Paliative care... terminal sedation

[Guest guest]

Palliative care isn't a panacea

Thanks to David Shapiro for setting the record straight on palliative care for the dying ("Palliative care claims are a cruel deception," Feb. 9). Those opposed to assisted dying on the premise that "what we really need is better pain management" both deceive themselves and ignore six years of Oregon's data, which shows that 87 percent of patients who chose to hasten their death cite loss of autonomy as the primary concern. Pain or the fear of pain ranks near the bottom.

While few would argue that hospices provide the best that palliative care has to offer, 86 percent of these same Oregon patients were enrolled in hospice, and thus it is obvious that palliative care alone is not the panacea groups like the Hawai'i Medical Association make it out to be.

For many patients, even when the pain can be controlled, the prospect of being kept alive in an eternal stupor, suffering from chronic constipation, constant nausea, shortness of breath or the many other side effects of heavy sedation is not how they wish to live.

Ironically, many of the same doctors who lash out against assisted dying already practice it; they just call it something a bit more palatable.

Take "terminal sedation" as one example of a very routine practice carried out daily in hospitals across the country. Under this procedure, the patient can request to be placed into a drug-induced coma after which his or her life support is withdrawn. The result is the patient dies, usually of starvation, within a few days or weeks. Although the patient couldn't have done it alone, no one ever accuses the doctor of "assisting" in the death. Yet that same dying patient, even when lucid and suffering intolerably, is denied the right to a prescriptive medicine that he or she can self-administer to bring about a peaceful and quicker death.

Yes, better pain management is desperately needed and yes, while it will unquestionably reduce the number of terminally ill people wishing to hasten their death, it will never entirely eliminate the desire for it.

For some, a dignified death means the ability of the dying person to control the time and manner of his or her own death, rather than leaving it up to useless medical science and technology. A physician's duty is not limited to healing but to ending suffering as well. And where this is only possible through a hastened death, the physician should be willing to help the patient experience a death in accordance with the patient's own personal beliefs and values.

 

George FoxPresident, Compassion & Choices; Honolulu

http://the.honoluluadvertiser.com/current/op/letters