May 6, 2012

The fear of suffering prior to death

"Death with Dignity" or physician-assisted suicide will be on the Massachusetts ballot this fall.  The Massachusetts Medical Society has come out against, saying that it corrupts medicine and the doctor-patient relationship.  I'm against it and one of the reasons is my  strong intuition that such a death robs the patient of what is most valuable in dying.  That is the opportunity for forgiveness and the mental, emotional and spiritual growth that comes with the dying process.  That said, all medical efforts should be directed to alleviating physical suffering.

Dr. Ty Meyer, a  palliative care physician, makes this argument in  Palliative Care vs. Physician Assisted Suicide

As the reality of approaching death sinks in, it brings with it many uncertainties and certainly fears. Many of my patients are naturally scared, but when investigated further this fear is of suffering prior to death and not death itself. This may lead to requests for hastening of death or physician assisted suicide. Dr. Ira Byock in his book The Best Care Possible notes that “any serious request from a patient for help in ending his or her life must be seen as a red flag that signals either that a patient is suffering or fears uncontrollable suffering in the future.” Requests for physician suicide can be seen as a plea to provide reassurance of relief of pain and suffering and reassurance that they as patients will not be abandoned as they are dying.

Too many patients have heard, “I’m sorry. There is nothing more that can be done,” as they approach the end of their lives. The reality may be that the medical options for cure or extending life are exhausted, but there remains much that is available medically to afford patients comfort and to improve the quality of their lives. By receiving high quality palliative care, either while undergoing curative/life-prolonging treatments with significant side effects or through a hospice program at the end of life, patients and their families are able to both deal with the current circumstances of their medical condition and begin to prepare for the future.

As a Catholic physician, I am often struck by casual comments indicating the justifiability of physician assisted suicide in situations of patient suffering and prolonged dying. It strikes me because I believe the final stage of life is vitally important to the dying person as well as to their family and is the natural consequence of living. The days and weeks leading to death can be very fruitful and in many instances are a healing time. In finding relief from physical suffering, patients are able to address the emotional, psychological, and at times spiritual areas of their lives that go unnoticed when physical symptoms are poorly managed. Imagine the difficulty of healing a broken relationship with a family member or God if every breath causes a stabbing pain in your chest or if your nausea is so bad that the thought of food induces vomiting.

Our goal in Hospice and Palliative Medicine is to provide the best experience for patients and families prior to death, to diminish suffering and allow a peaceful passage into the next world, but never to expedite death as a means of relieving suffering. By helping patients and families understand their illness and what to expect as it progresses and by managing physical suffering, they regain some sense of control and are able to focus on what is most important to them at the end of their lives.

In reassuring patients that they will not be abandoned at the end of life, their symptoms will be properly managed and their fears of suffering are addressed, hospices utilizing quality palliative medicine skills can help negate the desire by some to pursue physician assisted suicide. It helps turn a scary and unknown time in a person’s life into an opportunity for emotion and spiritual growth and allows for healing of the fractured relationships that are a part of life.
Posted by Jill Fallon at May 6, 2012 9:54 PM | Permalink