Oct 6, 2009

Putting Down Pets And People

I read a very poignant post by Neo-Conduit this morning about her terminally-ill friend who considered suicide. I was reminded of a question I have often been asked by patients:

We put down our dying pets humanely. Why can't we be so good to people in the same situation?
It is a good question that needs an answer. Doctor D used to just say, "Doctors shouldn't kill patients," but that really didn't respond to the suffering of people facing terminal illness.

I am glad that euthanasia is illegal where I work. Doctors have the ability to keep a dying person comfortable without putting them down like dogs. Human beings are not dogs. Doctor D was good to his elderly dog when he euthanized her, but there is a huge difference between killing a pet and a person.

The most important approach to suffering people is a deep respect for their value as human beings. That respect motivates me to care for their pain. It motivates me stop treatments when they no longer desire them. It also motives me to never give a deadly medicine—even if it is requested.

The approach of death can be disorienting and terrifying. There is a spiritual suffering that is often greater than any physical pain. In moments of hopelessness ending one's own life may seem like the only escape. A person asks him or herself, "What is the value of this dying thing that is me?"

Doctor D has had many patients nearing the end of life say to him, "I wish I could die now!" I have yet to have a single one be disappointed when I respond, "It is ethically wrong for me to end your life, but I will stay with you till the last breath and make sure you are comfortable and respected."
Suffering and dying people need to know they have some value that is more than the sum of days they have left. The deepest respect of all is reminding them they have the most valuable thing of all: a human soul.
Quality of Life is a subjective judgment. I honor my patients by letting them decide what is a quality life and what is not. Value of a Life is different. The value of every person's life is infinite. I honor that value by never killing a human being for any reason.
I already know Nurse K is going to give me a hard time for such a touchy-feely post. Doctor D promises to get back to some fun shit soon.

...But before we get back to fun questions what do you think of Euthanasia?


M. said...

Euthanasia is a basic human right. You are passing value judgement at the worst of times: essentially saying people's decisions are not rational, as if you knew better than they do what's the best for them. How can you do something like that? As a human rights advocate I feel disgusted.

Doctor D said...

Thanks for your comment M!

It is good to start the discussion with two differing opinions on Euthanasia. A human right or a human wrong? I'll be interested to hear other readers perspectives.

My first reaction is that if Euthanasia is a right then there must be a corresponding responsibility. Healthcare is a right therefore we have a responsibility to give people healthcare. If Euthanasia is a right, would you agree that it is our responsibility to kill someone who wishes to die? Are you comfortable with placing this responsibility on someone? Do I as a doctor have the responsibility to kill someone who asks me to?

Euthanasia is not the same as suicide when someone kills themself. In Euthanasia one person kills another person.

I'm sorry if I gave the impression I was judging terminally ill people. I am not. I can completely understand and respect those feelings.

The value I spoke of wasn't my values verses their values. It a mindset of recognizing people as infinitely valuable. My point was that killing someone is inconsistent with valuing them. I cannot deeply value someone and kill them at the same time.

Would love to hear your thoughts...


Hi Dr D thank you for highlighting this issue. Unfortunately this person I speak of is my closest relative. I have two sick close people to me on the go at present and because the relative doesn't anyone else knowing of their illness I have had to be privy to information I haven't been allowed to share which has been very difficult.

I am unable to write their real details on here due to privacy, but it is a progressive terminal illness.
It has been hard as I understand their situation, respect their wishes, but felt they needed help, I didn't also want their decision on my head alone. They needed time themselves to reassess what they are feeling.

The Dr told me yesterday that usually people who really want to die don't admit it. This isnt entirely true as my friend whom I found in a tree expressed her desire to die many times over and attempted it a couple of times. So I took my relatives desire seriously.

If they are truly at a point in pain, can't breathe and wish for death palliative care can do there best to keep them comfortable an offer sedation if needed.

I felt it was important they could take back their power a bit by knowing they had options in the future on how they can depart this world in comfort without committing suicide.

