Tuesday, January 31, 2006

Assisted Suicide in Oregon

There's been some talk on the net about the Oregon state assisted suicide law. The Supreme Court seems to have upheld it, but it still bothers me. Mostly I'm concerned for the situation it may put Oregon doctors in.

What happens to a doctor in Oregon that personally opposes assisting a patient in committing suicide? Can he refuse to help the patient kill themselves? I have heard of court cases involving abortion where a doctor was forced, by the courts, to perform a procedure (an abortion) he was personally opposed to, even though the patient could have gone to another doctor for treatment. Are doctors now going to find themselves in situations where, by law, they have to violate the oaths they took when they first became doctors?  Some doctors seem happy to push that oath aside, as if it doesn't matter. I'm not sure I want to go to a doctor that takes his oaths so lightly, but that's another matter. Here's one comment posted in a blog I found interesting.

There was a time in my younger years when I would have objected strenuously and in horror to assisted death. Our duty was to preserve life, not take it. But years of experience caused me to change my mind. ... I have seen my patients welcome death, beg for death. I came to believe that they had a right to be spared the long, drawn out degrading and dehumanizing experience if they so desired. They had a right to die in dignity and peace. ... .One of the best experiences I had with a dying patient came about 3 A.M. when an elderly lady coded and the usual emergency protocol was instituted. We would get her pumped up, then she die off again, over and over. One last time we managed to get her vital signs reinstated and we stood around her, watching her intently in case she coded again. We assumed she was in a coma, unaware of her condition. To our vast astonishment she suddenly opened her eyes, glared at the young attending physician and sternly admonished him, "Young man, why don't you leave me alone and let me die in peace!!" She then coded again but that time we were unable to revive her. She had escaped our well meaning ministrations and died as she wished. To her, death came as a friend.

The example given in the article of a doctor "changing his mind" on assisted suicide doesn't hold water for me. If the woman described in the article would have signed a "Do Not Resuscitate" (DNR) order then, when she first coded, she would not have been worked on and would have been allowed to die. Why was this not brought up to her as an option? The quoted doctor doesn't say. The problem in this case may not be assisted suicide so much as in self-serving doctors and hospital staffers not enforcing a DNR order to ease there own consciences and egos (I've seen that happen as well).

When I first went to college I worked in a nursing home. There I saw people die very painful deaths because of cancer, and yes it is horrible. Many of them just need to know that someone is listening to them, instead of ignoring them, even as they are dying. I worked with one elderly man who had a very sever stroke on his way out. When I went in to see him he kept saying over and over, "I'm dying! I'm dying!" When I held his hand and quietly said, "I know," he calmed down and was able to approach his death with dignity. He just needed someone to validate his experience, instead of lie to him about how he'd "be just fine."

Ending a dying patient's suffering is important, and an aggressive pain management strategy can assist in that. There are problems with balancing dosages of the meds, though. Doctors want to give enough of a drug to relieve suffering, but not enough to kill the patient. Tragically, in the most extreme cases, that isn't always possible.

The problem I see is not in allowing a patient to die, if that is their wish, the problem is in creating laws that makes a doctor become an accessory to their patient's suicide. Allowing a patient to die, because they have consciously chosen it, is very different from forcing a doctor into helping a patient kill themselves.

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