Thursday, October 18, 2012

The Myth of 'Death with Dignity' - Vote No on (assisted suicide) Question 2.

Marilyn Gardner is a public health nurse in Cambridge who wrote an excellent blog post about why she is opposed to physician assisted suicide and will be voting no on Question 2 in Massachusetts that was originally posted In her blog Communicating Across Boundaries. Read her post below:
The Myth of ‘Death with Dignity’ – A No on Question 2
As a nurse I’ve cared for hundreds of people who are going into surgery, women who are in labor, people who have cancer, people who are dying. It has been both a privilege and a burden. It brings me face to face with my mortality, my frailty, and my need to figure out what this thing called ‘Life’ is all about.
And in my work there is one thing I can tell you with certainty: There is no dignity in being sick. There is no dignity in bedpans. There is no dignity in throwing up. There is no dignity in fainting or seizures; in high fevers or runny noses, in chemotherapy or intravenous antibiotics. There is no dignity in getting the dreaded diagnosis “You have cancer…” None.
And yet Massachusetts is presenting me with a ballot question come November 6 – a question where I have the choice to vote ‘yes’ or ‘no’. It is called the Massachusetts Death With Dignity Act, but it is really a vote up or down for Physician Assisted Suicide.
I get it. We hate pain – for ourselves and for others. “Needless pain!” we cry out! Why should we have to suffer? Why should those we love have to suffer? We’re going to die anyway! Why not be able to control the process?
So why do I, who ooze compassion when I see a hurt bird, let alone human, plan to vote no on this bill that would supposedly “alleviate” suffering?
There are several reasons.
  1. While diagnosis is a fact, prognosis is an opinion. Most of us know people who have lived far longer than the prescribed prognosis given for a particular disease state. In end of life issues it is critical to distinguish between these two, yet prognosis in western biomedicine is often offered as fact.
  2. Amazing strides have been made in pain relief and end of life care. No longer does end of life care need to be a time of intense suffering. Current research and practice gives great hope to patients and families who are dealing with end of life issues. Palliative care focuses on relief of pain, easing of symptoms, and improving quality of life. This area needs to be strengthened, not weakened by diminishing its importance through allowing patients to request medication that will end their lives.
  3. There is no requirement in the language of the law that any family members be notified. This is unconscionable to me! That a patient can take the medication alone, with no one else present, and no record of having taken it is unbelievably bad practice. The potential scenarios this presents have lawsuits written all over them.
  4. Death is not, and never will be, dignified. To paint the issue with language like this is disingenuous at best. Just because you are the one who holds the medicine that can end it all doesn’t mean it will be dignified. The very nature of death is that of losing control, taking a last breath, mouth gaping open, losing control of bodily functions, fighting to live only to die. I am all for easing some of the pain and discomfort of death but let me repeat: It is not, and will never, be dignified. It’s death. The only dignity given in death is given by others to the one dying, it cannot be given to oneself.
  5. Organizations that I respect are against it. The Mass Medical Society, Massachusetts Hospice and Palliative Care Federation, the American Medical Directors Association, and the Massachusetts Academy of Family Physicians are all against it. Why? Because it’s poorly written, because there is already a strong end of life care program in the state that aims to alleviate suffering, because patients are not required to see a psychiatrist or psychologist to check mental health status before being prescribed a lethal dose of medication to end their lives, and because they recognize that physicians should be in the business of providing “compassionate, high-quality care during every stage of life.”
  6. I believe the act diminishes and violates the Hippocratic Oath at the deepest level. In the classical version of the oath the statement “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” are words sworn by most physicians on graduating from medical school. The entire oath speaks to the need to practice medicine ethically and compassionately.
I think the Massachusetts Academy of Family Physicians put it best in their opposition statement to Question 2:
“The role of family physicians is to provide compassionate, high quality health care to all patients, in each stage of life. End-of-life care is no different. Given the tremendous strides made in palliative care delivery services, patients with terminal illnesses often live active and fruitful lives for months, if not years…. Given the seriousness posed by the ballot question, and especially given our daily experience as family physicians caring for patients, we urge Massachusetts residents to vote NO to Question 2 on November 6.”


britmum said...

As a palliative care nurse (and nurse in general)...I get very offended at the idea of 'death with dignity.' It implies that those in society who are incontinent, differently abled or rely on the help of others to live do not have dignity. Nothing could be further from the truth. As a palliative care nurse in an acute care hospital I strive to help my patients live each day according to their current abilities. They are some of the most courageous people I have ever met and it is very rare for people to ask for help to die (which is not done, symptoms such as anxiety and existential suffering are treated with medications, love, and/or spiritual care/ social work). My patients generally want to live for as long as they can.

Marilyn said...

Thank you for posting this - I appreciate the work you do in promoting life and providing information on Physician Assisted Suicide.

Alex Schadenberg said...

Palliative care nurses are often the most compassionate people I have met.