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Friday, January 1, 2010

Physician Assisted Suicide

Sweet Little Wifey just put up a post on assisted suicide. Go HERE to read it. This post is my two cents on the subject:

As a physician, this is a topic with which I am personally and professionally acquainted. In my 30 year career, I have been involved numerous times in the care of terminally ill people, people who have exhausted all options, all treatments, all hope and are destined to fulfill their remainder of days in pain or perhaps in a mindless state in no way resembling the person at an earlier time.

Sometimes they have lost everything it means to be human. They no longer reason, they do not know their loved ones, indeed they do not even know they are in this world. Perhaps they are maintained with a series of tubes and machines indefinitely.

This brings us to the argument of euthanasia. We often find ourselves in the position of putting our beloved pets “to sleep”. It is a horrible thing but in the case of a suffering animal it may be the appropriate thing. We humans are indeed the only living creatures uniquely endowed with the knowledge of our own mortality. A dog does not know it’s a dog. A horse does not know it’s a horse. None of these creatures are aware of the fact that one day they will die and possibly cease to be. The Bible does not specifically address the idea of animals in the afterlife. I like to think that God in His infinite caring and wisdom will let me fellowship again with my animal friends I have lost in this world, but this is a hope created by me in an attempt to ease my pain and alleviate my grief. God has given me no guarantee that I will ever see them again. On the other hand, He has promised that one day all our tears will be wiped away. That’s good enough for me.

Animals live for the moment, driven by a mixture of instinct, genetics, and whatever amount of intelligence their cerebral cortex allows. They are not aware, nor do they care that today may be their last. Even as a lion sinks its teeth into the neck of an antelope, I doubt the antelope realizes it won’t be around tomorrow.

Humans are also unique in that we are commanded by the Creator to refrain from killing one another. No other creature on earth is subject to this edict, and indeed is not even aware of God. It is for this reason that I could never participate in an assisted suicide.

I had a young woman patient once who was diagnosed with small cell carcinoma of the lung. She had been through a variety of treatments, but nothing worked. The cancer progressed and her death was imminent. She knew it and I knew it. A few days later I found out she had been brought into the ER dead from a massive narcotic overdose, narcotics which I a couple of days earlier had gladly given her for her pain. She took the whole bottle at once. This bothered me for quite a while. Although she had never indicated to me her intentions and in fact seemed rather upbeat, all things considered, I felt for the longest that I was somehow complicit in her suicide. If I had ever had any doubts about assisted suicide, that settled the issue for me.

I’ll do anything to numb the pain and ease the suffering, but it is not up to me to administer the lethal injection. That final act remains with the Almighty.

Why does God allow such suffering to occur? I don’t have the answers, but then again, I’m not supposed to have all the answers. I do believe that God is aware of everything that has happened, everything that is happening now, and everything that is going to happen in the future. It is all already preordained, like a giant DVD of existence with all events already recorded. Our time here is but a fraction of a revolution of the disk in the eternal machine. It’s up to us to hang on for the ride. We have to play the hand we are dealt and make the best of our lot. No need to whine and complain. A hundred years from now, any whining and complaining we might do now will be long forgotten and will have accomplished nothing.

So, although I will not be the one to administer the final blow, I am completely comfortable withholding treatments, that are futile, uncomfortable, or unnecessarily expensive for the surviving family and yes…………..even the taxpayer keeping the hopelessly ill person alive through some gubment funded program.

This reminds me of Terri Schiavo. Remember her? Go read all about her if you want. I’m not going to go over the whole gruesome mess but basically she was a woman who suffered a severe brain injury. After many years and many legal battles, a court finally allowed her husband to remove a feeding tube from her. She died a NATURAL death a short time later.

I have seen a bunch of Terri Schiavo’s in my career. I remember a whole bunch of so called conservatives railing like lunatics at the thought of removing this woman’s feeding tube. Most of the lunatics had no personal or professional experience with people like Terri Schiavo.

Sadly, in spite of all this ranting and raving, this woman had lost everything that made her Terri Schiavo. That was lost the day of the brain injury. Her body was merely a shell kept alive for many years by tubes and machines. I remember some stories about how some of the nurses and family members would comment that Terri knew everything that was happening. I would hear stories about how she would blink or move her hand in a response to a family member…………..no, sorry, folks…………it’s called reflex. I’ve seen lots of Terri Schiavo’s. Take it from someone who KNOWS WHAT IS GOING ON. There is NOTHING going on upstairs.

