Marlowe's Shade

Tuesday, May 24, 2005

Euthanasia Is Not the Last Word in End of Life Debate

In response to the excesses and abuses of the euthanasia experiment in the Netherlands and legalization of physician-assisted suicide in Oregon principled doctors who oppose this agenda have been demonstrating an alternative care model.

An examination of the history of the Oregon experiment shows that the depressed and lonely, the elderly and the disabled are particularly vulnerable when PAS becomes an option. In a prescient article from 1997 in the Journal of the American Academy of Family Physicians, Dr Thomas Gates outlines the problems of PAS and Euthanasia for a principled physician.

I have argued that the principles of autonomy and beneficence by themselves are not sufficient to justify euthanasia and assisted suicide, primarily because I fear that once we accept the priority of these claims, there would be no logical basis on which to deny a sincere request for euthanasia from any suffering patient.32 Furthermore, even if assisted death seems reasonable in exceptional individual circumstances,33 the public policy implications of legalization are potentially very troubling, especially for the most vulnerable in our society. Finally, considerations of professional integrity remind us that our role as physicians involves more than simply acceding to patient requests.

But it would be a mistake to simply dismiss the concerns of the "death with dignity" movement. Public opinion polls have consistently shown that a large majority of the American public favors legalized euthanasia.6 Perhaps we should consider this public support as symptomatic of a wider disorder: millions of Americans are apparently so fearful of what the miracles of modern medicine may have in store for them at the end of their lives that they would prefer suicide. The debate on euthanasia can be seen as symptomatic of both the medical profession's failure to seriously address this concern, and also of society's failure to face the reality of human mortality and the ultimate impossibility of "controlling" death.

In one sense, the medical profession has brought this controversy on itself. Thirty years after Kubler-Ross, the philosophy of the hospice movement remains minimally evident within mainstream medicine. So often we persist in an exclusively curative mode far too long, while virtually ignoring the physical, psychologic and spiritual needs of dying patients and their families. Perhaps physicians on both sides of the euthanasia debate can at least agree on one thing: the medical profession, having contributed so much to our society's dysfunctional approach to death and dying, can now lead the way toward a more balanced perspective.

Family physicians in particular are in a position to demonstrate that the caring and holistic hospice paradigm can be incorporated into the care of every patient, not just those with less than a few days or few weeks to live. Regardless of their position on euthanasia, all family physicians should be expert in the control of pain and other symptoms in terminally ill patients. In addition, family physicians should facilitate discussions of end-of-life choices and advance directives with their patients and should be knowledgeable about the optimal utilization of local hospice resources.

The current debate about euthanasia and assisted suicide has the potential to polarize our society, but it can also have a positive effect if it helps us focus on the need to rehumanize medicine and the care of the dying. The danger and the temptation are that we will once again choose to ignore the real problem and instead substitute a pill--this time a suicide pill--that simply serves to conceal the symptoms of our disease. What is needed is not new laws to sanction assisted suicide, but rather a more fundamental and positive change in the way we meet the physical, psychological and spiritual needs of the dying patient.

There have been a number of physicians that have taken up the challenge to properly use palliative treatment for pain and quality end-of-life care to counteract the fear and despair that seems to be fueling the right-to-die movement.

[A] growing number of medical professionals who work with dying patients are speaking out to dispute this perception. Consider the following statements:

If we treat their depression and we treat their pain, I've never had a patient who wanted to die.

William Wood, M.D., clinical director of the Winship Cancer Center at Emory University in Atlanta, as published in Time, April 15, 1996, p. 82.

I simply have never seen a case nor heard of a colleague's case where it (physician-assisted suicide) was necessary. If there is such a request, it is always dropped when quality care is rendered.

Linda Emanuel, M.D., Ph.D., director of the American Medical Association's Institute on Ethics, as published in "The New Pro-Lifers," The New York Times Magazine, July 21, 1996.

In my clinical practice, I have been asked by suffering patients to aid them in death because of severe pain. I have had the opportunity to see these requests for aid in death fade with adequate pain control, psychological support, provision of family support, and with the promise that their symptoms would be controlled throughout the dying process.

Kathleen Foley, M.D., chief of pain service at Memorial Sloan-Kettering Cancer Center in New York City, as part of her testimony before the House Judiciary Subcommittee on the Constitution, Washington D.C., April, 1996.

The appeal of physician-assisted suicide and euthanasia is a reaction to fear and despair. Through the influence of the Baby Boomers and their media monopoly this has permeated our culture to the point of death being a central subliminal theme of advertising. I don't know if there is still time to get the word out that there is a better way. But before the rest of the country goes the way of Oregon and Holland, physicians of principle and supporters of the culture of life are duty-bound to try.
papijoe 6:24 AM