To the Editor:
Re “My Patient Was Making a Fatal Decision, and I Couldn’t Stop Him,” by Daniela Lamas (Opinion guest essay, Dec. 5):
As a physician, now retired after 43 years of practice, I admire Dr. Lamas’s thoughtful and sensitive writings on the challenges and dilemmas physicians face — in this case, dealing with patients and families who have a deep distrust of doctors and medicine.
It seems apparent that the young man who refused Dr. Lamas’s advice to allow the implantation of a pacemaker would have refused any available life-prolonging intervention. But this story is not just about this patient — it illustrates something larger going on in our society as well.
In his seminal 2004 book, “How Mumbo-Jumbo Conquered the World,” Francis Wheen describes the flight from reason that was taking place in every area of human endeavor. By now, 21 years later, conspiracy theories and nonsense have become so pervasive that one is obliged to frequently reorient one’s own sanity.
Anger at authority, along with its attendant acting out of hostile fantasies, is no longer the sole province of toddlers — it has become, thanks to our current political environment, accepted and normalized.
And just as in the tragic case of Dr. Lamas’s patient, the fact of his having consistently clung to his long-held self-destructive beliefs didn’t make his behavior any less pathological. I have had such patients even recently, who for reasons of distrust elected death over treatment. One fears that our entire nation may be just such a case.
A changing climate, a changing world
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Climate change around the world: In “Postcards From a World on Fire,” 193 stories from individual countries show how climate change is reshaping reality everywhere, from dying coral reefs in Fiji to disappearing oases in Morocco and far, far beyond.
The role of our leaders: Writing at the end of 2020, Al Gore, the 45th vice president of the United States, found reasons for optimism in the Biden presidency, a feeling perhaps borne out by the passing of major climate legislation. That doesn’t mean there haven’t been criticisms. For example, Charles Harvey and Kurt House argue that subsidies for climate capture technology will ultimately be a waste.
The worst climate risks, mapped: In this feature, select a country, and we’ll break down the climate hazards it faces. In the case of America, our maps, developed with experts, show where extreme heat is causing the most deaths.
What people can do: Justin Gillis and Hal Harvey describe the types of local activism that might be needed, while Saul Griffith points to how Australia shows the way on rooftop solar. Meanwhile, small changes at the office might be one good way to cut significant emissions, writes Carlos Gamarra.
Kenneth R. Rubin Cliffside Park, N.J.
To the Editor:
Being a physician would be easy if patients always followed our advice. But a patient’s right to choose includes making a decision different from the one the physician believes is best.
The hospital can be overwhelming to patients. I believed that it was my responsibility to be my patients’ advocate. When physicians browbeat patients to change their minds, they become adversaries.
If a patient refused a procedure I recommended, I acted within the limits that patient allowed. Asking family members to intervene was complicated. At times, the family members argued among themselves or insisted that I follow their wishes, and the situation became messier.
Death is a tragedy. A person’s last days shouldn’t be an even greater one.
Michael Streicher Chicago The writer is a retired thoracic surgeon.
To the Editor:
I am a psychologist with a clinical specialty in ethical decision making. This, however, does not prevent me from experiencing painful quandaries, as there are situations that, to me, offer no acceptable choice.
In her role as this patient’s doctor, Daniela Lamas displayed unwavering rectitude, guided by values, ethics and expertise. It is a fallacy to believe that doing right prevents unwanted outcomes, as it assumes we have more power and control than we do. When the going gets tough, those of us who provide compassionate and ethical care can be forces of nature, but that does not mean we can always turn the tide.
Dr. Lamas: If you had not been persistent in your efforts to change your patient’s mind, you would have left without ever knowing if you could. The outcome of your interventions was not knowable.
Sometimes our quest needs to broaden, to include learning how to be with the perceived tragedy of our patients’ choices. This is not failure (though we do fail). It is sorrow.
Jilisa Snyder Pownal, Vt. The writer is a senior psychologist at the Brattleboro Retreat, a mental health hospital.
How Farmers Can Slow the Climate Crisis
To the Editor:
Re “A Hotter Italy Puts a Strain on Cows, Milk and a Prized Cheese” (news article, Nov. 20):
In the examples of Italian cheesemakers and milk producers featured in this article, we see how hot weather is extending beyond summertime to threaten the food on our tables year-round. It’s proof that producers like these are on the front lines of the effects of climate change — but they are also part of the solution.
Because methane is such a potent but short-lived pollutant, lowering our emissions of it will pay off in our lifetimes. More than 30 percent of global human-caused methane emissions come from livestock. That makes farmers potentially key actors in slowing warming and building resilience.
Extreme and variable weather from climate change will continue affect all of us. To secure the future of farmers and the nutrition of our neighbors, we need to make science-backed methane mitigation and heat stress adaptation solutions accessible to the farmers experiencing climate effects every day. They can’t do it alone.
Britt Groosman New York The writer is a senior vice president for agriculture, water and food at the Environmental Defense Fund.
The post When Patients Lose Faith in Medicine appeared first on New York Times.
