Tuesday, January 26, 2010

Hedging the Word Murder for the Sake of Profession's Power and Pride.

MacDoctor writes at his site about the two verdicts recently reached in Britain on mercy killing cases, questioning both decisions. Then he proceeds to confuse the hell out of his readers on absolutes like suffering, murder and end of life choice. Like most conservative doctors who claim to know just what they're talking about when it comes to "euthanasia" but refuse to abandon the unreasonable absolutes they have been taught - he comes out in support of pain:

The first verdict troubles me greatly. I have enormous sympathy for this lady and for her daughter. Multiple Sclerosis is a truly awful disease that causes progressive debilitation, weakness and chronic pain in the patient. But, as I have argued in a number of recent posts on Euthanasia, the person requesting assisted suicide is highly likely to be depressed and therefore in need of treatment, not death.

Ok, so you're body is debilitated by MS and death is impending without a doubt. Maybe you're given less than six months to live (as Death with Dignity requires in the US). A little depressed, maybe? You've accepted that death is coming, caused by the incurable disease, and that surely tremendous pain and suffering will precede it. What does MacDoctor recommend? Cheer up! Because unless you're living with (unrealistic) hope that you will happily go on, you must be depressed - and that's bad. (No wonder doctor's fail to give their patient's direct, scientific, accurate diagnoses.)

The idea of assisted suicide should then be anathema to any doctor who follows hippocratic ethics. It is also highly unlikely that a parent could have the skill set to exclude a depressive illness and retain sufficient composure to make a reasoned clinical judgement on the issue. I most certainly could not do it. I therefore think the idea of “assisted suicide” is made plausible in the legal system, and in the eyes of the public, only because they do not understand the complexities of the situation.

Strange, I feel the opposite. When you know more about the effects of a disease, the particular disabilities visited on a patient, the general diagnosis, the amount of love and time and years the family have invested in that patient's care, when you let go of the myth of hippocratic ethics (MacDoctor fails to say what he means here, though I suspect the "first do no harm" stuff that is loosely taken from the original oath, written in 4 BC and seldom used in medical schools, an ethics I don't mean to belittle but would seriously like to have someone clearly - historically, technically - define), and when aid in dying is offered via the strict supervision of two doctors - the issue is no longer for the mother or parent or loved one to make. It is up to the patient. Is it not this necessary leadership to the Styx, this advisement and direction, this authority and wisdom that families look to doctors for?! Where is the authority in the face of suffering? Why have doctors again and again throughout the ages chosen to abandon patients at the end of life, in their suffering?

We maintain a myth of “mercy” killing, purely because we do not see the alternatives that may, in fact, make life bearable and even sweet for a patient again. Granted, these alternatives may not actually exist. But they need to be sought for in a reasoned and considered manner, not in the despair of a particularly bad day.

Ok, let's substitute the myth of mercy killing for the myth of relief - or the futile search for one? Or better yet, for the myth of redemptive suffering! Why? Because "giving up hope" - a euphemism for facing death - is bad, and it signals depression? As MacDoctor says, it shows lack of respect for life?! In neither of the cases noted here was the mother motivated by the vagaries of a particularly bad day. They spent years, decades even, caring with the greatest of patience for their dear children - always working and caring with hope. The women acted because they ultimately saw no future for their child - nor perhaps for themselves - and in one case because the child begged repeatedly for release. As Jeff Sharlet has said about the death of his mother:

Shortly before ! she died, she invited people of different faiths -- Buddhism, Evangelical Christianity, Catholicism -- to pray with her at the house. These people spoke of salvation -- of preparing for the next world, for life after death. But his mother, Sharlet said, wanted to pray for deliverance.

"She would say, 'I want to be delivered from my death.' ... That always stayed with me. That whole idea of deliverance versus salvation -- it's the most interesting dilemma you could have."

And the women MacDoctor condemns, albeit with the removed compassion afforded one who is not implicated, acted alone because they had no option of going to a doctor. They were isolated and forced to act out of compassion for their suffering children because neither the state nor the medical profession nor the church would hear their needs. Tell me, what does a dying patient have? What does a care taker have at the end? Abandonment, often. And the high-mindedness of a profession that fails to look realistically at the ramifications of that abandonment and desire for release.

I am acutely conscious that sometimes my colleagues and I are singularly useless in assisting suffering patients to seek other solutions besides death. This does not make murder right. Nor does it mean that “mercy killing” or ”assisted suicide” is somehow one step down from murder. By all means let us show mercy to those who resort to murder for reasons that are both understandable and non-malignant. But let us not dress it up as anything less than the “killing of another person , not for the purpose of self defense” – murder in anyone’s book. To do anything else is to devalue life.