The Good Cook said...

This is the most beautiful, rational explanation I have ever read as to why euthanasia is not offered to human beings. Well said. Value of life vs Quality of Life and the promise to make the passing as comfortable as possible.

I was with my grandmother when she passed. She had refused all medical intervention. It was difficult to witness, but very beautiful and natural. The doctors and nurses were respectful of her wishes and kind to us. She had what we call "a good death"... can any of us hope for more?

WarmSocks said...

Dr. D, it sounds like you’re a good doctor. Thank you for making the distinction between quality of life and value of life.

There is a huge difference between (a) actively causing another person to die, and (b) stopping futile treatments that won't cure a terminal condition.

If patients get to the point that they feel their life has zero value, then they need to take responsibility for that termination, not pass it off on someone else. It is illogical to say that it's wrong to end one's own life, but acceptable to request that someone else do it. The line-of-thinking that permits euthanasia also permits suicide. I’m not arguing in favor of suicide. Far from it. But it’s logically inconsistent to claim that euthanasia is acceptable and suicide is not.

How many people request euthanasia when they're really afraid of more pain and are looking for reassurance that all life has value? In a society that values people based on their material possessions and contributions to society, it can be hard to see that human worth is not based on external factors. If we really believe that people are only valuable based on what they do or what they have, then we can significantly reduce the national budget by discontinuing all medicare/Medicaid/disability claims. “Contribute or be euthanized” would be the new policy. We don’t say that, though, because life is intrinsically valuable.

Euthanasia is not merciful. Compassion is. Patients don’t have to be abandoned and suffer alone. People can be made reasonably comfortable with pain medicines. They can be completely sedated. Pain can be treated even when disease can’t.

queenofoptimism said...

I am so moved by this post. I'm not sure quite how to express my reaction. I have not looked at this subject in this way. I've only thought about euthanasia as an end to suffering that I may want to choose one day. Your patients are very fortunate to have you and to feel valued in the way you treat them. You know, I'm always up for another doctor if you want another patient or a crack at the puzzle!

Nurse K said...

The person who said "euthanasia is a basic human right" is insane, like drinking-mercury insane. Hi, you don't have a "right" to tell me or a doctor to kill you; what the HELL?

Everyone knows that if you want to die, you just see Happy Hospitalist for anything, including suicide.

Moose said...

I have heard of situations where the pain, the discomfort, the mental and emotional anguish at the end of life was more than medicine could support, and I can easily believe it.

I have taken strong opiates as a means to attempt to control severe pain (I vaguely remember someone once asking for a 1-10 pain level and me responding with "37"). But then, even in my addled mind, I knew it wasn't permanent. I couldn't carry on a conversation for more than 30 seconds. Most of my memories from those days are garbled or missing. Worse, it was sometimes 8-12 hours before dosages were adjusted, meaning I was in incredible pain AND brain scrambled from the pain meds until the right people got the right information and it was dealt with.

If I saw my pain getting worse and harder to control in an end-of-life situation I would rather go before the pain and the medication made me that miserable again.

I've heard anectodaly that my story isn't an uncommon one. So were I in the situation of spending the last days of my life in a medicated haze in a futile attempt to stop pain or to be able to end it before I reached that point I would hope I could find a medical person willing to help me end it before I am too far gone. I don't think that's suicide. I think that's mercy and compassion.

Sandy said...

I could ramble on about this forever and explain why I feel the way I do but I will simply give my opinion. I believe that at the end of life (by this I mean the person is under hospice care and has reached the point of non-responsive) instead of gathering family to sit around and wait for that person's body to completely shut down and all close family members are afraid he/she will pass while they are gone that life should be ended through euthansia. I say this from experience...my father passed in my home under the care of hospice, my husband passed in my home under the care of hospice and my mother passed in a hospice facility. It is very hard on the family to set around waiting for the inevitable. Just my opinion...

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