Friday, July 13, 2007

To Kill is to Cure

The most recent article in the 'case records of the Massive Genital Hospital' in the New England Journal of Medicine discussed a patient with end-stage diabetes characterized by vasculopathy and multiple cerebral infarcts. The interesting aspect of this case was not the differential diagnosis or the pathological discussion; instead, it was the patient's choice to withdraw treatment and die that intrigued me.

The physician discussant points out that he was unable to offer euthanasia or physician-assisted suicide. They simply withdrew insulin, nutrition and hydration. She died two days later.

Why? Why? I ask. Why can't we help people die? Fuck Hippocrates. When I'm a drooling vegetable, shoot me in the fucking head. Please. We have decided it's OK to let someone suffer instead of helping them with their wishes.

Fuck it. I'm moving to Amsterdam. Maybe I can score some spliff on my way to hell.


  1. Thank you! Thank you so FUCKING much! And I mean that sincerely. I don't think I've ever dropped the F bomb in a comment here or elsewhere, but I feel so strongly about this issue I just had to use it.
    I think it's barbaric how we, as a culture, make terminal patients suffer needlessly, instead of providing them an easy exit from life.
    Once it becomes clear that death is inevitable, that this is a Rational decision, why should physicians NOT be able to help their patients? I'm not a physician, or a nurse, or even an EMT, anymore. I'm a retired Social Worker. BUT, it seems to me, that the Hippocratic oath was written thousands of years ago, at a time when physicians did not have the diagnostic tools to enable them to KNOW that further treatment of a disease or injury was FUTILE. So, sometimes, treating them IS harming them by prolonging their pain and suffering, ergo, helping them to die IS doing no harm.
    Does that make sense, or is my typing out pacing my brain?
    Etotheipi, I know you're probably gonna catch a bunch of flack from the "Life at all costs" crowd, just let me know if I need to go kick some ass. I've watched too many of my loved ones die lingering, painful deaths, even while in hospice care, b/c of that mind set. I got your back on this one.

  2. HollyB: Thanks...I think we may be in the minority on this one...

    Peace out, e^(i*pi)

  3. 'Massive Genital Hospital' eh? Is this where end-stage porn stars go?

    I certainly don't agree with physician-assisted suicide simply because it's not usually necessary when withholding treatments usually does the job when the job needs to be done. That's the way people have died not getting medical treatment and just dying naturally. The trick is convincing people to not continue futile treatments.

  4. We are more concerned about the comfort of our animals in this country than we are about humans (I must say that I also fit into this catagory on most occasions)in regards to euthanasia. Let your animal suffer or prolong his demise and you've got a plethera of activists judging you..."put the poor creature down! Don't let him suffer! What quality of life is that when the poor dog in messing himself? PUT HIM TO SLEEP!! It is the humane thing to do!" But when it's Granny's turn, let's let her starve and thirst and die in her own private lingering hell.

  5. All doctors should be able to choose to do any compasionate act, even if i and others don't agree with it.

    I think of it similar to abortion. I'm against it, though others should have the opportunity to make their own choices. Doctors should get the choice to refuse any care they find morally offensive also.

    I am really against the government paying for it or encouraging it. If it is just between a doctor and a patient that is for them to decide what is right or wrong. But when government regulates, pays for, encourages, or prohibits is when there is tyranny and abuse.

    My tax money should not go to support abortion or assisted suicide, no more than it should support plastic surgery.

  6. Just a little extra morphine when the time comes and get me so stoned I don't notice I've stopped breathing.

    We're not quite so tight assed with narcotics north of the 49th.

  7. I don't disagree with you, Etotheipi, but here's my thought: life itself is not painless, all kinds of pain. Why this demand that death should be painless? How do you even know that doctor-assisted-suicide is painless? What I think we should work for is allowing doctors to give dying patients as much pain-killer as it takes to give them relief from debilitating pain (pain is entirely subjective -- the patient knows).

    My daughter's mother-in-law died in hospital last year. She'd been disabled for many years with diabetes, arthritis, heart disease, etc. In the hospital her organs began to shut down; she was in so much pain, but the doctors said they had to be careful not to give her so much it might kill her.

    At the same time, the doctors were advising my daughter and her husband to allow them to remove the feeding and breathing apparatuses and the IVs and let her die because she was not going to recover. Now THAT was insane, and devasted the kids, who were pacing the hallway begging someone to give her pain meds.

    Life is not painless, death isn't either, but for doctors to want to 'pull the plug' so to speak while also refusing pain relief is criminal in my opinion.

  8. A couple of points:

    Life is not painless. True. But if we can relieve pain, we do. If I want to die to relieve pain, and I can't do it myself, please, someone help me. A narcotic induced stupor is not a terrible option I guess.

    Should the gov't pay? No. Should
    the gov. pay for stupid visits to the ED? No. Should my doc go to jail when he kills me (for free!) at my request? No. I don't care if no one pays - just make it legal.