I remember the loud mouthed yankee lunatic, Sean Hannity, in a tirade over this issue. He more or less skinned alive a Florida judge for allowing removal of the tube. It so happened that the judge was a conservative who was just following the law. Hannity became guilty of allowing his feelings and emotions and probably his Catholic upbringing to cloud his judgment instead of relying clear thinking and logic. How many times have you heard conservative pundits accuse liberals of being driven by feelings and emotions while throwing logic and common sense out the window……..HMMMMMMMMMMM????

After Terri Schiavo, I pretty much quit listening to Hannity. It became obvious to me that he was an ignorant, loudmouthed hack.

Many, many times I have seen families cling to tubes and machines and false hopes. I know their loved one is not coming back. I blame a lot of this on my colleagues. Many doctors cannot muster the courage to simply tell people the truth. I am not one of those. Rather than admit that Uncle Joe is at the end of his life and will never again be like they remembered him, the cowardly doctor will be the first to jump in and recommend useless and expensive tests, tubes, machines, ventilators, nursing homes….on and on and on and on…………and on and on and on………

It’s tough to tell family members with hope and tears in their eyes that their loved one is gone. It is tough to accept when the heart still beats, the lungs still breathe, and the kidneys still make urine. It has been my experience though that when it is all said and done, most people truly appreciate your honesty and they will thank you for sparing them the agony of watching their loved one waste away on some machine.

End of life care is something that should be talked about and decided upon BEFORE the end is near. At the end, emotions may be running too violently to make a rational choice. End of life care is something that should be personal and private between patients, doctors, and families. No politician should have a say in such matters. Would you want some idiot like Harry Reid, Nancy Pelosi, or Barack Obama making such sensitive decisions on your behalf as I have described above? I think not. In death as in life, the gubment should stay the hell out of my business!

If you don’t have a living will and advance directives, you need to take care of this right away. Do it now while you still have your wits. Don’t wait until your wasting away in puddles of your own urine and feces, connected to some machine.

Aunt Bessie exclaimed, “Look! I saw his finger twitch!”

My friends, there are MANY, MANY, MANY things worse than death!

8 comments:

  1. Well said. I failed to urge people in my post to please get their wants and desires concerning end of life decisions IN WRITING, in a legal document signed, witnessed, and notarized.

    Make sure your doctor, hospital, and especially your family know your your wishes and that you have someone designated to carry out those wishes no matter what everybody else says.

    Debbie
    Right Truth
    http://www.righttruth.typepad.com

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  2. Well said Grouch. I have already informed my family that if I am in the same condition that Terry Schiavo was, pull the plug. I even have it in writing. The body is basically being kept alive by machines, trapping my soul. Let my soul go free.

    For all other conditions, as long as I have my wits, I'll fight for every minute of life there is!

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  3. Grouch,

    It is indeed a fine line. My late wife Sara had experienced a terribly brutal life -- born three months premature, spine snapped at age 13, abused by her father, by her ex, struck by lighting, beaten senseless by an ex-boyfriend, alcoholism, poverty, cervical cancer at 29, three bouts of throat cancer, etc. etc.

    She ultimately died when cancer spread into her lymph nodes and, well, her body basically disintegrated right before my eyes. To make matters worse, her goofball Canadian doctor prescribed OxyContin when she was being tube-feed and, like an oaf, I innocently ground the tablets into fine powder effectively defeating its purpose. I cannot tell you how many times I walked in on her bobbing her head in agonizing pain.

    Regardless, Sara kept her demise from the world. She always inquired of MY day and hid her own concerns from me. A few days before she passed away, she was more worried about whether I was paying the lady who was watching her while I was at work than whether she herself was doing okay.

    Myself, I couldn't handle a simple thing like a kidney stone without trying to take the entire hospital staff down with me. There's no way in hell I would be able to endure what Sara went through.

    This brings us to doctor-assisted suicide. Many people are like me, they do not know how much pain they would be able to endure and therefore would opt-out fairly quickly.

    I never had enough data on the Schiavo case to pass judgment, but for the most part Catholic teaching has been to protect human life at all costs until it becomes what I term "artificial life" (e.g., no machines keeping us alive for a thousand years merely because science can do it).

