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Why Not Choose Death?

There can only be dignity while we live

 

New Jersey may soon vote whether to give doctors the legal authority to prescribe medications for terminal patients to take, if they wish, to commit suicide.  Incredibly, the macabre name of this bill is the “Death with Dignity Act.”  As an oncologist, as the first hospice certified physician in the state, as a caregiver who has sat at the final bedside of thousands, let me declare emphatically - There is no dignity in death.  Death is dead.  Death is not an action or process.  Life is the process and there can only be dignity while we live.  As long as our focus is on getting to death by the quickest route, we risk depriving the living of the opportunity to live with dignity.

The NJ Home News Tribune (Sunday 11/25/2012) presented four excellent views on whether this bill should receive our support.  Reduced to each argument's essence these opinions are: 

  • Rev. Bill Neeley (Unitarian): Choosing the time of one’s death, especially if one is suffering and terminally ill, is a matter of personal freedom and for intellectually intact patients should be an option.
  • Rev. Michael Manning (Catholic): Only God can chose the time of death, the bill threatens the physician-patient relationship and may be a slippery slope.
  • Roseann Sellani (RN, JD): Having this choice would improve honest communication about end-of-life between patients and doctors and give a vital freedom.
  • Donald Pendley (Hospice): The bill devalues the importance of life and distracts from efforts to provide pain and symptom control. 

What is being said, in other words, is that because doctors communicate badly, or at least insufficiently, about end-of-life issues, and because doctors provide erratic and often inadequate comfort care for terminal patients, that patients should be given the freedom, and assistance, to die.  In addition, this argument hinges on the concept that for large numbers of patients, quality, near the end-of-life, is not possible.  Therefore, this bill deems it reasonable to turn to your doctor and say, “listen, I do not believe you can help me live, why don’t you just help me die.”

This logic is flawed and places patients in great danger.  The first error is to assume that doctors do not and cannot communicate well about dying.  There is no doubt this is an area where the physician-patient relationship often breaks down, but there is also no doubt that it is an increasing focus of education and learning.  Medical students now routinely take classes in end-of-life care, physicians are much more focused on the skills necessary and the specialty of Palliative Care, for which communication is a core skill, is exploding.  For most patients and families, basic information about their situation relieves much suffering and confusion.  Doctors can do better.  We must demand it. 

The idea that most patients experience uncontrollable suffering at the end of their lives is without foundation.  With proper palliative care more than 90% of pain can be controlled, we can relieve anxiety (i.e. fear), shortness of breath, depression and most other symptoms.  In fact, recent data shows that many terminal cancer patients not only live better, but longer, receiving hospice care rather than active chemotherapy.  This bill deprives patients of these highly effective techniques by giving up and says to the physician there is no need to offer quality care, death will do. 

Is suicide an individual freedom?  That is an ethical question far above my pay grade.  However, that is not the freedom proposed.  What is proposed is “physician-assisted suicide.”  That involves two people and their relationship and I have absolutely no doubt that the relationship will be corrupted.  Having been involved in such interactions every day for decades, if the active reach for death is on the table, the physician-patient relationship will never be the same.  Physicians and patients already struggle with end-of-life communication; I cannot imagine that trust will improve with the addition of assisted suicide.  The motivations of patient, family and physician will be suspect, tainted and goals distorted. 

The physician-patient relationship by definition focuses on life, and the end of our lives is still about life, not death, and can be lived with quality.  To undermine the foundation of the physician’s role is to deprive the patient and family of that opportunity.  If we truly wish suicide to be a realistic alternative then perhaps someone else, like perhaps funeral home directors, should do it.  At least that relationship is clear.  Why does that sound ridiculous?  Because funeral homes are about being dead and doctors are about being alive.  Why don’t we just keep it that way?

 

As published in Sunrise Rounds.

 