    I've told my wife over and over - my wishes are to not just be "let go" - I want to be killed. Not now, mind you, but when my brain is gone, then so am I.

  9. You know what I love? I love reading these posts before I read who wrote them and trying to guess which one of you wrote it. I am right nearly every time! I knew it was etotheipi. I just love how you think/write.

    Good thing you were clear with your wife about not wanting to be killed rigt now...I am occasionally tempted with my husband, so it was good of you to provide some definite boundaries of when that would be your wish.

  10. He's just trying to drum up more business. Back down to your basement!

    In America, appearances are the key. We wouldn't want a terminal patient to suffer any pain, would we? So we must give plenty of morphine to keep them comfortable. That gasping looks uncomfortable...more morphine please. That's OK, I'll push it.

  11. I just don't see the bullet to the head as a viable option.

    One thing I can't stand is the smell of brain matter post gun shot. I have been know to leave the Trauma Room for air when that comes in. (my other weak point is grossly displaced fractures, when body parts end up turning the wrong direction) I've seen numerous messy failed attempts, resulting in turning the victim into even more of a gormless vegetable, than I have with "accidental" morphine OD's in house.

    If I ask you to take care of me when the time comes do so gently, but please make sure it's done right the first time.

  12. i do not completely disagree with you ETOTHEPI but i do in this regard. if you want euthensasia then great. just keep it out of our (physicians) hands. train some folks to be the death dealers, keep our hands out of the mix. i feel perfectly comfortable telling a family "we have reached the point of medical futility" but i do not want to push the lethal dose. i know you will poo-poo this, but i just think that that kind of power added to the power we already have is a recipe for disaster. doctors for healing, hemlockers for death.

  13. Yes, Yes, YES! When my dad died of lung cancer earlier this year, I fought the medical people. My dad was septic so he had no blood pressure and had leg pain. They wouldn't give him enough meds to keep the pain down but they were pushing me to withhold treatment.

    In the final conversation with my dad's oncologist I called him a part of the female anatomy because he wouldn't give my dad more pain meds because "it might kill him" and then expecting me to pull fluids and stuff. Just wanted me to do his dirty work. I gave permission to pull the blood pressure support meds and he died 5 hours later. But they never gave him anymore morphine..but my dad was unconcious and didn't appear to be in pain.

    If I ever end up with a terminal disease, I have every intention of offing myself before getting that far so my kids aren't forced to make the decisions I had to for my father.

  14. again, being in general agreement of the sentiment of this post i do feel like playing devil's advocate a bit.

    yes, i know what the terminally ill go through. yes, i've seen people die over months. yes, i've seen them die in five minutes. yes, i've seen them in pain and i've seen them is states that may be pain and i've seen them in states that only God knows what they're feeling.

    we put animals down in the name of kindness. suffering is part of the human condition. only in the past century has it been possible to alleviate physical pain and then only in western countries until very recently.

    physicians are trained to diagnose disease, treat it, and heal it when possible. do not come running to me, please, when grandpa, who has been smoking all his life, and has had lung cancer for 5 years with mets to the the liver, and has stubbornly refused to sign a DNR/DNI seem so be suffering in his death throes.

    i am truly sorry but i am not, nor do i ever want to be, God. please people, make up your minds before this happens. have the disussion. sign a living will. if there is any doubt at all about your intentions the default mode is rescussitation. period. you may not want to be on the vent but if you or the medics or your family can not prove it to me then i'm putting a tube down you so james sokolov or one of johnny cochrane's flunky's doesn't sue me for wrongful death. sorry.

    and a fianl philosophical point. whatever happened to sitting up with the dying, and being at the bedside with grandma when she passed? this excercise, i believe, was a difficult but salutary part of life. we don't do that anymore. we are a bunch of pussies. death scares us and i understand that. only in the last fifty years in this country though, has death become something other than the natural and unavoidable result of life.

    don't lay it on the docs.

  15. I would have to agree with 911 on this one, unless we are specifically talking about you, etotheipi. But I think if you are in pain or suffering you should have enough morphine/fentanyl to be gorked as you shuffle off this mortal coil.

    By the by, before you die call me. My wife said I can go to Amsterdam with you and help you end the thousand natural shocks to which the flesh is heir.

  16. 911Doc...what about the patients who HAVE signed a DNR and a living will and DO have family BEGGING for more morphine as they lay in their bed, at home, moaning in pain? The Hospice Nurse and Doc told me that he couldn't have any more morphine b/c it would kill him. Hell, the CANCER was killing him. NO, he was NOT a smoker. It was MET. RCC. Just like his Mother, and two of his Uncles, [that we know of]. Finally, he quit eating, when that didn't work, he quit takin' fluids. Know how long he sufferd after THAT? A FUCKIN' WEEK!
    If I had known where to score some heroin in Killeen, by gawd, Texas, I'd have given him a bolus in his IV line.
    I'm with time comes with a terminal didease or I get Alzheimer's...while I'm still in control on my mind...I'm checkin' into the Adolphus; ordering some DOM, Lobster, and then takin' and Overdose AND Shootin' myself [I belive in redundant systems]. I will not place the burden of "pullin' the plug on my kids. I'm gonna be cremated anyway, so a good lookin' corpose isn't an issue.

