Killing Me Softly…
There is much commentary in the blogosphere about the rather poignant letter of Dr. John Pollock to the New Zealand Doctor magazine advocating euthanasia. Dr Pollock is dying from terminal malignant melanoma. While I very much empathise with Dr. Pollock, I think neither he, nor the blogosphere supporters of euthanasia, actually understand the implication of what they are requesting.
I have blogged on a number of occasions that the reason why people are so enthusiastic about eusthanasia is because of the woefully inadequate state of palliative care in New Zealand. Dr Pollock attempts to turn this argument on its head by saying:
“Yes, most pain can be relieved to a large extent but at the cost of symptoms such as constipation, nausea and drowsiness, which may be partially controlled by other drugs with their side-effects.
“Breakthrough pain is common and its prevention requires constant medical attention which is not often available. We are not good with neuropathic pain. Other symptoms are poorly controlled – in particular that horrible, hopeless, helpless state of feeling so weak and ill you can enjoy nothing – not food, not conversation, not reading, not telly, not even the touch of loved ones.”
Actually we have the medical technology and know-how to alleviate most of these symptoms but very few people with the skills to provide this sort of care. Even neuropathic pain, notoriously hard to treat as it is, can be ameliorated to a large extent by selective dorsal root lysis of nerves and similar techniques. The point is that quality of life for dying patients is entirely dependent on the amount of skill and effort put into their medical and psychological management.
This brings me to the central problem I have with human euthanasia. It is a cheap cop-out.
”Dr Pollock correctly points out that, if we had a pet in the same situation, we would usually turn to euthanasia immediately. There are two reasons for this. Firstly, while we care for our pets a great deal, they are, after all, merely animals. It is not possible to get them to understand concepts such as quality of life or purpose and meaning. Secondly, we kill our animals for a much more mundane reason – it is cheap.
Maintaining adequate pain relief and caring for derangements of normal functionality is a very expensive process. Coupled with the fact we would never be able to make our pets understand what we are doing, it simply is not worth the effort and expense to maintain their lives.
This brings me to the central problem I have with human euthanasia.
It is a cheap cop-out.
Least I be called insensitive in the face of Dr Pollock’s eloquent and emotional letter, let me say that I say this entirely in the context of medical practice. I do not consider Dr. Pollock’s desire to die rather than suffer a “cop-out”, I consider the legalisation of euthanasia to be a cheap (and nasty) alternative to adequate palliative care. And therein lies the chief dilemma.
Governments being what they are, as soon as euthanasia is legalised, there will immediately be a subtle drive to euthanase dying people. It will not escape bureaucratic attention that having granny die a few months earlier will save the government health budget millions a year. Recall that the bulk of expenditure in healthcare is spent on the last year of life. The vast majority of these people are clearly terminal in the last three to six months of this period. Imagine the cost-savings of involuntary euthanasia.
While I am fairly certain involuntary euthanasia will never become a healthcare cost-cutting tool, there is no doubt in my mind that pressure will be subtly placed on the terminally ill to “end it all”. It will be put as an “escape from suffering” or “to spare the family” or “to not be a nuisance/burden”. But it will still be coercion no matter how it is dressed.
Is this really how we want our society to be? Driving the elderly and infirm to a premature death in the name of convenience? Are we really so unable to train our physicians in the proper care of the terminally ill? Or is the word compassion only reserved for those who would kill rather than care?
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Jul 22 10 8:00 am
“The point is that quality of life for dying patients is entirely dependent on the amount of skill and effort put into their medical and psychological management.”
If this were true it should be possible to get Dr Pollock back to his chirpy self, running down the beach, playing tennis, whatever it was that gave him his quality of life before he became ill.
The truth is that the aliments that have taken his quality of life: “that horrible, hopeless, helpless state of feeling so weak and ill you can enjoy nothing – not food, not conversation, not reading, not telly, not even the touch of loved ones.” are “poorly controlled” and will always be poorly controlled, unless you dose them up on such powerful narcotics that you may as well call them junkies, presumably if they’re happy, junkies must have quality of life.
Nope, can’t agree with you, but what would change my mind would be proof that you’re right. This could be provided simply by providing the medical care that would cause Dr Pollock and other advocates of euthanasia with a terminal condition to cease they support for euthanasia.
Jul 22 10 10:36 am
Interesting that the only quality of life you will accept is complete restoration. This implies that all disabled people should seek euthanasia, as should all who have had major disabling surgery (amputations, colectomies etc.). After all, I cannot restore these people to perfect health either.
I think your test misses the point here. If a person still wishes to end their life, no-one can effectively stop them. However, government approved euthanasia should not be used as an excuse to continue to provide inadequate terminal care.
