Saturday, October 1, 2011


“I’ve been treating this sixty-year-old woman for emphysema. She's on some meds, plus oxygen at home. She’s smoked a couple of packs of Camels every day for the past forty years, and you know what? She won’t stop. She takes a drag from her cigaret, then one from her oxygen mask, back and forth. I’m tempted to fire her. I mean, this is ridiculous. She claws back any advantage I can give her. What do you think I should do?”

This was asked of me by a physician friend who’s aware of my interest in medical ethics. What would you do? Me, I’ve learned generally to answer every question with another question.

I said, “Well, you’ve thought of firing her. Why haven’t you?”

“I’d feel awful. She’s doing herself in, but she’s still my patient.”

“What does it mean to you—that she’s your patient?”

“I’m her doctor. I guess that means I’ll stand by her no matter what. This is really beyond what I was trained in, diagnosis and treatment. What I’m doing with her is only palliative.”

Only palliative?”

“I’m not a hospice doctor. I don’t do palliative.”

“You don’t?”


  1. What a great blog! Yes, that is an interesting question to raise....

  2. "Only palliative?" That question says it all.

    At this point, kindness and mercy, compassion and dropping all cloaks of judgment are all that matter. That said, I can only imagine how tough it must be for your colleague. When my mom was dying of emphysema, I couldn't help but feel angry that she was leaving me because she couldn't or wouldn't quit smoking. But there is time for those emotions later (in psychotherapy...). When someone is dying, they deserve love, hope, acceptance.

    You know. Of course. Your colleague likely knows too.

  3. Next question to the doctor: Does palliative care = hospice care?
    And thus the next question lingers: how many doctors even know what palliative is?