  17. Just playing devils advocate,
    "A court in Switzerland has sentenced a retired psychiatrist to three years, for helping three depressed people commit suicide.

    Peter Baumann, who ran his own assisted-suicide association, was found guilty of involuntary manslaughter in a country which has some of the most relaxed assisted-suicide laws in Europe."

    I have to conclude it can't be up to one person to decide, has to be a commitee or like a court thing.

  18. Great post, Etotheipi !
    That is EXACTLY why I bought the book 'final exit'. If I ever need it, please I'll go on my own with dignity as fast as I an.
    Suffering is pointless and expensive.

  19. The really disgusting thing about this is that there are people arguing that the death penalty is inhumane and the prisoner may be suffering, that the current method of lethal injection may cause suffering. Well, boo freaking hoo, do you think that prisoner gave a crap about the people they killed, tortured, raped, etc.? Why should we give a damn about their well being when they obviously have no regard for human life?!? But you take a person suffering from a debilitating disease and you're not allowed to make them more comfortable? You're not allowed to ease the transition for them? Why should prisoners sentenced to death be given more consideration towards their comfort than a regular citizen when it comes to death and dying?

  20. We assured her that we would make every effort to honor her wishes and that we would use all means necessary to ensure her comfort but told her that we could not provide physician-assisted suicide or euthanasia........ She did not believe that more aggressive treatment of her pain, other physical symptoms, or depression would change her wish to die, but she agreed to let us try these interventions. After all symptoms were controlled, and after a psychiatry consultant felt that her decision-making capacity was intact and not compromised by depression, she still wished to die. She specifically requested that nutrition and hydration, as well as insulin, be discontinued, despite our suggestion that insulin be continued to prevent discomfort from ketoacidosis. Insulin therapy was discontinued, and she died with her family at the bedside 2 days later. The family expressed appreciation that her wishes were honored.

    Doesn't sound like they really honored her wishes. First they tried to control her sx, then got a psych consult, then made her re-affirm her wishes. Wonder how long all that took?

    Then they tried to continue the insulin despite her wishes! Arrrggghhhh.

    Just let me go quickly, don't try to prolong the agony.

  21. Good Monday morning Docs !
    I left you special blessings on my blog today --
    Hope that you have a good one !

  22. everyone who disagrees with me is wrong. End of discussion.


  23. I love my dogs dearly, and I would do anything to prevent their discomfort. I would not allow them to suffer for the sake of my selfishness to have them with me. I would beg to have their life stopped as peacefully as possible.

    I can't imagine doing any less for my parent, my husband or my children whom I love even more than my dogs. Maybe having the doctor doing the "termination" is a bit of a gray area with all the law suits cropping up. I don't know what the answer is, but I do know that if my family allows me to become contracted into a fetal position with decubitus on both hips and heels and I smell from the flesh that is slowly rotting between my joints.........I'm going to haunt the hell out of them.

  24. again i would simply caution on the confusion of "kindness" with "love". the analogy to putting animals down to avoid their suffering is an apt analogy and i guess if you believe that we are no different then there's really no controversy here.

    cs lewis and most Christian theologians would see a fundamental problem here and since i am no theologian i will simply quote the following and direct you to the website...

    God's idea of goodness is almost certainly unlike ours; yet, God's moral judgment must differ from ours "not as white from black but as a perfect circle from a child's first attempt to draw a wheel" — or we could mean nothing by calling him good. Thus, where God means Love, we only mean Kindness, "the desire to see others than self happy; not happy in this way or in that, but just happy". We want "not so much a Father but a grandfather in heaven", a God "who said of anything we happened to like doing, 'What does it matter so long as they are contented?'" (Let us note in passing how much this confusion between Love and Kindness is akin to our modern thinking: it sheds light on many present controversies, from assisted suicide to abortion to contraception.) But Love is not mere Kindness. "Kindness cares not whether its object becomes good or bad, provided only that it escapes suffering", while Love "would rather see [the loved ones] suffer much than be happy in contemptible and estranging modes".

  25. I will surely die long before my time, because I will put a gun in my mouth before I will go to a hospital with any complaint that might leave me incapable of ending my life and in the clutches of ghouls determined to keep me alive or to make me die slowly.

    All because we can't trust doctors to do the right thing.
    There are laws against it? Yes, because most doctors want them that way. It wouldn't take much AMA lobbying to get them changed.