Duty to Die: Author Says Too Few People in Oregon are Requesting Assisted Suicide

being mortal

How about this for piling on.

Here are my brief thoughts about someone else’s article. That article is kind of a review of a book review.  More like a response. And I just happened to finish that book, and I really enjoyed it. The book is called, “On Being Mortal” by Atul Gawande the Harvard trained surgeon who has produced a number of good books in the last decade. I have read them all 🙂

Anyway, Gawande’s book is about aging and dying and how the healthcare system has not done a very good job in actually helping people live better lives during the last phase of their journey. He spends a few pages talking about assisted suicide, and I would disagree with what he says (he thinks it is OK under some circumstances). But regardless of your position, he makes what I think is a compelling point. In America, and other countries, we are making huge strides in palliative care and hospice services.  And contrary to popular conception, those treatment modalities are not about helping people die as much as to live as well as they can during those difficult days.  People with painful and  incurable diseases are choosing to live out their days with family and finding more dignity than they knew was possible. And it is worth mentioning that how we live when we are dying is an important part of the human journey. How the story ends is truly important.

But it seems that in the Netherlands, the availability of assisted suicide has become the quick fix that has railroaded more promising alternatives. Rather than developing health care systems that can help people live full lives to the end, they have opted instead for something more sinister in the name of “dignity.”  Here is a quote from Gawande’s book, ”

 “I fear what happens when we expand the terrain of medical practice to include actively assisting people with speeding their death. I am less worried about abuse of these powers than I am about dependence on them.”

“The implication is that we might begin to substitute assisted dying for palliative care and hospice. He points to the experience in the Netherlands, where he says the fact that “one in thirty-five Dutch people sought assisted suicide at their death is not a measure of success. It is a measure of failure.”

The author of the article at LifeNews.com, Wesley Smith J.D. makes a point that is even more disturbing. Marcia Angell, an author who is an advocate for assisted suicide, has been quoted as saying, “I am concerned that too few people are requesting it. It seems to me that more would do it. The purpose of a law is to be used not to sit there on the books.”

Is this debate about presenting options that people want, or imposing your choice on others?

Source: Duty to Die: Author Says Too Few People in Oregon are Requesting Assisted Suicide | LifeNews.com

If We Are Unaware of Human Suffering, Does It Exist? Thoughts on Chronic Pain

My sister posted this article on Facebook recently. She suffers from chronic pain and has had trouble getting a diagnosis. This article by psychologist/ neuroendocrinologist Chandler Marrs discusses pain in terms of a philosophical principle. We don’t need to be in the forest to believe that trees fall when we are not there, and that they make noise even when no one is around to hear them.  She says that we tend to think that “awareness predicates existence,” when that is clearly not true. If we close our eyes, the world doesn’t cease to exist.

The big idea in this article involves depending on our ability to “measure” pain objectively as prerequisite to its existence. Does pain only truly exist only when the clinician can objectively perceive it? Is it possible that there are some disease states for which we do not yet have adequate tools to be able to measure it? The fact that millions of people complain of pain where clinicians cannot identify the causes should make us consider the limits of our knowledge and tools. 

Why is this important? In my experience as a healthcare provider, if someone higher in the chain of command ran all the available tests and couldn’t identify a known cause for the pain, then often the conclusion was not favorable. We thought that the patient was seeking drugs, or that they had some kind of mental imbalance. The polite term may have been “somatoform disorder.”  They were often lumped into that big diagnostic basket of “fibromyalgia,” which basically meant “you have pain and we can’t find a reason for it.”  This label could easily function as a flag to dismiss the reality of the patient’s claims.

Marrs also discusses how our perception is affected by our humility and our humanity.  Our compassion is based on our ability to believe that another person is truly suffering.  A lack of empathy can result in an inability to perceive someone else’s problems.

If we put these two factors together we may find that our insensitivity prevents us from believing someone’s  complaint, and concluding that it is not real.  And since there are real “malingerers” and drug seekers out there, we can easily put people into that category when they don’t fit. The result is tragic.

She writes:

“In the case of modern medicine, if the suffering is invisible to current diagnostic tests and intractable to medical therapeutics, it is not real. Indeed, whether cognitively or reflexively, every time a physician dismisses a patient’s complaint or prescribes an anti-depressant for pain, he denies the existence and veracity of their suffering. He denies the tree in the forest, because he does not see or hear it himself in the context necessary to recognize it – e.g. by currently available diagnostic technologies and taxonomies. Here, medical technology, and the physicians who wield the technology, assume an infallibility that precludes the existence of realities beyond their sight lines, beyond their control.”

Source: If We Are Unaware of Human Suffering, Does It Exist? – Hormones Matter