Jul 22 10 11:04 am
“Interesting that the only quality of life you will accept is complete restoration.”
No, that’s not what I said or implied, my point was that the quality of life is certainly not “ENTIRELY dependent on the amount of skill and effort put into their medical and psychological management.”
“This implies that all disabled people should seek euthanasia”
I’ve suggested no such thing, whether people chose to end their own lives for reasons other than terminal illness and the associated suffering should be their decision, I’m not suggesting what they should do, but rather what they should be allowed to do.
“government approved euthanasia should not be used as an excuse to continue to provide inadequate terminal care.”
I haven’t suggested that either.
You’ve suggested that euthanasia not be allowed because you think it’s possible to restore quality of life, but it’s not “possible” if the required medical care simply isn’t available, wishing ain’t going to change that, and neither is not allowing euthanasia.
Jul 22 10 9:22 am
While I am fairly certain involuntary euthanasia will never become a healthcare cost-cutting tool
more’s the pity. I hope that it will rapidly become a “tool” both in healtcare, in education, in corrections, and in welfare reform.
Please explain why I – as a taxpayer – should have to pay thousands of dollars to ‘educate’ (really warehouse) some drug-dealer’s kid who won’t learn anything. Please explain why I should have to pay ten of thousands to some dole bludger or WFFer who can’t earn enough money to even feed their family.
Please explain why I should have to pay hundreds of thousands to provide “end of life care” to some other loser who didn’t make private provision for their own retirement or health insurance. And please explain why I should have to pay hundreds of thousands – or millions – to keep, feed, house, doctor, educate etc some piece of criminal shit inside for murder or GBP or rioting or sedition or whatever.
Here’s the deal: if you want to pay for your palliative care, or your education, or your incarceration – absolutely fine!
If you don’t – then I’m happy to pay for 2g Nembutal. It’s still voluntary – you can decide to take ‘em. or not.
Jul 22 10 11:11 am
Your compassion for the suffering of others overwhelms me.
Jul 22 10 9:25 am
MacDoctor, you make a good point about the nature of bureaucracy, and the present paucity of good palliativer care, but I’m afraid you have failed to address one crucial point in the argument, i.e., whose bloody life it is anyway.
A patient has a right to end their own life if they wish, and apart from offering advice it’s none of of your business if they do. That’s really the end of the story, except to ensure there are sufficient legal safeguards to ensure that voluntary euthanasia is truly voluntary.
Jul 22 10 11:07 am
Peter
You are confusing two issues here. Any person can end their own life at any time they choose. While I would consider this prima facie evidence that that person is depressed and in need of treatment, the fact remains that I cannot easily stop them from killing themselves. The terminal patient will usually retain the ability to end their own life until the last few days of their illness.
What I am arguing against here is state and medical collusion in that suicide. This is a very dangerous line to cross for the reason I have given. I have friends who have practiced in Holland and they confirm my worst fears. The elderly, in particular, are subtly maneuvered into euthanasia as soon as they become ill. The Dutch law is also very liberally interpreted, in much the same way as our Abortion laws.
Least you think I might approve of relatives assisting a suicide, I do not. Their motivations for assisting are more complex than the state’s cost-driven one. Compassion for their loved one is invariably mixed with desire not to be burdened with care, cost of care and the mistaken belief that their loved one will die horribly. For this reason and others, it is difficult to clearly determine whether euthanasia is truly voluntary here as well. Having been in many, many terminal care situations, I can confirm that relatives are usually hugely conflicted in their desire to “end granny’s suffering” – particularly when terminal care is adequate and granny is clearly not “suffering”.
Jul 22 10 9:57 am
The one phrase he used that stuck out to me was his desire to be in ‘control’. I wonder if dying is the one act in life we are not supposed to have control over? Lots of times we are uncomfortable, in pain and not in ‘control’ during life. Giving birth is only tolerable because you have a baby to look forward to. Suffering from accidents and disease, and the treatments of those accidents and diseases, is also uncomfortable and painful. But you have a hopefully pain-free life to look forward to, while Dr Pollock is looking ahead to a time when he will be very, very ill, and that must scare him and his family.
I sat by my dad as he died over a week in hospital. Our family knew he was going, he knew he was going and the medical staff certainly knew it. Would I have pumped him full of morphine, given a chance? No. I really wanted to. If I had, it would have been more to save my own suffering than his. He was unconscious most of the time. In the end I was not there when he passed, although other family members were.
Of course, Dr Pollock, as a doctor, knows exactly how to end his own life in a way to works best for him and his family, and he may well do so while he is still able to. However, I wonder if, when the time comes, he chooses to let ‘nature’ take it’s course?