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KC November 29, 2012 at 06:09 AM
Katy seems to know it all, but she doesn't.
George Clark November 29, 2012 at 01:22 PM
katy calls me bitter? I type this crap with a smile. she seems to really love that capitalism more then her God tho, she keeps defending it and not him. Actually, by taking capitalism so much to heart, she's actually denying and or defying most l of God's commandments. I know you all will all love that truth of mine but it is my truth as far as I can see it.
Bill November 29, 2012 at 02:39 PM
Katy - wouldn't god be angry with you for making comments like that ? Typical of the "religious". Go to church on sunday to ask god to forgive you for being a b*tch all week.
Laura November 29, 2012 at 03:05 PM
Katy Lake sounds angry and bitter towards anyone who doesn't seem to agree with her. Maybe she should stop reading all those books about communism- sounds like it's poisoning her mine!
True Dat November 29, 2012 at 03:17 PM
I hate when a mine is poisoned. You have to completely evacuate and seal all entrances. Oh wait, she said mine, not mind? Okay then, still the same answer.
Laura November 29, 2012 at 05:57 PM
Haha Head-I noticed that too late and for some reason can't delete it.
Monk November 29, 2012 at 06:16 PM
A number of commentors are critical of prolonging life by extraordinary means, but that is no argument for directly causing death. George, to say, "religions, all of them, have been utter failures", is too sweeping a statement. What is your criteria? Religions are all practiced by fallible humans. So, there will always be failures. And religions make progress, too. The Crusades are a matter for historians, not for honest religious critics. Some Southerners are still fighting the Civil War, and some critics of religion are still harping on historical events for which the religion itself has formally, publicly expressed deep regret.
Joanne November 30, 2012 at 12:13 AM
Uncle Moe you have the real answer. THANKS
Joanne November 30, 2012 at 12:30 AM
I agree with you. Please let this law pass.
Olive Blacock November 30, 2012 at 01:34 AM
Monk - Believing in anything on insufficient evidence is NEVER a good thing. I know of no society in human history that ever suffered because its people became too desirous of evidence in support of their core beliefs.
Monk November 30, 2012 at 10:25 AM
Too sweeping to say "Believing in anything on insufficient evidence is NEVER a good thing", Olive. That would seem to prohibit many admirable commitments people have made throughout history. People can eschew God and religion all they want, but when they turn around and pursue something secular with great commitment, only the object of the commitment is different. They are still trekking into the unknown on faith.
George Clark November 30, 2012 at 01:47 PM
monk, religion, as far as I can tell, was and is always a pact between us sinners saying we'll still try to live together without killing each other or judging each other worthless then life or at least a decent one. Today and as always it's being used for exactly the opposite purpose ie all religions have failed because they have been deliberately turned against one another because we don't get the real message or at least don't want to really live by it. But we will die because of not living by it, as is always the case. That's not bitter or dark but just the facts. your books all say so, so don't blame me for writing them back to you. olive, all societies have suffered for not being desirous enough for the obvious evidence that supports the fact that our free for all to take as much as one can get regardless of how or whom it hurts, even if it devastates one's own society, is forever destined to fail in the horrors of war, disease, famine etc.. etc.. it's happened before and always will if we keep denying the evidance of it.
Tamara Winfrey November 30, 2012 at 05:11 PM
The horrifying alternate reality where Nazi Germany won is no longer spec fic. It's here.
Monk November 30, 2012 at 09:00 PM
What's especially sad for me is when someone turns away from religion after barely scratching its surface. And everyone can only just scratch its surface. I probably have more reason to turn away from my religion than many, but I know it is deeper and broader than any disappointment I've experienced. I'll stick with it as long as I am of sound mind. The same goes for living. Life is deeply meaningful at every stage. Snuffing it out prematurely is simply dropping out. It's just tragic, that's all. Suicide is certainly not something we should promote, in my opinion.
Christopher December 01, 2012 at 06:56 PM
SO happy to come across this article, as I had no idea this bill was being considered. I think it's a great idea and hope it passes.
Steve December 01, 2012 at 08:32 PM
Ayn Rand -- influential philosopher, as well as moral compass for numerous conservatives, including Governor Romney's running mate, Paul Ryan -- urged the full legality of both suicide and drugs as individual rights. Hear her own words: http://www.youtube.com/watch?v=kh7Bg-mKKCY
Monk December 01, 2012 at 11:29 PM
Suicide just seems like such an admission of failure or hopelessness. The sometimes hard, but always rewarding, task is to find meaning in life. At the least, make a little effort, please. I wouldn't assume that Paul Ryan or numerous conservatives subscribe to every Ayn Rand thought. To involve other people, especially physicians, in one's suicide is really, really perverse.
BN December 02, 2012 at 05:29 PM
If those who want to choose suicide are allowed that option, then at least allow those who oppose it to document in our records that it isn't an option and shouldn't even be discussed.
Katy Lake December 02, 2012 at 05:44 PM
