A Matter of Conscience

THE 1944 classic movie Arsenic and Old Lace depicted the rapid death of several elderly men after drinking elderberry wine spiked with arsenic. The movie epitomizes the common perception that arsenic is always a fast-acting, lethal poison. In fact, the sudden deaths portrayed in the movie were due, not to the arsenic, but to the strychnine and the cyanide that were also added to the wine cocktail.

“The manifestations of arsenic poisoning are typically not acute,” writes Dr. Robert E. Gallagher in The New England Journal of Medicine. He does add, however, that “arsenic poisoning due to contaminated drinking water and industrial pollutants is a serious public health problem in many parts of the world, where it predisposes people to a variety of diseases, including skin, bladder, lung, and liver cancers.”

Given the above information, it is understandable that health-care providers would not normally consider prescribing arsenic as a form of treatment. But follow this experience from Canada carefully. Notice how when blood transfusion and then arsenic were proposed as treatments, a clash of conscience developed between a patient named Darlene and her doctors, nurses, and the pharmacist involved. Darlene tells her story this way.

“In May 1996, I had some problems with severe bruising, hemorrhaging, and unusual bleeding of the gums. My hematologist, Dr. John Matthews, in Kingston, Ontario, diagnosed the problem as a rare type of cancer called acute promyelocytic leukemia (APL). After a series of tests, including a bone-marrow diagnostic, Dr. Matthews in a very kind manner explained what APL is and how the problem is treated. The normal treatment protocol included a blood exchange along with chemotherapy, but my Bible-trained conscience would not allow me to accept blood transfusions.

“Rather than lose precious time by trying to change my mind, wisely the doctors made a search for another medical treatment. The modified treatment involved the use of a vitamin-A derivative, in combination with moderately intensive chemotherapy. My leukemia went into remission for three months, only to return with a vengeance. The pains in my head, caused by the swelling of the brain, were unbearable. Furthermore, I had built up a resistance to the treatment. It was then that the doctor informed us that without blood transfusions there was no treatment for me. We were told that I had less than two weeks to live.

“The next few days were frantic, with more blood tests, visits to the lawyer about my will, and funeral arrangements. During this interval Dr. Matthews told us of an unusual medical therapy used successfully by medical doctors in China for APL, which had been reported on in respected scientific journals such as Blood and Proceedings of the National Academy of Sciences. While doing research, the doctor and a colleague had  read in a medical journal that ‘it will probably come as a surprise to many that arsenic trioxide has been used successfully in intravenous form, with limited toxicity, for the treatment of acute promyelocytic leukemia (APL).’

“Now there were two options—either violate my conscience and accept a blood transfusion or take this little-known treatment with arsenic. I chose the arsenic treatment. * Little did I realize the turmoil of conscience that would touch doctors, nurses, the pharmacist, and even hospital officials.

“The hospital subsequently checked with regulatory authorities to confirm that arsenic trioxide could be administered. Only then could they permit such treatment to proceed. Initially the pharmacist was reluctant to cooperate, since in good conscience he questioned its safety. My attending physicians, Dr. Matthews and Dr. Galbraith, had to make convincing and positive presentations on this treatment. Eventually, being presented with sufficient medical evidence about the treatment, the hospital authorities and the pharmacist felt that they could cooperate.

“The pharmacist agreed to prepare the arsenic product and sterilize it for immediate infusion. But now the collective conscience of the nurses would not allow them to hang the intravenous bag of the controversial substance. They stood by as the doctors hung several units of the solution themselves. The nurses pleaded with me to take blood. They were convinced that I would die, so I appealed to their professionalism, asking them to respect my conscientious refusal of blood. I expressed my gratitude, put my arm around them, and asked them to put their personal feelings aside. We maintained a good relationship. The arsenic trioxide treatments continued for six months, and I recuperated well. The doctors then agreed that I could have the balance of the treatments at home.

“Arrangements for home visits were made with the Victoria Order of Nurses, who administer home-care services. Again the matter of conscience came into the picture. They too were reluctant to administer the solution. Meetings, letters, and medical articles from respected medical journals turned things around. The nurses subsequently consented to cooperate. In September 1997, my treatments were completed.

“Oh, yes, my kind of cancer can come back. The doctor says that it is like living on a time bomb. But I have learned to find joy with each passing day, never forsaking my place of worship and keeping busy sharing the Bible-based hope of a time when ‘no resident will say: “I am sick.”’”—Isaiah 33:24.

Medical professionals have a weighty responsibility in providing quality health care. They generally take this seriously and conscientiously proceed with treatment within the bounds of their expertise and current knowledge. As this experience bears out, doctors, nurses, and other health-care professionals can accomplish much by remaining flexible and sensitive to the convictions and conscience of the informed adult patient.

[Footnote]

[Picture on page 20]

Darlene Sheppard