Medical Ethics and the Stewardship of Life
What should the relationship between doctor and patient be?
There are two different kinds of conversations that take place. There are pediatricians who go to parents at a most difficult time. Picture the emotional situation. You've been waiting for nine months. All that's in your mind is the Gerber baby with the pink cheeks, but what you've got is what they call wrongful life. In this emotional disappointment the physician comes in and explains that the baby will not have a life worthy to be lived and that he thinks it should not be fed. That is a terrible decision to have a mother and father make about their own child. If they're dealing with a pediatrician who would like to see all children born normal, but if they're not born normal he'd rather see them die, as I would not, then you get one kind of information. Some intensive care physicians in newborn nurseries claim that 14 per cent of their patients die because treatment was deliberately withheld. If this were twenty-five years ago, I would say that a lot of doctors would have done this reluctantly. But that's not the case now. When I first came into this branch of surgery, I was the sixth person in the country who practiced pediatric surgery exclusively. When I came to this hospital there were babies who died without a surgical consultation—babies that I could have fixed. A lot of people think that the deformity they see is a lethal one. It's not. These children live on and on. Even if you don't feed a child it sometimes takes a month for it to starve to death. The film Who Shall Survive, put out by Johns Hopkins, showed the decision-making process on the part of the staff and the family to let a mongoloid child with intestinal obstruction die. The intestinal obstruction could have been fixed by a twenty minute operation, which has about a 98 percent effectiveness. Mongolism is not curable. Mongoloid children are mentally deficient; some are educable, some are not. They are loving, cute little kids, but a great burden to their parents. So they decided that they would let this child die.
They put the baby in a corner of the ward and hung up a sign that said "nothing by mouth." It took twenty-eight days, as I recall, for the child to die. When this film was showed at the Kennedy Center I am told that a jury of twelve men not only condemned the decision but also the inhumane way in which it was done.
How do you deal as a Christian and doctor with the distrust many people feel toward doctors?
I deplore the attitude that the doctor knows it all and doesn't consider the patient capable of understanding his explanation. I am on the side of the layman when he has a physician like this. I can't think of anything more reprehensible than the attitude of that kind of physician. I approach a family as intelligent human beings who are entitled to know everything they can understand about their child and his problem. I draw pictures on the wall of my examining room to explain things. They and I are allies against the disease that affects their child. I seldom have a distrusting parent. The rapport that I have with parents is great and when something goes wrong they don't say, "This is the fault of that magician Koop, who hasn't told us anything." They say they knew this was one of the possibilities. We have a law that says that a patient is entitled to informed consent. But it has always been my position as a Christian physician that it was a Christian's obligation to give the information to his patient that permitted his consent to be informed.