Dr. Clarkson was doing his best to honor his patients wishes. This was the part of the job that medical school had not adequately covered. There had been practical lessons done on cadavers, books to pore over, and lessons to be heard. However, the actual 'how-to manual' to deal with patients was covered in short two hour lecture which dealt mainly with philosophy. Donald Copely was dying, months ago his wife had brought him in for shortness of breath and a cough. Examination revealed a partially collapsed lung. With a steady hand Dr. Clarkson had guided a needle and drained off some fluid for testing. It had revealed cancer, the news did not sit well with Donald. He wanted to know what could be done. Options were discussed but there weren't many to choose from. His wife Iris brought him back to the hospital for she was overwhelmed. Influenza was running amok and the good doctor was also feeling overwhelmed. He had asked Isobel for help and she had come without a grumble.
Nearing the end of one of his morning rounds he was approached by Isobel, "Mrs. Copely has just told me that Mr. Copely wants no more drainages, no more exams."
"Well that's fine and well within his rights, but he just told me yesterday that he wants those things." Out of nervous habit Richard fiddled with his stethoscope. He flashed Isobel a smile before going to Mr. Copely's bedside.
The screens were moved and Clarkson came inside the enclosed space, "Mr. Copely, I want to discuss treatment with you."
The man in the bed seemed small, and his chest heaved with the effort to breathe. He looked up at the doctor, "I want everything."
Clarkson sat in a nearby chair generally occupied by Iris, "You want drainages, exams and medicine?"
"Yes." he affirmed.
"All right, nothing has changed I will carry out your wishes." With that he stood and went back to find Isobel. He found her comforting Iris, the brunette turned to him, "So you'll be stopping then."
Inhaling slowly he softened his voice, "That's not what he wants."
"But he just told me!" Iris nearly wailed. Instantly Isobel's hand went to the woman's shoulder rubbing soothing patterns on it.
Richard hunched down so he could look at Iris, "I believe you that he said it to you. I believe you, nonetheless I just asked him what he wanted and he wants treatment."
"But he-" Iris spluttered,
Again Richard's voice was soft, "And I believe you, we will make sure he is comfortable."
"Come on, lets have some tea." Isobel said softly and Richard was bloody grateful that she was here.
Later that evening both of them were in his office sharing a glass of brandy that one of the patients had brought the doctor in gratitude. Isobel had been rattled by the Copely incident and she needed to voice her thoughts. "Richard can I ask you something?"
The fact that she had used his name was not lost on him, and he set his glass down to give her his full attention, "By all means."
Isobel's finger pointed towards the door, "Have you ever done something in your medical career that might be seen as unethical. Mr Copely..."
"Are you referring to something like palliative sedation?" He asked.
Isobel could only nod.
"Do you mean have I ever done it?" he asked in quiet tone.
Once again Isobel could only nod.
Richard ran a hand through his hair musing it, "In all my years as being a doctor...Twice."
Snatching up his glass he drained it welcoming the burn as if to steel himself against his memories. "It is my purpose, my oath to ease suffering. "I have had two patients that during the active phase of their dying their suffering was so great that the dosage needed to alleviate their pain would put them under."
Isobel knew about this having been married before to a doctor. Many a night she found herself and Reginald by the fire discussing medicine. Reginald while being a doctor was focused mainly on research some of these agonizing decisions he had never had to make. For them it was a philosophical exercise which had begun when Isobel had read an essay by Samuel Williams. Her mind could still recall the passage
That in all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer chloroform or such other anaesthetic as may by-and-bye supersede chloroform – so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.
She shook her head and imbibed her own drink. She then switched topics to something a little less cerebral.
In the days that followed Donald Copely began to decline, his pain was increasing so much so that Iris became scared by it. Isobel became her constant companion, alway by her side, explaining things and offering comfort. Dr. Clarkson was swamped, with the flu in full force he was being thrown to and fro from home to home checking on patients. His overnight cot had become his oasis where he was able to snatch a few hours sleep before being called out again. On Friday he left before the sun had even risen and came back to the hospital well after it had set. He found the screens around Mr. Copely's bed removed. He grabbed the chart hanging at the end of the bed. Mr. Copely had died in the afternoon and Graspies had been notified and retrieved the body. Fishing a pen from his coat he signed his name on the bottom of the chart.
Crawley House was quiet, Isobel had given the servants the night off and since Saturday was their free day many had taken the train to go to the theatre. Isobel had boiled water in her kettle twice each time forgetting to put it into the brown pot to make tea. She was currently engaged in a debate with herself. The principle of double effect was rattling around in her mind the three points being repeated over and over.
1. the nature of the act is itself good, or at least morally neutral
2. the agent intends the good effect and not the bad either as a means to the good or as an end itself
3. the good effect outweighs the bad effect in circumstances sufficiently grave to justify causing the bad effect and the agent exercises due diligence to minimize the harm
Mr. Copely was actively dying, she knew the signs. She also knew that he was in agonizing pain. While Iris had been in the lavatory he had rasped to her, "enough...I've had enough." There was no amount of cool cloths or handholding that could soothe him. Making a decision she rose from her chair and went to the medicine cabinet.
Richard had rang the bell, when no one had answered he had pushed on the door to find it spring open. The lights were on and he could feel warmth from the fire lit within. He stepped inside and then leaned on the door to close it quickly securing it behind him. He found her in the drawing room staring into the fire. Even though she couldn't see him yet she knew he was there and somehow he knew that too. "What can I do?"
She turned to him and he saw that she wasn't distraught, she was calm and reflective. "Make me feel alive, I know you can."
Richard stood rooted on the spot, he didn't want a one night stand to relieve tension but he didn't want to abandon her either. She could see his hesitation and she extended her hand to him, "Today was a catalyst for me, I've wanted you for a long time. The effect of good you would bring to me outweigh the bad."
Richard was curious, "What bad would there be from having me?"
"The pain of eventually losing you." She answered and he understood, she had lost her first husband and her son. She was trying to stop future pain by sacrificing present happiness.
"May I take you to bed?" He asked.
"Yes." she answered softly.
"Will you let me undress you?" He asked as his nose nuzzled hers.
"Yes" she answered shakily, feeling warm at his words.
A kiss to her temple, "Will you let me make love to you?"
"Yes" she answered as she kissed his cheek.
"Will you let me love you?" He asked in all seriousness.
Her hand gripped his before placing over her breast so he could feel her heart, "Yes."
The fire crackled loudly as they came together for a kiss. While fraternizing with nurses was frowned upon Richard did not consider this to be his third unethical act as a doctor.
A:N/ Two of my roommates during my undergrad days were studying to be nurses. We discussed ethics. The passage Isobel recalls is from Essays of the Birmingham Speculative Club. The three points are from the Principle of Double Effect.