The editor in chief of the Journal of the American College of Cardiology, (aka: JACC, the leading cardiology journal) has written an opinion statement concerning end of life care. He discusses a clear cut case of an elderly patient who is dying from advanced heart disease. He appropriately describes the transitioning of life prolonging treatment to supportive symptom relief known as palliative care. So far, not so controversial.
However, in the following paragraphs he goes on to discuss physician assisted suicide. How does choosing appropriate end of life supportive care focused on the relief of symptoms even remotely engender the idea of assisted suicide? This is outrageous. Physician assisted suicide is not palliative care.
The political firestorm of late concerning discussions of a patient’s goals of care at the end of life have morphed into the notion of “death squads.” This is preposterous. It is a fueled by misinformation. Every time I discuss implanting a defibrillator with a patient, it involves consideration of end of life goals, as a defibrillator interrupts a peaceful sudden cardiac death with a 750 volt shock. No death squads, just a discussion on goals of care.
It is sad that a leader in Cardiology has spread such misinformation on the choice of supportive palliative care. Why is this so relevant?
Patients are living so much longer, often with chronic diseases that in years past would have been fatal. Also, medicine, particularly cardiac care, has become so technologically advanced, that often times my most difficult decision is when NOT to apply these advanced therapies. How do I know when not to operate or prescribe a risky procedure?
I try to be a master of the obvious. I think, would I have recommended this procedure for Non or Gramps. A good test indeed.
The moving of catheters, leads and ablation of cardiac tissue to terminate arrhythmias is the easy part. Deciding on applying the technology in the best interest of the patient and explaining the decision tree is much harder.