So the alternative to "mercy killing" is to allow sanctioned suffering as the default treatment? Doctors can't do anything about end of life suffering often. But by all means, let's not change the laws to address more humane ways of treating dying patients. That would "devalue life"? What the hell does this sort of insensitivity mean coming from a doctor - indeed the medical profession? Rather maybe than ask doctors to take a stand against senseless suffering, the profession would prefer to enjoy their quiet, noble, paternalistic position by inflicting futile care and prolonged death on the suffering? The church and their pride have convinced them that they are the keepers of pain. Rather than break down ideas of murder and mercy killing for those in pain, let's continue to sanction it for an abstract idea like "sanctity" and "life."

Maybe all those cries from "pro-life" groups that doctors who participate in humanely ending life really have hurt the profession's noble pride. Who wants to be ostracized for standing up for a particular, controversial issue? Particularly when you can snow the public to believe that the "double effect" is completely separate from aid in dying. Particularly when you can exempt yourself and your profession from the truth of dying - in lieu of noble ideas that have no place near the sick bed. So long as it's not your pain or suffering and you can claim loose ideas like compassion, why not let a desperate, cornered, abandoned, grieving mother face government and society sanctions. Why speak up when you're not the one spending the next 9 months in jail - and a lifetime thereafter wondering why society has abandoned you.

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Anonymous MacDoctor said...

I see I am right in my assessment that you (and many like you) do not understand the complexities of euthanasia and choose only to react emotively.

I do not advocate suffering at all. I have dedicated much of my life to alleviating suffering. It is therefore an absurd, and extremely insulting, comment to say that I am "in support of pain". Neither am I against death, which is a natural end.

However, the correct response to a suffering human is NOT the same as the response to a suffering dog - "put it out of it's misery". The correct response is to alleviate suffering as best we are able. You suggest that these two women had been abandoned by their doctors, but there is no evidence at all for this. Worse still, you fail to realise that neither of these patients were terminally ill. Your entire argument therefore falls apart.

I mention that sometime we doctors do not do a very good job of alleviating pain and suffering. But the proper response to this is to get better, not to commit murder.

The problem with euthanasia is always where do you draw that line between treating a patient and killing the patient? The reason why ethical doctors cling to that archaic oath "First do no harm" is because as soon as you lose sight of that, you lose sight of what makes a doctor.

Your 90 year old granny with multiple co-morbidities? Just kill her off, it's quicker. Your depressed 17 year old girl? Let's help her suicide, she'll just be a drain on the health system. Why bother with palliative care at all? Lets kill them now!

If hippocratic ethics are a myth, the above is what you will unleash on the world.

I suspect you do not really want to live in a world like that. I note you are involved in hospice. Bit of a contradiction, don't you think? Surely it would be kinder to kill them all now?

January 27, 2010 at 7:27 PM  
Blogger L A Neumann said...

Dear MacDoctor,

Your comment I believe demonstrates the lack of nuance I mention in my original post. Those who support aid in dying as legalized - and highly regulated and reported - in Oregon and Washington (Montana is another case) have no desire to start killing those who suffer.

Opponents of a woman's choice of when she has children make the same argument you do, that choice means the "culture of death" is out to get the vulnerable. It is a rhetorical argument that has no bearing in fact so long as one recognizes women, and for the sake of our conversation, elders or the disabled, have a right to their own autonomy and decisions.

By legislating theological ideology, opponents to patient choice are making the case that their beliefs are more important than the rights of patients. This is unjust.

No one wants to live in a world where the vulnerable are preyed upon, regardless of one's views on abortion or aid in dying. So let's stop demonizing and "killer" calling, shall we?

My point is that patients who face death from a fatal disease are dying. The medical culture makes it difficult for patients to die without futile care - and as a doctor, you know how terribly difficult it is for a patient to deny death-prolonging treatments. Hospice and palliative care offer continued hope to those who have no chance of recover: hope for a dying of their choosing.

As to the care-givers in Britain who were recently brought to courts, they too suffered the challenges of providing care. We often glorify the task of care-taking (particularly for women and especially mothers). These women were not demons hell-bent on killing their children. Not to recognize their lack of support, the great challenge of their task, the loneliness and daily pain that they and their children suffered is unrealistic and convenient if one is to argue against them.

"First do no harm" is a fine ethic but by no means is it what guides medicine if you examine the definition of harm. And it is this semantics that narrow, flat arguments avoid. Is unnecessary chemotherapy that offers unfounded hope to a patient who doesn't want to die not doing harm?

The definition of harm should not be up to the doctor, the state, nor the church but to the patient and their care-givers. Discussing impending death is healthy and life-affirming.

Demonizing culture that wishes to give patients the decisions for their medical care - with factual information as a guide - doesn't forward the discussion. It is the equivalent of a foot-stomping insistence that leaves patients and their care-givers alone without resources.

Thanks so much for writing. I'm very glad you stopped by. Ann

January 28, 2010 at 5:25 AM  

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