Wednesday, January 13, 2010

Margaret Somerville on Patient Dignity and Suffering.

Margaret Somerville, an opponent of aid in dying, writes for today's Globe and Mail some great things about how to help dying patients in pain feel as though they still control their lives.

While I agree with much of what she writes, her disingenuous digs at "euthanasia" ring hollow and unjustified in the context of the article. Patient dignity and control is not negated by aid in dying, when provided in the context of strict laws, but in particular terminal cases enabled by it. But the Canadians have their own culture war over "euthanasia" waging. Somerville has an ideology to enforce; unfortunately that's made an interesting and beneficial story into a piece of advocacy work, undermined by a position that she espouses but doesn't back up with fact.

Euthanasia is proposed by its advocates as an appropriate response to pain and suffering, precisely because, they argue, it gives patients ultimate control over what happens to them. But if, for ethical and practical reasons, we believe (as I do) that legalizing euthanasia is a very bad idea, what else can we do to reduce the suffering of seriously ill and dying people?

First, everyone has a right to all necessary pain-relief treatment: We must kill the pain, not the person with the pain. To unreasonably leave someone in pain is a breach of a fundamental human right and a breach of trust.

Trust in one's caregivers is very important in reducing suffering. In the past 30 or so years, we have changed from blind trust – “trust me because I know what's best for you” – to earned trust – “I will show you can trust me and will earn your trust.”

Earned trust requires honesty, and shared information and decision-making, all of which increase the patient's sense of control, thereby reducing suffering. When it's not possible for the patient to be in control, honouring the patient's trust becomes even more important.

We have medicalized, depersonalized, dehumanized and technologized death – and, as a result, dying people suffer intense premortem loneliness. We need to recognize and address that loneliness. Euthanasia is a medical technological response to suffering and death. But in a caring, ethical society, the answer to loneliness and abandonment is not a lethal injection.

We need to understand what seriously ill or dying people require to feel respected. Harvey Chochinov, a Manitoba psychiatrist who specializes in the care of terminally ill people, and his colleagues have developed a treatment they call “dignity therapy.” They identified the elements that contribute to dying people's suffering and designed interventions to counteract these elements. Hope, for instance, is very important in reducing suffering. It requires having a sense of connection to the future. We can give people “mini-hopes” – things to look forward to – even when a long-term future is not possible.

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