In this program we explore the issues around medical science that are forcing us to define life, death, quality of life and patient rights. We confront the moral and ethical questions that arise when facing critical healthcare decisions. Part 3/4
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Host: The discipline of bioethics is essential to our progress toward understanding how to deal with the monumental questions in our lives; quality of life, birth, reproduction, equal access to medical care and death. Individuals, private corporations and our governmental institutions need to sort through the many issues that our medical progress is creating. Next, we’re going to explore the ethical questions that we face when making critical decisions about terminally ill patients. When do we reach the limits of medicine? How much pain medication should be administered to patients in agonizing pain even when there could be a risk that it could hasten death? Male: While modern medicine can sometimes provide solutions which seem extraordinary, there will always be a point where we much accept that there is a limit to what medicine can offer and we must face our mortality. George F. Blackall: When we think about end of life decisions and we think about what are the primary goals in medicine in helping our patients, certainly, one of the primary goals of medicine is to preserve life and extend life but another important goal and you could also say a primary goal is the relief of suffering and sometimes, those two goals can intersect and there’s a time where the preservation of life may no longer be a realistic goal and in that, then you have to decide how to relieve suffering in the face of end of life. Male: Dr. Blackall has worked as a Pediatric Psychologist with children suffering from cancer and has witnessed the physical and emotional distress and pain. George F. Blackall: There’s a whole multitude of sufferings and when you look at how we help people with that, certainly the oncologist use their, if you will bag of tricks to relieve the physical suffering with the combination of both how they do their procedures, decisions they make about interventions for the child, medications to relieve pain, medications to prevent or relieve other very distressing symptoms like nausea and vomiting. Male: Dr. Blackall acknowledges that the entire situation is emotionally charged. Children and parents develop fears that have to be addressed but he sees children as being highly resilient with tremendous coping skills. George F. Blackall: They go through this period of intense adjustment but over time, what seems like an impossible task becomes a normal part of their life. They adapt, they smile, they come to the clinic, in the hospital and they interact with staff and they’re playful. They had this incredible capacity to adapt and this resilience that keeps bouncing back and that’s an important thing. When we talk with parents about their concerns for their child, certainly from the emotional suffering side, one of the things that we as parents to look out for is, “Has their child lost their resilience? Has their child lost their ability to bounce back?” Male: When medicine has reached its limits, doctors face decisions around pain management and another ethical issue arises according to Dr. Berg. How far should doctors go to treat the pain? What are the legal and ethical implications of pain management? Jessica Wilen Berg: I think there are probably two big areas that we’re seeing a concern of physicians, one is in pain treatment. Because we have seen an increased in prosecutions against physicians for inappropriate use of pain medication, there is clearly a hesitancy to prescribe significant amounts of pain medication. Male: Pain management becomes complicated according to Dr. Berg because people can respond very differently to the same dosage of medication. Because there is a fear by doctors of over medication with legal ramifications, doctors tend to go in the other direction. Jessica Wilen Berg: Which means that you’re basically sending a signal to physicians to undertreat pain, which is really problematic since we know that we already undertreat pain. So, you probably don’t want to make it harder for physicians to actually treat pain

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