LETTER
Nonabandonment: Medical Ethics
Michael Levy, MD
15 September 1995 | Volume 123 Issue 6 | Page 475
The article by Quill and Cassel on nonabandonment [1] has nothing to do with abandonment. The first patient described was a woman who refused to accept her diagnosis and its implications. It is one thing to support patients but quite another to give them false hope and prolong the agony of their death. There is no justification for giving parenteral nutrition to a patient dying of cancer simply because they could not accept their diagnosis. It appears that the patient spent a considerable part of the end of her life in agony, with no benefit to her. Her life would have been much more comfortable and shorter if total parenteral nutrition had not been given and if she had been placed in a hospice earlier. Her physicians seem to have allowed her to manage her course and completely control her treatment.
As far as the second case is concerned, I hope that we do not need multiple references to remind us to be compassionate. I hope that many of us have learned not to argue with patients about their medications that seem to keep them comfortable and do not do them any harm. A resident who comes out of training proclaiming that he or she is never going to give patients benzodiazepines quickly learns that at times it is the right medication, even when the reasons are not academically pure.
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Author and Article Information
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Park Nicollet Medical Center; Minneapolis, MN 55416
1. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995; 122:368-74.
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