The most challenging clinical cases usually are the ones where patients are suffering from existential distress, or in other words, loss of purpose in life in the face of suffering. I would also name it "depression of the soul." Fortunately, there are ways to approach these problems.
One that I use frequently and I teach medical residents is the one developed by the great Jewish psychiatrist, Viktor Frankl. After losing his family and surviving a concentration camp, he managed to write his masterpiece Man's search for meaning. In it, he makes the point that people can find meaning in life: by creating a work or doing a deed, by experiencing something or encountering someone (the meaning of love) and by the attitude one takes toward unavoidable suffering (the meaning in suffering). He was fond of repeating Nietzsche's words: "He who has a why to live can bear with almost any how."
He challenges us to go beyond ourselves and move to a level where we can find meaning outside our own human limitations.
I heard of a South American young man dying of AIDS and complicated with a rare type of cancer. His daily request was to be euthanized. His treating physician asked one of the hospital volunteers to offer to visit him. The doctor noted his request stopped, and one week later, the doctor asked the man why he was not interested in euthanasia anymore. His response was: "I do not want to die; now, I have a friend."
In the face of unavoidable suffering, this man chose to find meaning in encountering someone. It is a personal choice, one which a physician does make for the patient.
At the end, as Viktor Frankl says: "love is the only way to grasp another human being in the innermost core of his personality."
René Leiva, MD,
We need more physicians like Rene Leiva who choose to care for their patients and reject the concept of killing them.
Link to the letter in the Ottawa Citizen: