or hospital designees -- usually without patient or public involvement.

On one hand, it's unfortunate that we doctors and patients seem to be moving away from the bedside and closer to courts and policy documents to resolve our conflicts. Too often, that move is fueled by deep mistrust and failures of communication.

On the other hand, courts can offer patients and doctors a mechanism that allows the facts of an intractable dispute to be aired in broad daylight, under insightful legal consideration. The adjudicated cases could propose rules for everyone to follow and help to minimize future conflicts.

It often seems miraculous to me that we doctors and patients come to agreement in the vast majority of cases involving medical decision-making. Crossing religious and cultural and philosophical divides, in the end, we tend to reach a good-enough covenant over issues of life-and-death magnitude.

To get there, it helps to remember my old patient -- as a physician, to be reminded that science provides a valuable but partial tool; and as a patient, to realize that miracles shouldn't require the full-court press of modern technology to happen.
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Kate Scannell is a Bay Area physician, syndicated columnist and the author most recently of "Flood Stage."
Copyright 2012, Kate Scannell