To die or not to die

Anyone who wishes for death will wish for one that is quick and painless.  What about those who are doomed to die a long and painful death?  I have watched this process; it can go for hours, days, weeks or months.  It is painful, it is long, and it is devastating.  I once watched a 49 year old man with a terminal brain tumour lay on the palliative care ward for weeks waiting to die.  His condition deteriorated significantly in the final days, he was on a serious assortment of pain relief, nausea relief, laxatives and those medications to stop that gurgling sound when we are close to death (which is more for the comfort of the family than the patient).  But what if we had a choice about how we die?  What if there was a way out for those suffering terribly, creeping closer and closer to deaths door? There is an option, and it’s called euthanasia.

What is euthanasia? By definition it is intentionally putting to death or allowing someone to die within the context of a terminal illness.  It would likely be performed with an overdose of a painless medication like morphine.  Should we as doctors be able to end the life of a suffering human being?

Before we can answer this question, there are several factors that must be considered.  The most important piece of information in these scenarios is the patient’s wishes.  In some cases when patients are aware they are terminal they can formulate a plan in case of their demise to be acted upon their behalf when they can no longer communicate.  At a rational point in time you may have decided to be resuscitated no matter the circumstances, but how do we know that when the pain, the incontinence and the misery strikes and you are no longer able to communicate that you wouldn’t change your mind? How can we really know what the wishes of a person are at that time when they are unable to communicate?  The short answer is, we can’t. The solution would be to allow medical staff to act on the patients best interests, but have we then encroached upon patient autonomy, a vital aspect of medical care.

What about age?  Would we agree with euthanasia in a terminal 98 year old and not in a terminal 21 year old? Should one suffer more than the other?  Or do we just not want to accept the death of a young person?  And would this really be about the patient’s best interest, or our own?

I mentioned earlier in this article should a terminal person be ‘allowed’ to die.  For those of you who don’t know, suicide is illegal and the consequence is obviously death. I always found this strange, if I want to end my own life should I not be allowed to?  After all, it’s my life, it’s my body.  This brought what’s known as ‘assisted suicide’ into the mix.  Assisted suicide is where a doctor ‘assists’ a patient to end their life, by providing them with the information on how to end their life, providing them equipment and providing them with the appropriate medication.  This method takes away the direct involvement of the doctor and places more of the responsibility on the patient.  But leads to the possibly of coercion by medical staff for patients to end their life and also means decisions must be made prior to reaching a point where the patient is no longer able to communicate.

As much as no one wants bring it up, there is also the issue of money.  It costs money to keep a palliative patient in a facility, tending to their daily needs, managing their daily pain.  If we could allow people the choice, if they are deemed as terminal, to choose when to end their lives with a pain free method we could have more funding to provide better quality of life rather than quantity.

One thing I have learned as a doctor is that quality is more important than quantity.  Overall it seems better to have a better quality of life over a shorter period of time than a horrible quality of life for a long period of time.  I think euthanasia is an option.  It is not so clear cut at this stage and their will need to stringent rules and guidelines put in place to ensure it is not misused.  In my opinion the most appropriate option would be to open this discussion early with terminal patients and educate them on their options.  Then allow the patient to make their own choice and assist them with their decision.

As doctors we always see death as a failure.  Death is not a failure, it is part of the process of living and instead of avoiding death or trying to prolong life despite its quality, we need to focus our efforts on leading people into death the best possible way we can.  Our role as doctors should not be to attempt prolonging a terminal life at all costs but to treat death as a normal process of life.  We would only fail if we allowed a patient to move into death in pain and misery and we would succeed if we transitioned a patient into death with the best quality of life we can, with respect, with dignity and pain free.

-The Doctor

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