As a regular, non-medical person, I don’t have that knowledge or access to the appropriate drugs. So I don’t have that choice. And maybe that’s a good thing. I just don’t know.
How do we go about improving the care of the dying? Can we buy ‘death insurance’ to cover the cost of palliative care if we need it?
Jul 22 10 11:57 am
You make an excellent point Linda. How much of this debate is about the feelings of those who are going to survive the terminally ill patient, and how much is about the patient themselves.
Accepting that a loved one is terminally ill is deeply traumatic to all involved, but it can be managed. I have recently watched a friend’s terminal illness, which was bourne with courage, dignity and black humour, despite the dreadful nature of the illness. The local Hospice was closely involved, and a sad and tragic end to a life well lived was made as good as could be possible in the circumstances.
Inventory2´s last [type] ..A Whale of a Tale
Jul 22 10 12:17 pm
“How much of this debate is about the feelings of those who are going to survive the terminally ill patient, and how much is about the patient themselves.”
A very good point! When I read the phrase “death with dignity” I always think of my father in law who died of cancer. He was given a a lot of morphine for the pain, and died happy and high, in fact he giggled quite a lot in his last few days. However, he, um, passed gas. He passed gas a lot, often and loudly. That’s a side effect of the morphine , of course, and I wonder if those who clamour for “death with dignity” are actually those prim, uptight types who don’t like sitting at the deathbed of someone who is passing a lot of gas.
I oppose euthanasia, but I do support plenty of palliative care, and if that includes huge doses of morphine or even, for some patients, heroin, I say ‘go for it’! I want to die comfortably, and I don’t give a toss about dignity at such a time. I had to surrender all dignity to give birth, after all.
Jul 22 10 10:35 am
MacDoctor: Well done for deleting that last arsehole. But he was fair making your point for you: imagine with a shudder one of his ilk holding the clipboard making a decision about Granny.
Peter Cresswell´s last [type] ..“Red Delicious” – David Bowers
Jul 22 10 4:23 pm
I read this book a few months back
http://www.amazon.com/Deadly-Compassion-Death-Humphry-Euthanasia/dp/0688122213
It was disturbing to read how someone supposedly dedicated to ending suffering was so cruel to his wife after she was stricken with cancer, and also after her parents had died.
And in the end, it turned out that he’d murdered (not assisted in her suffering) his first wife.
scrubone´s last [type] ..It’s over- for now
Jul 23 10 3:18 pm
MacDoctor, you seem to be saying if enough resources were available for palliative care then there would be far less suffering and less demand for euthanasia. The problem I have with that argument is that there is unlikely ever going to be these resources.
Your second point that Governments being what they are, as soon as euthanasia is legalised, there will immediately be a subtle drive to euthanase dying people is a very good argument. However, I do not think it is a good enough reason not to seriously consider some legislative change that may allow for euthanasia in some circumstances. However, the legislators should do their best to assure your reasonable concerns are addressed.
Even if the law is not changed to legalise euthanasia perhaps one of Dr Pollock’s concerns could be addressed. In Dr Pollock’s case he would have access to the drugs to commit suicide. His one concern was that he would have to die along as if any of his family was in the room when he took the drugs they could be charged even if they did not assist him in any way. If this is in fact correct perhaps this is something that could be looked at.
Jul 23 10 3:26 pm
There are really two debates here and it’s important people don’t confuse them. The right of an individual to end his/her own life has nothing much to do with giving the State the power to approve euthanasia. The individual who chooses suicide is beyond the reach of the state but a loved one assisting that act is not–and neither should they be.
This helps ensure that the decision to aid someone to kill themselves isn’t taken for selfish reasons. There’ll be a (possibly very high) price to pay for pre-meditated murder.
State interference not only distorts this check–it gives people with little or no real accountability a “backdoor” and degree of legitimacy to killing people for social reasons.
Look around you people and name one thing the state manages well. Then ask yourself if you trust those same politicians and bureaucrats with the power of life and death over you and your loved ones.
I don’t.
Jul 27 10 4:41 pm
Beautifully put! I had a family friend who died in her nineties, who would never kill herself (catholic) but who never wanted to put others to bother or trouble, so would have been highly susceptible to such coerced euthanasia. And I understand coercion is frequent in those countries that have legalised euthanasia (like Netherlands).
It seems NZ does healthcare poorly for non-A&E stuff (ie mental health, disabled/invalid care, and frail care, which includes the terminally ill). Not a criticism of staff, just of the lack of government interest, the anti-institutional attitude which has seen so many abandoned to an unsupported life, and often death.
I hope more medicos add to your thoughts to build an intelligent alternative to the culture of convenient death being pushed by the euthanasia lobby.
One of the unlovely left