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On Being a Doctor |

Death with Dignity: A Case Study

Walter J. Kade, MD
[+] Article and Author Information

Editor's Note: The family of the patient described here gave permission to publish this report. At the family's request, however, the author agreed that his real name would not be used. Walter J. Kade is a pseudonym.


Ann Intern Med. 2000;132(6):504-506. doi:10.7326/0003-4819-132-6-200003210-00014
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I voted twice against legislative measures in Oregon that would allow physician-assisted suicide. Within months after the Death with Dignity Act became law, I received a call from the parents of a patient of mine requesting that I assist their daughter in her suicide.

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Death and Dignity and Decision
Posted on September 16, 2004
Ashish Goel
AIIMS, New Delhi 110058
Conflict of Interest: None Declared

Who is the best judge of my suffering if not me myself? What is the scale to measure suffering? Is a common scale valid or the scale has to be individualized for every patient? Is the suffering of an uncomplaining patient dying of motor neuron disease, who is completely alert to his surroundings and his misery more or less than a patient of stroke, who has lost the ability to comprehend the surroundings and his own self? Is the suffering of a patient with tetanus throwing spasms in any way more than that of one with encephalitis? Or let me give a more blatant example. Is the suffering of a patient with terminal cancer pain more than someone with a toothache? Really? Who decides? The patient who is suffering or the doctor who stands at the side and has never experienced either? What is suffering and when does is become intolerable? Does intolerability of suffering depend on tolerance threshold of the individual? Is this threshold different for each individual? Who decides when I should die? Who decides whether I have gone so far beyond that there is no point in resuscitating me? Who decides that the life of a patient with stroke is less important than that of a young patient with snake bite of the neuroparalytic kind?

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