We discuss the issue of when to help a patient die. Doctors of our generation are not newcomers to this question. Going back to my internship days, I can remember many patients in pain, sometimes in coma , with late, hopeless cancer. For many of them, we wrote an order for heavy medication--morphine by the clock. This was not talked about openly and little was written about it. It was essential, not controversial. The best way to bring the problem into focus is to describe two patients whom I cared for. The first, formerly a nurse, had an automobile accident. A few days later her lungs seemed to fill up; her heart developed dangerous rhythm disturbances. So there she was: in coma, on a breathing machine, her heartbeat maintained with an electrical device. One day after rounds, my secretary said the husband and son of the patient wanted to see me. They told me their wife and mother was obviously going to die; she was a nurse and had told her family that she never wanted this kind of terrible death, being maintained by machines. I told them that while I respected their view, there was nothing deadly about her situation. The kidney  failure she had was just the kind for which the artificial kidney was most effective. While possibly a bit reassured, they were disappointed. Here was the head surgeon seemingly determined to keep everybody alive, no matter what. Within a few days the patient's pacemaker  could be removed and she awoke from her coma. About six months later, the door of my office opened and in walked a gloriously fit woman. After some cheery words of appreciation, the father and son asked to speak to me alone. As soon as the door closed, both men became quite tearful. All that came out was, "We want you to know how wrong we were." The second patient was an 85-year-old lady whose hair caught fire while she was smoking. She arrived with a deep burn; I knew it would surely be deadly. As a remarkable coincidence there was a meeting for discussion going on at the time in medical ethics . The speaker asked me if I had any sort of ethical problem I could bring up for discussion. I described the case and asked the students their opinion. After the discussion, I made a remark that was, when looking back, a serious mistake. I said, "I'll take the word back to the nurses about her and we will talk about it some more before we decide." The instructor and the students were shocked: "You mean this is a real patient?" The teacher of ethics was not accustomed to being challenged by actuality. In any event, I went back and met with the nurses. A day or two later, when she was making no progress and was suffering terribly, we began to back off treatment. Soon she died quietly and not in pain. As a reasonable physician, you had better move ahead and do what you would want done for you. And don't discuss it with the world first. There is a lesson here for everybody. Assisting people to leave this life requires strong judgment and long experience to avoid its misuse. The first patient's husband and son wanted the doctor  _  .
to save her life to end her life use an artificial kidney to maintain her life with machines