My last post, riffing off a report that physicians may have euthanized some patients in a New Orleans hospital during Katrina caught a fair amount of heat for promoting a news story which was, in the eyes of some, an urban legend. One of my more–umm, hyperbolic admirers– has some choice words about my decision to lend credence to this obviously fraudulent story, drawing the conclusion that I am a moron seriously in need of growing a brain, and a threat to my patients’ health and well-being. Well, you can’t please all the people all the time–and no suggestions on just how to grow a brain were proffered, so I guess I am on my own there. But criticism–never pleasant–can be both cathartic and corrective, as indeed it was in this case. And so I thought a few words of reflection on that post might be in order.

First, when I first ran across this report in The Mail, a British tabloid, I was alarmed that it might have occurred, and frankly found the story at first generally plausible (perhaps a bias on my part to believe it existed), but nevertheless found it suspect in some regards. British tabloids are not known for accuracy in their sensationalism–lagging behind even the NY Times in this regard. It appeared to be single-sourced, and only one named witness was given. The witness was separately mentioned in another, unrelated story quoted on the BBC, as a British citizen living in a town near New Orleans, and plausibly involved in relief efforts there, lending some credence to the story. Other aspects of the story seemed very odd–the pharmacy lockdown, the use of high-dose morphine to kill (potassium chloride or barbituates are much more efficient), and the oddness of having a non-medical emergency worker notify the families. Based on these reservations and the single source, I twice expressed some reservations about the story’s veracity. This was clearly not enough skepticism for some, but I trust my readers’s intellects and instincts, and doubt any would be misled to believe the story was absolutely verified. For those who may have come to this conclusion, let’s be clear:

I do not know if this story is true–in fact, there is substantial reason to doubt that it is, and that doubt is growing.

Over the past day or so I have been following the story on the web. It has been repeated almost verbatum in several British, Australian and Canadian papers–often without attributing The Mail as its source. But nothing in the States, nothing from the affected families or local population. To date, Snopes has nothing, pro or con, on the topic. Orac–whose skeptical birddogging of alternative medicine and thoroughness in debunking all things mythical, has an excellent summary of the information to date, and comes down (not surprisingly) on the side of urban legend. Even the crowd over at Democratic Underground are bouncing this one around with some skepticism (odd for this conspiracy-loving crowd–although if it did happen, it was Bush’s fault), which is summarized here.

So why run an iffy story like this as a basis for a commentary on physician-assisted suicide? Well, several reasons: I was at first, less skeptical about the story than I am now–and probably less skeptical than I should have been. Secondly, it was an easy framework in which to comment and discuss many of the issues surrounding euthanasia. How could an urban legend be the legitimate basis for such discussion? The answer, I believe, is simple–and is the reason this story has sustained a life of its own on the web, even if legend: quirks and odd details notwithstanding, the scenario is entirely plausible.

First of all, voluntary and involuntary physician-assisted suicide is already a reality in this country–although it is rare, and much of it is underground. An anonymous survey of over 3100 physicians published in 1998 in the New England Journal of Medicine cited the surprisingly high incidence of physicians who had considered–or performed–assisted suicide: 11% said they would be willing to administer a lethal medication to a patient who asked, even if illegal; 7% would be willing to administer a lethal injection themselves; and nearly 5% stated they had already administered such a lethal injection. Significantly higher percentages said they would consider such a recourse if it were legal. It should be noted that this was not a cross-section of all physicians, but the survey was directed at those involved in terminal care. A smaller survey in JAMA, also in 1998, revealed that nearly 16% of oncologists had participated in active euthanasia–and over 15% of these cases were involuntary (i.e., without patient request). Oregon’s Death with Dignity Act was passed in 1994, and as of 2004, 208 patients have died from a prescription for a lethal dose of barbituates given them legally by their physicians (Oregon physicians are not allowed to directly administer lethal oral or injectable medications). The incidence of unreported physician-assisted suicide (PAS) is impossible to gauge–in part because of the grayness of deaths due to high-dose opiates in terminal cancer pain, which may be either incidental or intentional. But there is fairly widespread support among physicians for some sort of PAS–with as many as a third supporting the idea, at least at the theoretical level.

Furthermore, anyone who has any experience discussing euthanasia with proponents or listening to such debates will have heard every single argument put forth by the anonymous physician in the New Orleans story. We hear about “death with dignity”, “compassion” “they are going to die any, so why not be merciful?” And who would doubt, should such a scenario occur, that the media would be apologists, to prevent exposure if possible to those who committed such acts lest they be “scapegoats”? This story–true or fabrication–embodied the bulk of the rationalizations and arguments of those who support assisted suicide or active euthanasia, and therefore served–even if fictitious (and I surely hope it is)–as a hypothetical framework for addressing these points.

I will in the future be more cautious about such stories–even when they prove a teachable moment, and I apologize if any of my readers were led to place more credence in this story than it appears to merit at this time.

And one more comment–about comments: I continue to marvel at how absolutely clueless and disrespectful some commenters can be. Believe it or not, it is possible to disagree–even passionately–with another individual with insulting them personally or questioning their integrity. The anonymity of the web allows–even encourages–such abrasive discourse, seemingly without consequence. And I generally try to tolerate such excesses in comments, up to a point. But though you are anonymous, your character shines through when you resort to personal attacks and character assassination. The chances that your point or position–whatever it may be–will be heard and considered, by either me or a reader, drop like a rock. And a life lived stewing in a cesspool of anger and hatred–popping your head up only long enough to throw an anonymous turd at someone you do not know, but detest anyway–will be its own reward. I may listen, I will pray for you–but have little interest in giving you a soapbox for your arrogance and condescension. Folks like you have nothing positive to add to life–and the rest of us tune you out immediately. So keep it civil, folks–the Delete Comment button is just too easy to hit.