Words Matter: Physician Assisted Suicide Is NOT Physician Aid In Dying

Words Matter: Physician Assisted Suicide Is NOT Physician Aid In Dying

Posted on Thursday, March 26th, 2015 at 10:23 am by lifemediamatters

The classic Hippocratic Oath, translated by Heinrich Von Staden, requires a new physician to swear to the following oath:

And I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from [what is] to their harm or injustice I will keep [them]. And, I will not give a drug that is deadly to anyone if asked [for it], nor will I suggest the way to such a counsel.

A 1964 translation by Louis Lasagna, Dean of the School of Medicine at Tufts University, rephrases the classic oath to say:

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

A 12th-century Byzantine manuscript of the Oath. Courtesy WikiMedia Commons

A 12th-century Byzantine manuscript of the Oath. Courtesy WikiMedia Commons

Physician-assisted suicide is now legal in Oregon, Washington, Vermont, Montana and New Mexico. It is under consideration in 13 other states. Along the way, the terminology has moved from “physician-assisted suicide” (PAS) to “physician aid in dying” (PAD). “Suicide” has traditionally conjured up a vision of premature death prompted by despair, impaired judgment and the like. As a result, several professional organizations have objected to the use of the term “suicide,” articulating that this word does not describe those opting to exert control over their end of life under the laws allowing this deliberate choice.

I argue that the true paradigm for physician aid in dying is palliative care, and that physician-assisted suicide is just that- suicide. Palliative care reflects and delivers on the Hippocratic Oath, among the oldest binding documents in history. For those who are terminally ill, it is “physician aid in dying” in its purest sense. Palliative specialists do not send patients on their way with lethal medication which- if following legal requirements- must be self-administered. Palliative specialists do not ask patients to respond to their condition alone; palliative care is patient-centered and collaborative.

Palliative care is specialized medical care for those with serious illnesses. It focuses on providing patients with relief from symptoms and stress of serious illness, and it is not restricted to those with diagnoses of six months or less to live. Its goal is to improve the quality of life for both the patient and his or her family.

Palliative care includes a multidisciplinary team of doctors, nurses and others who work together with other providers to provide an extra layer of support to meet personal goals and goals of care, assuring that pain is always managed. A patient is not required to forego curative treatments to receive palliative care; palliative services maintain patient autonomy and control over individual destiny but they do not include killing oneself.

Surveys indicate that 91 percent of those opting for assisted suicide do so to gain control; only 30 percent choose this route due to pain. My earlier article, Is Autonomy All We Really Want?, explores “the space between,” the dialogical encounter and the isolating, frightening aspects of autonomy. A high quality palliative care team can mitigate that aloneness by accompanying patients shoulder to shoulder, respecting their autonomy and goals while providing warmth, sympathy and understanding. Not only do patients benefit from a higher quality of life, but physicians stay true their vow to “avoid…traps…of therapeutic nihilism.”

I argue that the true paradigm for physician aid in dying is palliative care, and that physician-assisted suicide is just that- suicide.

Words matter. Physician-assisted suicide is equivalent to the facilitation of killing. There is no other way to characterize the act. Physician aid in dying in the context of palliative care supports the chronically ill and dying in a respectful, professionally honored tradition. As Leon Kass, physician and Hertog Fellow at the American Enterprise Institute, states:

In forswearing the giving of poison when asked for it, the Hippocratic   physician rejects the view that patient’s choice for death can make killing him right…the deepest ethical principle restraining the physician’s power is…the dignity and mysterious power of human life itself. A person can choose to be a physician but cannot choose what physicianship means.


Snapshots Of Bobby

Posted on Tuesday, March 3rd, 2015 at 9:11 am by lifemediamatters

By Ellen Rand
Hospice Volunteer, Holy Name Medical Center, Teaneck, NJ

One winter afternoon during my first year as a hospice volunteer, I drove slowly through the kind of neighborhood where the only people you see during the day are landscapers, contractors and housecleaning services and where one house is grander than the next. I was looking for the ranch house where Bobby had been living since his diagnosis.

Most people I visit, as a hospice volunteer, are my senior by 20 years or more, but Bobby was the first person I’d see who was my age. Too close to home, as it were; a reminder that, yes, it can happen to you. Worse, Bobby was in hospice care for ALS (Lou Gehrig’s disease), whose cruel impact I’d last encountered with my aunt 15 years earlier.

Heavy and pear-shaped, with a full head of gray-white hair and lopsided glasses, Bobby sat in one of three wheelchairs positioned side by side in a dark, silent and cluttered family room that felt like a cave and greeted me with a wan handshake. That first conversation was tentative, as awkward as a blind date.

Before I left, he said,  “There’s no hope. And all I want is a cure.”

I felt that I couldn’t leave without responding; that he needed his fear and despair acknowledged.

“Well, there’s a different kind of hope,” I said. But even though this is what I truly believe — that there can be hope for good days, for good companionship, for the comfort of being with friends or family, for seeing another season — my words sounded hollow even to me.

***

Hospice volunteer Ellen Rand

Hospice volunteer Ellen Rand

In the course of a few months, it became clear that we had virtually nothing in common. But he did tell me about what he used to love to do: rollerblading, driving, going to Central Park. He brightened only in talking about his three German shepherds that he missed so much, who remained in his house in a nearby town, cared for by his girlfriend Jenny.

“Can’t the dogs stay here? Or visit?” I asked. He looked at me as if I’d asked if he could leap out of the chair and fly away.

“No,” he said. “My brother hates dogs.”

***

One time I rooted around my basement to find a checkers set because the week before Bobby  had told me that he liked playing checkers. I won the first game we played. By the time we played the second, he didn’t have the strength to move his own pieces, but indicated to me where they should go. He won that game, which annoyed me no end.