BN, people who want to "die with dignity" by committing suicide CAN do it quite easily right now. They don't need any changes in the law. But that's not what they're about. They want to extend the suicide pact to everyone, and eventually to people who cost too much money to keep alive. Mark my words. It's NEVER just what they say it's about - there's always an ulterior motive.
Katy Lake December 02, 2012 at 05:48 PM
Steve, so what? Ayn Rand was also an atheist. Paul Ryan is not. Ayn Rand certainly isn't the first person to come up with free market economics! It's possible to agree with some of a philosopher's tenets without buying the whole thing, lock, stock and barrel. I know you guys can't conceive of such a thing as individual thought. You swallow ALL of the left's hate filled agenda without a second thought...or for that matter, an initial thought.
Ryan Hardy December 04, 2012 at 07:14 PM
James is a typical muderous technocrat. I bet he can't wait for Obama's death panels.
Joe R December 04, 2012 at 09:38 PM
There are no death panels. But having 48.8 million uninsured (US Census) is a type of death panel. According to a recent Harvard study, about 42,000 Americans die each year due to a lack of health insurance.
Katy Lake December 04, 2012 at 10:31 PM
Stop lying, Joe. I'll repost this since you didn't read it the first time. Maybe you can find someone literate to break it down so you can grasp Obama's death panels. "Obamacare provides for an "Independent Payment Advisory Board" which will ration medical care, and that means older and sicker people will be denied treatment that an unelected bureaucrat decides on. HMO decisions can be appealed (and a majority that are appealed are granted); there IS no appeal from the Obamacare Death Panels, oh, wait, the "Independent Payment Advisory Board" that RATIONS healthcare. A good article on how Obamacare's healthcare rationing board will work: http://www.forbes.com/sites/scottatlas/2012/10/21/ipab-president-obamas-nice-way-to-ration-care-to-seniors/ "
Christopher December 04, 2012 at 10:49 PM
"Suicide just seems like such an admission of failure or hopelessness." No. In these situations can be a bold, courageous, and powerful way to seize control of your own life and choose your destiny. It's a choice that should be afforded to any terminally ill patient who is capable of making a sound decision.
Donald December 04, 2012 at 11:03 PM
Actually, it is the foregoing poster that may require some assistance in understanding the "Independent Payment Advisory Board." Independent, nonpartisan PolitiFact considered similarly deceptive claims made by rejected presidential candidate Mitt Romney and, after a detailed analysis, concluded such assertions are "mostly false," saying: "OUR RULING When Romney was talking about the Independent Payment Advisory Board and Medicare, he said, Barack Obama 'put in place a board that can tell people ultimately what treatments they're going to receive.' He avoided the more inaccurate and harsher wording of some other critics, who have falsely described the board as 'rationing' care. But Romney’s claim can leave viewers with the impression that the board will sit around a table and talk about whether grandpa can get his bypass or not, and that’s not the case. The board can reduce how much the government pays health care providers for services, reduce payments to hospitals with very high rates of re-admissions or recommend innovations that cut wasteful spending. And there are questions about whether that could lead to different treatment decisions, but Romney's comments give a misleading impression. We rate his statement Mostly False." By the way, it was Paul Ryan -- whose moral muse regarding an individual's rights is Ayn Rand -- who similarly suggested cutting more than $700 billion from Medicare payments made to health-care providers and hospitals.
Eggs-n-Toast December 04, 2012 at 11:49 PM
Well Said Christopher! Well said.
Monk December 05, 2012 at 03:32 PM
Boldly and courageously seize control of your own life ... and commit suicide? It still sounds like an acceptance of failure or hopelessness. Kate is right. There is nothing to prevent a person from committing suicide at present. So, why is legislation being proposed? And there is certainly no call for bringing suicide under the aegis of healthcare.
Bill December 05, 2012 at 03:54 PM
@ Monk - failure ? How is dieing a failure ? Everyone dies. Some of us just don't think laying around for months ( or years) pumped up on pain meds is any way to live waiting for the inevitable. I certainly hope you are never in the situation to go through it, or watch someone go through it. But you might have a different opinion if you do. "There is nothing to prevent a person from committing suicide at present" Really ? Announce your plans to commit suicide and see what happens. Or have a family member sitting by (maybe to comfort you in your last moments) while you do it and see the legal nightmare they end up in afterwards.
Katy Lake December 05, 2012 at 04:05 PM
Monk is correct, and he says it well. Suicide is an admission of failure, except for the mentally ill, who at least have an excuse. The suiciders who want to kill sick people usually have an ulterior motive. Many times it's to get their hands on the sick person's money (they consider it to be a "waste" if you spend your own money staying alive), or they're truly lunatics and think that people are a cancer on Mother Earth and the fewer of them, the better. Of course, they never, ever, EVER volunteer to remove themselves from the planet. It's always someone else they say needs to die, and the sooner the better. They are different from the mentally ill who for emotional reasons commit suicide - but they are unhinged, nonetheless.
Steve December 05, 2012 at 04:09 PM
Christopher is right. He says it better.

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