“You Had To Be There …” Caring for a Patient to the End of Her Life

By David C. Leach

It has been more than thirty years since she first came to see me – a vital woman in her early seventies who had detected a lump in her breast on a self-exam. A diagnostic work up confirmed cancer and the smallish lesion was removed. It never recurred. By the time a second lump appeared in the other breast we had come to know each other. She was now in her late seventies and this lump also proved to be cancer. It was removed. Postoperatively in the hospital she looked a bit depressed.

She was not an alcoholic, however, she had told me that she enjoyed an occasional martini before dinner. I did something I had never done before and have never done since. I brought a Waterford crystal glass containing a nicely mixed martini to her hospital room. She accepted it without comment. We talked while she sipped. She told me that she had discovered and joined the Hemlock Society. In her words: “Dr. Leach, I know that given your lily white ethics you would never countenance euthanasia so I joined the Hemlock Society. I now know what to do and you needn’t trouble yourself.” I thanked her for her consideration and we talked briefly about her concerns and choices. In my opinion she was not at risk for suicide. She knew that this lesion also was small and with negative nodes would likely not recur. What she wanted was to be empowered to make her own life decisions. I assured her that she was. . .

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Surgical Bioethics: Is It Different?

By Wydell L. Williams, Jr.

Recently I was asked to give a talk on ethics to my surgical colleagues.  The Nevada Chapter of the American College of Surgeons has regular meetings and there are usually one or two speakers giving talks that are relevant to surgeons and their practice.  The speakers are usually academic surgeons or residents talking about their research or someone from the national level discussing policies that will affect our practices.  I was excited to be offered this opportunity because I felt that it was an acknowledgement of my recent degree in bioethics and would allow me to share with my surgical colleagues the concepts I learned.  Suddenly I realized that I was going talk to surgeons who sometimes view themselves as being compassionate, self-sacrificing, methodical, and confident but also can be dominant, brash, impersonal, egocentric, difficult and demanding.  So, I needed to find a topic that would appeal to the diverse surgical specialties and personalities that would be present.  I decided to look at the principles of bioethics and consider how they apply to surgery and do they apply differently from other specialties…
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