An intensive care unit doctor reveals his thoughts on the euthanasia debate.
Cross-posted from The Sydney Morning Herald
I am no expert on Death. He never stops to chat, even though he visits my intensive care unit regularly. I’ve lost count of the times we’ve crossed paths – I guess it must be two or three thousand by now? I suppose we’ve never got along. After all, 75 per cent of my patients with life-threatening disease – his prime clientele – survive. Maybe he doesn’t like me?
Much of my time is spent listening to patients with a life-threatening illness and their families. I have since found that much of what I was taught about Death was wrong. Even more of my time is then spent dispelling the myths disseminated by his marketing department.
His latest advertising gimmick is that euthanasia is popular. This strikes me as odd. According to popular opinion there is overwhelming community support for euthanasia. And yet when I listen to dying patients and families I discover this is simply not true. What they fear is loneliness, pain and indifference. What they prefer is quality to quantity, symptom-relief to suffering, time spent close to loved ones not machines, shared decision-making, and above all a doctor who will listen. This is not euthanasia. This is simply good medicine.
I admit I have been asked to hasten death. But in my experience this is surprisingly rare.
So I decided to quiz at least 20 other specialists who care for the dying in a dozen major hospitals and palliative care services. I discovered I was not unique. The topic of, let alone a request for, euthanasia rarely surfaces during end-of-life discussions.
So why do we cling to the myth? I suspect Death employs a very shrewd public relations manager.
His favourite ruse is that dying is painful. I freely admit too many suffer in their dying. One is too many. Yet we live in an unparalleled age of extraordinary means to relieve suffering and control unpleasant symptoms.
Sometimes suffering is prolonged. I confess this is not because I try all possible treatments and they fail. More often it is because treatment is found difficult and is left untried.
Contrary to popular opinion, doctors do not purposely prolong life when death is unavoidable. If there is opportunity to restore health or independence, treatment is offered. If it will no longer help, we do not and should not offer it, even if you demand it.
I admit, however, that I am still sometimes slow to recognise Death.
Death claims he is a natural part of life. He may be universal and occasionally merciful, but I have never found his claims to be of comfort to a dying patient or their loved ones. It is good to celebrate a wonderful life, but not the event that extinguishes it. It may be a relief to see the end of pain, but not the price this requires.
What I have discovered – to my astonishment – is that far more are comforted by hearing that death is heart-breaking and wretched, irrespective of the age or the circumstance.
Of all the myths about Death, the saddest and most malignant is that you have no say. This, too, is false advertising.
If you have a serious or long-term illness, talk to your family and friends and your doctor. Tell them what is important to you. Independence? Family? Relationships? Staying at home? Being active? Reaching a milestone? If you are unsure, say so.
Treatment requires your consent, so get the facts. Ask about treatment options, risks, prognosis and symptom relief. Will I recover? Return home? Regain independence? Be wary of misinformation, even from my own profession. If you are unsatisfied, ask for a second opinion. Take along someone you trust. If you are scared, admit it – you are not alone.
Appoint someone trustworthy as your medical power of attorney. If you have a serious permanent illness, ask about advance care planning. If you wish to decline treatment(s) consider a Refusal of Medical Treatment certificate.
Symptom relief is a compulsory component of healthcare. Contemplation of euthanasia is dubious, frequently dissolving in the presence of effective healthcare.
Many patients and families have been kind enough to return and express gratitude. Even on the odd occasion to declare they have euthanised their membership of Dying with Dignity. None, to my knowledge, have signed up.