In a Guest editorial (2006) in the Caribbean Medical Journal, Dr Leonard Bernstein, DMD, MPH stated that too often physicians wind up with a mindset that all diseases have to be treated as much and as long as possible to keep the patient alive. For many centuries the rise of this mindset persisted to the extent that the physician was culturally imbued with a sense of power. All too often this sense of power transferred into an authoritarianism – too often found in physicians today. This segued into a set of actions that treatment must go on in spite of the wishes of the patient and even family members. His intention was to to try to start a conversation about Dying with Dignity in Caribbean medical circles. Four bio-ethicists (Professor Hariharan Seetharaman, Associate Professor Satesh Bidaisee, Dr Darren Dookeeram and Dr Kareema Ali) produced quite a remarkable and lengthy response in a later edition of that same journal. In summary – they say – healthcare professionals are constantly faced with a challenging dilemma of deciding between the apparently conflicting needs to preserve human life and prevent suffering. While it is well understood that it is an extremely difficult decision to make, ultimately it is the decision that should rest with the patients, their relatives and the healthcare teams, who must engage in discussions in an honourable manner within the legal framework. We also understand that our viewpoint may not be exhaustive to cover every aspect of PAD, we sincerely hope that this may add material to the local discussion on this matter.
