Monday, August 31, 2009

Who Cuts the Thread?

Last week I spoke with a representative of Compassion & Choices, the nation's largest aid in dying advocacy group and a party in tomorrow's appeal case in Montana, about a story I was doing for ReligionDispatches.

One of the questions I had for her concerned the continued need for what is commonly called "assisted suicide" but what C&C calls aid in dying or death with dignity. Why, if palliative care, or medical treatment for pain, has advanced so much the past decade, is aid in dying - lethal prescriptive drugs for those with sound mind and less than 6 months to live, what "pro-life" groups and the state call homicide - so necessary? My impression was that back when patients had no choice but to suffering with inadequate drugs and a medical industry untrained in end of life pain, aid in dying seemed more necessary. But now that hospice facilities are springing up all over the country, it seemed to me that palliative care in these facilities could keep a dying patient comfortable.

She replied that a terminal patient had a right to decide when they died. No one knows how long a broken body will cling to life long after the patient has decided to stop fighting a terminal disease. Who cuts the thread, in other words, is the question being discussed at tomorrow's trial. What we call nature or god or the mysterious inner workings of the body? Or the owner of that body, the mind and soul that lived a life therein?

Even if a patient facing a painful death were to choose hospice and palliative care, those facilities are only beginning to effect the lives of the dying. Facilities may proliferate but end of life and palliative care is still a highly specialized area of training. While all doctors are required to learn how to deliver a baby, few are training in pain relief at end of life. It is still not easy for the terminally ill to arrange a painfless death.

One of the ways that terminal patients, lacking legal, non-violent means to end their life, have chosen to die is refusal of food and hydration. I asked if dying of dehydration or starvation was painless. No, she told me, for some patients, starvation and dehydration were very painful. More importantly, they could be delusion-causing. A griefing family or a medical staff could mistake delusioned calls for water or food, after the patient has chosen to die, and have feeding and hydration resumed, resulting in a more painful and prolonged death.

There is a difference, the representative told me, between prolonging life and prolonging death. Our medical industry is still very poor at knowing the difference.

For more on the Montana case that will begin tomorrow, see:

listen life here: http://www.montanacourts.org/oral_cal.mcpx

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1 Comments:

Blogger Amy said...

I found your blog entry and your Religion Dispatches article well-researched and thoughtful. It's very easy to get caught up in the hyperbole and rhetoric. It's refreshing to read something that takes a step back.

And you are so right. How can we as a society have a thoughtful discussion about end-of-life issues if we aren't even understanding each others' language on the issue.

I would love to speak to you about this. Didn't see an e-mail link, so will provide mine:

Amy Cannata
Communications Director
ACLU of Montana
amyc@aclumontana.org

August 31, 2009 at 3:47 PM  

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