Under the Dome Falsely Portrays End-of-Life Care

SPOILER ALERT!  Do not continue to read this post if you don’t want to know what happens in episode 13 of season two of Under the Dome: “Go Now.”

There are many portrayals of the practice of Medicine in entertainment.  As a physician I cannot help being a critic of these portrayals.  Some are better than others.  Normally it is just an issue of inaccuracy in the manner in which facts are established or the way a procedure is performed.  The mistake in the last episode of season 2 of Under the Dome was different from either of these errors.  Rebecca administers an additional dose of morphine to Pauline to treat her pain.  Pauline has already been mortally wounded, and Sam has stated that an additional dose of morphine could kill Pauline.  Pauline’s pain is resolved, but she also dies shortly after the additional morphine takes effect.

morphine injectionThis event is portrayed as a “mercy killing” or euthanasia.  It is not.  It is appropriate treatment for Pauline’s pain.  Any medical procedure or medication administration has potential benefit and potential harm.  This administration of morphine had the potential benefit of pain relief, a very likely benefit of pain relief.  It also had the risk of death, a very likely risk of death.  Both of these potential effects occurred.  It does not mean that Rebecca acted to kill Pauline.  She was treating the pain resulting from another terminal injury (bleeding from a stab wound).  That dose of morphine would most likely not have resulted in death had Pauline not been bleeding from the stab wound.  It was an unintended adverse drug effect.  That does not make the outcome any less serious for Pauline, but it does make a difference the morality of Rebecca’s act in giving the fatal dose.

This balancing of risk versus benefit is done every time a decision is made to treat a patient with a medication or procedure.  It is not unique to this circumstance.  It is just made more serious by the high likelihood of a result of patient death.  Both the patient and the person administering the treatment were fully aware of and accepted this as a risk of the treatment.    I want to be clear that I do not condone euthanasia.  Euthanasia is acting to hasten death in a way which does not potentially benefit the patient.  As a physician I have prescribed many potentially fatal medications after serious discussion with and agreement from the patient.  Such action has always been done because the potential benefit for the patient outweighed the potential risk of death, either because the risk of death was not likely or the current living state of the patient without treatment was so terrible.

This is not written on a medical blog because I care about the moral decisions of fictional characters.  It is written because we often have misunderstandings in the public regarding end-of-life care and hospice.  I want it to be understood than the provision of this kind of care to our patients is done with clear discussion between health care providers and the patient with their family.  We will provide desired treatment to achieve comfort for our terminal patients.  We never authorize or give a treatment for the purpose of hastening death.  It is actually rare that end-of-life treatment for patient comfort has a detectable impact on time of death.  We provide medicine to decrease or eliminate pain and anxiety as natural death occurs.

If you would like more information regarding hospice care in our area please contact Hospice Care through Sutter Auburn Faith Hospital.


Mark Vaughan, M.D. is the Medical Director and founding member of the Auburn Medical Group, an independent Family Medicine practice in Auburn, California. He speaks on general medical topics on the Auburn Medical Group YouTube Channel. His handle for Twitter and Instagram is @doctorvaughan.

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