Wednesday, January 13, 2016

The Changing of Our Culture: Physician-Assisted Suicide

My blog posts are generally written for Christians, but today, I'm writing for the atheist and the agnostic, as well as the Christian. 

I generally write to teach and encourage. Today, I'm writing to inform and warn. Be prepared to be shocked.

Yesterday, I received an email in my inbox with an intriguing title. "Good News About Dying in America." It was a commentary article from Medscape, a respected medical company. They provide medical education and medical news. I read their emails and continuing medical education materials fairly often. This is not a radical, edgy organization. This is medical mainstream.

"Changing a culture is one of the most difficult of human tasks," the article by Dr. George Lundberg began. That's true, but to begin by admitting a plan to change our culture is underway was very concerning to me.

"The American cultural norm, for many decades, even centuries, has been to sustain life and to prevent death for as long as possible." This is also a true statement. Humans are born with the certainty that they will also die. Every single one of us. Letting go of those we love is hard. I understand that. I've been at the bedside of dying people numerous times. 

Somewhere along the way, people began to ask physicians to "do all you can do", and we've done it. Whether it was sensible or not. We've prolonged death with pointless treatment when palliative care would have been more appropriate and more reasonable. The threat of lawsuits, combined with the need to avoid "failure" and an unwillingness to "give up" are only part of the problem. 

No one races to embrace grief. It's hard and long-lasting.

We don't like it, and we never want it, but dying and grief are a normal part of life. The problem is compounded when the process of dying includes pain and suffering. 

We want suffering to end, and we want it to end immediately. Especially if the suffering is our own, or that of someone we love. I understand that desire, but killing ourselves or someone we love to end the suffering should not be an option.

We need to understand that death happens, come to grips with our beliefs about life after death, and make decisions accordingly. We are all going to die, even those we love the most. 

Sometimes a plethora of medical devices and treatments are appropriate because the expectation of recovery is reasonable. Sometimes, they aren't.  

Dr. Lundberg's article continued by reminding the readers of two articles published in respected medical journals, both written by physicians who had assisted in the death of a patient's life. In 1988, a physician related assisting the death of a young woman with terminal cancer by giving IV morphine. (There was an uproar in the medical community about this.) In 1991, a physician admitted giving a terminal patient a prescription for medication that would end her life. That decade also saw the shocking notoriety of Dr. Jack Kevorkian, who assisted dozens of patients with their deaths.

"The right message writ large but by a deeply flawed messenger," Dr. Lundberg wrote, and I knew for sure where his commentary was headed. His agenda is physician-assisted suicide.
It's already legal in several states, including Oregon, Washington, Montana, and Vermont. Laws legalizing physician-assisted suicide will soon go into effect in California, as well. "Many more states will follow as we approach a tipping point."

He has judged the culture correctly. 

"At long last, the Centers for Medicare & Medicaid Services has approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician payment schedule. When you pay physicians to do something, they will do it."

Physicians have always given end-of-life counseling. "Your mother is dying. There's nothing more we can do." That's the beginning of an end-of-life counseling session that should be followed by an explanation of the futility of ongoing aggressive medical care and the appropriateness of hospice and palliative care. A discussion about the ways to alleviate suffering with appropriate medication and comfort measures should be included. I've had those discussions with patients and their families many times.

Never has my end-of-life counseling session included the option of physician-assisted-suicide. Never have I offered to assist patients in killing themselves. I, like other physicians of my era, took the Hippocratic oath. I vowed to "first, do no harm". 

Assisting a patient in killing themselves is not doing no harm.

Now, Medicare will pay physicians to discuss options about end-of-life issues. It's not a big jump to expect that, as laws legalizing physician-assisted-suicide spread across the country, Medicare will begin to pay for ending life, not just counseling.

I have long thought cultural change is needed, but killing people to hasten their death is not the answer. Palliative care (with comfort measures and adequate pain control) can, and does, make the process of dying much less difficult. 

A few months ago, I spent eleven days (and some of those eleven nights) at the bedside of a dying neighbor.  She was moved to Sanctuary Hospice House, where she lived for three days. They kept her clean, and turned, and comfortable. She was given medication to stop her cough and help her pain. They actively alleviated her suffering and, when she stepped out of this life and into the next, it was so quiet, her husband almost missed it. 

When her time came, she died.

Not once did she ask for help to hasten her death. Not once did we consider it.

Death is a part of living and the process of dying is not without benefit. It gives us time to grieve, to say our goodbyes. It gives our family members time to accept the inevitable. 

Some suffering cannot be avoided, but it doesn't have to be wasted. We can learn and change, even in the midst of suffering, and palliative care can help us.

Killing ourselves and those we love is not the answer. No matter how lovely the words used to describe physician-assisted-suicide, it's not an act of mercy. It's not "doing no harm". It's not the answer some might want it to be. 

My friend and colleague, Dr. Bill Toffler, lives and practices in Oregon. He has written an excellent article on this issue and I encourage you to read it. Click on the link to Killing Isn't Caring.
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In case you missed one of this week's posts, here are the links:  The Same JesusThe God Who Never FailsHalfway to CanaanThe Blessing JarThe Potential for HeritageDoes God Know When I Will Die? Part 1Does God Know When I Will Die? Part 2How to Live Longer, and Is Longer Life Worth the Cost of Obedience?
#physicianassistedsuicide #PAS #medicare #lifeisprecious #SanctuaryHospiceHouse