We feature an article written for us on the need for terminally ill patients to have better end of life choices by Dr. Hans Engel.
AB 651 will be heard in the next month in the Senate Judiciary Committee and is a hot topic in light of the recent US Supreme Court decision upholding Oregon’s law on death with dignity. For more information, The LA Times Editorial and the Compassionate Choices website have a wealth of information.
Terminally Ill Patients Need Better End of Life Choices
BY DR. HANS ENGEL
Surely we all agree that nothing is more sacred to us than life. This core tenet of humanity is reflected in our religious faiths, in our governments’ laws, and very often in our professional and personal lives.
Yet conflicts still occur because the very definition of life has developed and evolved over time. The Catholic Church now says life begins at conception, but in the recent past the church defined the beginning of life as motion in the womb. The end of life was defined as the final heartbeat. But because of advances in medical science, that’s a vastly different concept today than just a few generations ago. Now, many bodies remain by that definition “alive,” even though the brain and other organs have ceased to function.
For physicians, it presents a changing set of challenges to determine the best course for our patients. But what is “best”? Is it the wish of the patient? The wisdom of the physician? The advice of the imam or rabbi? The conclusion of the patient’s family? The law? Often there is no satisfactory answer.
As medicine continues to advance and our definitions of life and death and right and wrong continue to evolve, the questions will grow more complicated.
Which brings us back to square one. Is it always best for the patient to keep his body alive? Maybe the answer is – maybe. Maybe at the very end of life, a dying person may decide that he’s lived long enough and the time has come to leave with dignity. He may have explored his life and come to the conclusion that much of it was good and some was bad, but the point has come where he sees no possibility of any positive events in the future, only pain, loss of bodily and/or mental function, no pleasure ever in food, drink, hearing, vision or independent motor capability. He has decided not to continue in a partial or full vegetative state. A patient may have been told that his cancer was terminal; another that his deteriorated liver could not be replaced because of his viral hepatitis or HIV.
I have had patients ask me to help them die. Some reasons were better than others. I did my best for all of them, but did not obey their requests – even though there were some whom I wished I could have helped. Some, who wanted to die a bit more quickly, probably should have had their wishes respected.
I’ve grappled with this not only as a physician caring about patients, but as a human being seeing loved ones have to suffer terribly against their will. My live-wire mother lived to the age of 92, alone for forty-odd years since my father’s death, and for most of it as vibrant and active as ever. But at the very end, as death approached, her body betraying her and the independence and freedom she loved gone, she decided she wanted to die. Angry with me for not helping her, she tried unsuccessfully to end her own life, by trying to catch pneumonia and by throwing herself off her bed, before the end finally, mercifully came. Was I wrong not to respect her wishes and help her die? All my refusal brought her was more pain and suffering at the end.
My companion of 27 years had a massive stroke. Her declining health, failing bodily functions and loss of independence were brutally painful. She chose to stop eating and drinking and soon became comatose and died. When I was notified of her death, I found her face calmer and more beautiful that I had seen in many months. Would it have been wrong, in the final days, to help her speed up the dying process and shorten all the pain at the end?
When a person knows life is nearly over, they have explored all the possible benefits of their limited future – and find none, just more pain and suffering, do they not have the right to end their suffering? Should we physicians not help them to fulfill their wants and what is actually best for them? I believe so, and that’s why I’m supporting providing terminally ill Californians with better end of life choices.
Dr. Hans Engel is a physician in Woodland Hills.