    It all boils down to the concept of human dignity. Our Lord had it rougher than anyone on this planet and He still accepted His Cross. We Catholics are also taught that God never permits us to endure more than we can.

    With doctor-assisted suicide, we permit ourselves to equate death with inconvenience. If a person becomes blind, then they will decide that life is not worth living, for example. What about diabetes? Who draws the line? Will anyone draw ANY line? Look what's happening with life issues such as gay marriage and religion?

    As Helen Keller once said "Although the world is full of suffering, it is also full of the overcoming of it."

    Nobody in their right mind would want to be kept alive by a machine breathing for them, eating for them, and, perhaps, even thinking for them. However, nobody in their right mind can decide when it is time to die also.

    Great post!

    R.J.

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  4. What part of THOU SHALL NOT KILL is politically correct/incorrect ? None of it, IT'S THE TRUTH. Grouch as a physician has had to tell the truth too many times, but has to. Political medicine wants to offer itself as a "death alternative", but it is not a "life restorer". Only ONE can be that powerful, and He is chosen not elected. RJ your wife sounds like my aunt from Hazel Park. She had so many surgeries and incidents I don't think she could remember them all. But try to get her to talk about herself HA! Her first words were "How are you ?" She's the one in the wheel chair and then the gurney. Wheeled into church by grand kids and friends with her husband by her side. When she finally passed on it was with dignity and God-loving humanity, sent on her way by a loving family. I spent 11 years as a cop and now 23 years as a physician. I have held both life and death in my hand as a human deciding what is right. There is no interpretation that is politically correct therte is only one Rule. The person who wants to finish their life has to be the one to do it, without the direct mechanations or devices given to them purposefully by or attended by a physician. This has to be spelled out in legal irrevocable language..I was served legal process to stop care on an IMPROVING geriatric case because the family was going to have to wait for her to pass for a longer time. As reprehensible as that was it drove home my initiative to help people through with this arena. GREAT JOB GROUCH KEEP IT UP !

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  5. A thoughtful post Grouch. Death should never be political and should aways remain in the family. That said, politicians on both sides are always trying to cross the line. Suicide of any type must never be condoned or assisted.

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  6. Thanks all for the comments. This is indeed a touchy subject. What really frosts me is people like Hannity who have no personal or professional experience in the matter who make it a point to bloviate and pontificate and self promote themselves to the position of expert. Politicians excel in doing this on a daily basis.

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  7. Thank you for this thoughtful post.

    Compassion & Choices (compassionandchoices.org) is the nation's leading advocacy organization for physician aid-in-dying. We strongly believe in patient's rights and autonomy and we fight every day to ensure your end-of-life wishes will be honored.

    One thing to consider: the comparison of physician aid-in-dying to the euthanasia of pets is not an especially good one. In fact, it's people who make the decision FOR a pet to end it's suffering. Physician aid-in-dying is about people making decisions FOR THEMSELVES and then having those choices honored.

    It's critical to have an advance directive filled out AND to discuss it with loved ones so that they know your wishes. Compassion & Choices offers state-approved advance directives FREE OF CHARGE at our website:

    http://www.compassionandchoices.org/ad_page

    If you're interested in our advocacy work and regular updates, please join our action network here:

    http://www.compassionandchoices.org/home/signup?signup=true

    If you have questions or would like additional information, feel free to email me at caxtman (dot) compassionandchoices (dot) org.

    Carla Axtman
    Online Community Builder
    Compassion & Choices
    compassionandchoices.org

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  8. Carla Axtman,

    Thanks for your comment. Let me be clear. I AM NOT IN FAVOR OF PHYSICIAN ASSISTED SUICIDE. On the contrary I think comparison between animal euthanasia and human euthanasia is relevant and important in order to emphasize the fact that we are different from the animals and commanded by God not to take a human life even if it is our own.

    To choose suicide no matter what the circumstances is not a choice we are entitled to make.

    Such "choices" open doorways to abominations such as abortion. Women argue they have the right to choose. They do not.

    I'm fine with withholding feeding tubes, CPR, IV's, ventilators etc. but when it comes to actually choosing to administer the lethal injection, I have to draw the line.

    I realize this is a very touchy subject with many people.

    Thanks for visiting.

    Grouch

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