Wediscusstheissueofwhentohelpapatientdie.Doctorsofourgenerationarenotnewcomerstothisquestion.Goingbacktomyinternship（实习）daysIcanremembermanypatientsinpainsometimesin
Wediscusstheissueofwhentohelpapatientdie.Doctorsofourgenerationarenotnewcomerstothisquestion.Goingbacktomyinternship（实习）daysIcanremembermanypatientsinpainsometimesincoma(昏迷)withlatehopelesscancer.Formanyofthemwewroteanorderforheavymedication—morphine(吗啡)bytheclock.Thiswasnottalkedaboutopenlyandlittlewaswrittenaboutit.Itwasessentialnotcontroversial.
ThebestwaytobringtheproblemintofocusistodescribetwopatientswhomIcaredfor.Thefirstformerlyanursehadanautomobileaccident.Afewdayslaterherlungsseemedtofillup;herheartdevelopeddangerousrhythmdisturbances.Sothereshewas:incomaonabreathingmachineherheartbeatmaintainedwithanelectricaldevice.Onedayafterroundsmysecretarysaidthehusbandandsonofthepatientwantedtoseeme.Theytoldmetheirwifeandmotherwasobviouslygoingtodie;shewasanurseandhadtoldherfamilythatsheneverwantedthiskindofterribledeathbeingmaintainedbymachines.ItoldthemthatwhileIrespectedtheirviewtherewasnothingdeadlyabouthersituation.Thekidney(肾)failureshehadwasjustthekindforwhichtheartificialkidneywasmosteffective.Whilepossiblyabitreassuredtheyweredisappointed.Herewastheheadsurgeonseeminglydeterminedtokeepeverybodyalivenomatterwhat.
Withinafewdaysthepatient'spacemaker(起搏器)couldberemovedandsheawokefromhercoma.Aboutsixmonthslaterthedoorofmyofficeopenedandinwalkedagloriouslyfitwoman.Aftersomecheerywordsofappreciationthefatherandsonaskedtospeaktomealone.Assoonasthedoorclosedbothmenbecamequitetearful.Allthatcameoutwas"Wewantyoutoknowhowwrongwewere."
Thesecondpatientwasan85-year-oldladywhosehaircaughtfirewhileshewassmoking.Shearrivedwithadeepburn;Iknewitwouldsurelybedeadly.Asaremarkablecoincidencetherewasameetingfordiscussiongoingonatthetimeinmedicalethics(道德).ThespeakeraskedmeifIhadanysortofethicalproblemIcouldbringupfordiscussion.Idescribedthecaseandaskedthestudentstheiropinion.AfterthediscussionImadearemarkthatwaswhenlookingbackaseriousmistake.Isaid"I'lltakethewordbacktothenursesaboutherandwewilltalkaboutitsomemorebeforewedecide."
