First, do no harm …

Yesterday, a news story came up on my FB feed.  I’m still thinking about it and trying to figure out how I feel about it.  I decided to write about it, hoping it might help me process my thoughts.  It’s about a 29-year-old woman with stage 4 brain cancer (glioblastoma, the same kind of tumor that Dr. Greene (Anthony Edwards) on ER had) and she is going to die on November 1.  She lives in the U.S., in a state where, apparently, there are laws in place that allow patients to take their own life when terminally ill.  She states she’s not committing suicide, rather, she is taking control of her illness and deciding when and how she will succumb to it, not the other way around.  Most of the comments posted after the article are all like, “Wow, what a brave woman”, “Good for her”, “I’d do the same”.

Really?  I was kind of surprised that no one seemed to question the ethics here.

I can’t even begin to imagine what this woman is going through. To be diagnosed at such a young age with terminal cancer, it’s truly heartbreaking and tragic. One of my colleagues said she’d probably do the same if she were in that situation.  I’m really not sure I would, to be honest.  Or maybe I would? How can one ever know until faced with the reality?

I have three children.  This young woman has none.  Would her decision change if she had kids?  How would you explain to your children that you are going to end your own life before the cancer gets a chance to?

Death is a natural part of life – granted, dying at 29 doesn’t seem all that natural.  Dying at 90 on the other hand, does.  Still, we are all going to die, none of us can ever know when or how, that is, unless we are diagnosed with a terminal illness and even then, no one really knows how long we have.  Last spring, I visited a patient dying of prostate cancer. I saw him about 12 hours before he passed, peacefully, at home, surrounded by his family. When I spoke to his wife the following morning, she struggled with the fact that she was asleep when he died.  I wondered if it would have been easier for her to witness his death? I’m sure it would have been difficult regardless.  To the very end, my patient hoped and prayed for a miracle.  It was never stated, but you could see it in his eyes. He didn’t want to die; he didn’t want to leave his wife and children. He should have had more time. He kept fighting to the very end.  I admired him for that.

I have a hard time knowing that this young woman is going to actively end her life. That she picked the day she was going to do it, much like one picks a wedding day.  It’s two days after her husband’s birthday.   She has been told there is no cure, that her final days will be spent in pain, perhaps with multiple seizures and it’s not something she wants her family to witness.  I understand that, I really do, but there are ways of helping dying patients be more comfortable in the final stages of life.  It’s the whole reason Palliative care exists.  The process of dying has to remain a natural part of life, once we start helping patients to die, we no longer adhere to the Hippocratic Oath, in my opinion.

First, do no harm.  A physician, in good conscience, cannot be a party to the death of another human being. I can already hear those on the other side of the argument – NOT assisting a patient to “die with dignity”, causes harm.  I don’t believe it does and I don’t think this is what Hippocrates had in mind when he wrote the Oath.  I don’t wish for any individual to suffer on their deathbed, far from it. Medicine has come a long way in the past 150 years – expected death can be painless for the vast majority of patients.  I think we are actually inviting more harm to patients, their family, and society as a whole if we decide that assisted suicide, euthanasia, dying with dignity – whatever you want to call it – is okay.

It’s just not.

 

13 thoughts on “First, do no harm …

  1. I have lots to say – I’m sure we could have an interestin discussion about it. I agree with you in the case of this woman, but there are just so many other situations… I don’t think there is an easy way to know the right decision on PAS, and that’s probably why it has remained so contentious a subject

    • I’d love to hear your thoughts. I had a long discussion with my colleague today. I think I am so taken aback by this case because of how young this woman is. It’s heartbreaking.

      • I recently read an article that was pretty much the opposite of this – a young woman with stage 4 colon cancer and even though she is terminal, she is doing everything to make sure she lives what’s left of her life to the fullest. She also has kids and says she wants to teach her kids that life is worth living. I’ll PM you the details of the article on FB.

  2. Soylent green…! Seriously though, I am going to have to think about this some. Part of the fear of dying is that we are just awful at helping people through the process as physicians. Awful.

    • Are we though? Awful? I’m not sure what it’s like in the U.S. but here our palliative care teams are great. A lot of patients are given the option of dying at home and more and more seem to be doing it if they can. They are allowing the process to happen naturally. It just feels like a slippery slope – where do you draw the line?

      • I can only speak to the US. We suck. At least what I have seen around me sucks. We should be talking about death from the beginning of the aging process or bad diagnosis. But we don’t. We wait until tons of suffering has already occurred and they are already on death’s doorstep. We don’t treat pain well. We under utilize palliative care teams. I was called Dr. Death by an attending for
        Discussing DNR with an end stage CHF patient. Maybe I should do a post….

      • Oh my goodness, that *is* awful.

        Palliative care was part of my training here in Canada. I’ve discussed it with all of my terminal patients (though, there haven’t been that many yet). 2/3 in recent years did die at home; the other patient was elderly and had an elderly husband who just couldn’t care for her at home anymore, so she went to a palliative care bed and died in hospital. It was so hard on her husband, but she was comfortable at the end.

  3. I commend you for sharing your thoughts on such a controversial topic. I am also a Canadian physician and I try to remain open-minded about both sides of the physician assisted suicide debate. Given this, my personal opinion seems to fluctuate on this subject depending on individual examples such as yours. As physicians, we see people suffer and our desire to intervene is certainly amplified when a terrible death is inevitable. In theory, it sounds logical to fulfill a dying patient’s wish to lessen their suffering, but on the other hand helping a young woman die does cross a boundary. Ultimately, it becomes a fine line that I am sure many physicians would not want to professionally cross when it comes to delivering the lethal dose. Fortunately, palliative care options exist and physicians can remain on the healing side of medicine.

    PS – I am happy I came upon your blog.😊

  4. Pingback: A Happy Ending | Behind the White Coat

  5. I would do the same as her. Life is to be lived and experienced in the way that you desire. I never want to have someone wait day after day for the last breaths. I don’t want them to experience the tragedy of finding my body and of knowing I died alone. I don’t want that either. I would want someone to hold my hand and whisper I love yous. To die on ones own terms when they are ready is the last gift that this life can give to them.

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