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LETTER
Nonabandonment: Medical Ethics
Del J. DeHart, MD
15 September 1995 | Volume 123 Issue 6 | Page 475
Quill and Cassel [1] distort nonmaleficence until the physician faces the conundrum of choosing between the "harm" of disease and the harm of best treatment. I do not see how either author could believe they had any part in choosing the harm of disease in the cases they presented. In their world, they would have the physician assume personal responsibility for disease, responsibility for the "harm" of death itself. In reality, it is the patient who faces the conundrum posed by mortal disease, death by disease or death by choice, and no amount of physician empathy can spare the pain of that harsh reality. Empathy is not a sparing of pain but a sharing of it. Despite their appeal for "innovative solutions," death will remain the "disintegration and humiliation" of us all, and it is a serious misreading of the hospice movement to think that we can alter this. Even posing such a question as "... or is it worse to force them to continue to suffer against their will" belies a troubling condescension, both toward patients (in the light of autonomy) and most of their colleagues, those of us who are also holding hands, wiping brows, sharing tears, cursing the damn unfairness of disease, yet all the while resisting the urge to redesign ethics to comfort our psyches.
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Author and Article Information
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Michigan State University; Saginaw Cooperative Hospitals, Inc.; Saginaw, MI 48602
1. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995; 121:368-74.
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