“Two out of three?” I asked, my competitive streak raising its sly little head. But he was too tired.

Another time, when his voice was giving out, I told him I could play some music on my iPhone with the Pandora music app.

“Can you get Johnny Cash?” he asked. And I did, cranking up the volume. We sat in companionable silence, me on the couch in the family room, Bobby in one of the wheelchairs, as Johnny croaked about Folsom Prison and being caught in a ring of fire.

***

Bobby was released from his own prison in early May that year. I learned about it via a short  email from our Volunteer Coordinator, chronicling his fatal breathing problems. It was a shock, partly because I had seen him just a few days before that. I’d left earlier than I normally would have then, when a friend showed up, presenting Bobby with a large, detailed drawing of his three dogs. I wanted to give them a little time together. And fully expected to see him the following week.

***

In hospice volunteer training, we’d talked about the Big Questions that people often focus on close to the end, if they’re blessed with a clear, conscious mind: What did my life mean?Why was I here? What was my purpose? What’s my legacy? And despite ample evidence to the contrary, I believe in the possibility of resolution and reconciliation and redemption. But for Bobby there was none of that.

I thought about how he left the world, in anxiety and fear, with many regrets. Was I of any comfort at all?  I was a visitor, who played some checkers, played some music, told some jokes and listened to him expressing his sorrow and anger without telling him that everything was going to be OK.

A witness.

Ellen Rand is a hospice volunteer with Holy Name Medical Center in Teaneck, NJ and visits people in their homes, nursing homes and assisted living facilities throughout Bergen County, NJ. She has been a reporter and writer for more than 40 years, including a five-year stint as a weekly housing columnist for The New York Times. This piece is adapted from a book she is writing about end-of-life issues, whose working title is “Endings: Finding Hope and Comfort Through the Close of Life.”


Delightful Dysfunction in Death and Dying: Larry David’s Fish in the Dark

Posted on Sunday, March 1st, 2015 at 9:19 am by lifemediamatters

FISHINTHEDARKNo subject has ever been off-limits for Larry David, who has spent a career in comedy saying exactly what he thinks- even it happens to offend African-Americans, poke fun at Parkinson’s patients or expose the awkwardness of accepted social norms.

Somehow, his observational humor always hits big, and it does so again in Broadway’s most popular show, Fish in the Dark. The creator of Seinfeld and Curb Your Enthusiasm is making his first appearance on stage, shattering any assumption that we’re not supposed to laugh about death and dying.

Officially opening March 5th, David’s newest work has sparked more than $14.5 million in advanced ticket sales. Fans eager to experience this end of life expose are finding seats at Cort Theatre difficult to come by, as only a few hundred tickets remain for the estimated 110 shows scheduled through June 7th.

For those who have ever considered the comedic elements of illness, intensive care and the intra-family dynamics that often accompany the dying process- this show is for you.

“Oh my God, who’s dead!”

Those are the first words of the curmudgeonly pessimistic Norman Drexel- played by David and hardly a stretch- in response to the three a.m. phone call we all dread.

Sure enough, the call did come from the hospital; it was regarding Drexel’s father. But he wasn’t dead just yet. Getting there, however.

Since no decisions would be made about his care until the doctor’s visit in the morning, Drexel asks the logical question to a full house of laughter and nods: “Then how does waking up at three a.m. do anything?” He then goes back to sleep.

Larry David and Rosie Perez in "Fish in the Dark"

Larry David and Rosie Perez in “Fish in the Dark”

He arrives at the hospital later, only to wait. And wait. He soon greets his brother, Arthur, who arrives with a statuesque and buxom blonde.

“His father’s dying, and he’s bringing a date?” Drexel asks his wife, Brenda, played by Rita Wilson.

He then turns to Arthur, played by Ben Shenkman, to point out the practical: “This is wildly inappropriate. I hate to inform you, but the deathbed is not a good place to introduce new people.”

The introduction turned out to be welcomed by their father, who is spotted touching the girlfriend’s breasts and thigh. She doesn’t seem to mind, at all. He is a dying man, and she’s delighted to ease his exit.

When the time comes for making medical decisions, Norman and Arthur realize they never had the discussions that the majority of Americans do not. They never learned their father’s end of life care preferences.

“The ventilator would keep him alive, but he would never recover,” the doctor tells them, instructing them to ask their father whether or not he would like to continue the intensive medical treatment.

When the brothers ask the doctor what he would do if they were not there, he says he would ask the patient himself. “Well, we’ll go get a bite, and you’ll have your ventilator talk,” Norman says desperately, hoping to avoid the uncomfortable encounter.

That’s just the first act.

The family dynamics from then on devolve, as neither brother knows exactly to whom their father was speaking when he uttered his last words: “Take care of your mother, I do not what her to live alone!”

If the overbearing, outspoken matriarch, Gloria, were to move in with Norman, his marriage with Brenda would be unquestionably jeopardized. However, Arthur won’t consider the possibility of his mother as roommate. His excuse: he just can’t.

Norman wonders why his father’s wishes are only voiced in his last breaths, and even then, they’re not too clear.

While the details of dying prove difficult for the Drexels, they are delicious for the audience, as we all see our own family eccentricities within this messy Jewish family with a Puerto Rican maid, Fabiana, played by Rosie Perez. While the Drexels do just about the antithesis of everything that could enable an enriching and peaceful end of life experience for their family, they do so to our delight. David’s sharp observations about this universality prove, once again, educational. Don’t do it like the Drexels did.


Facebook Helps Users Plan For Their Digital Death

Posted on Friday, February 13th, 2015 at 6:13 am by lifemediamatters

Legacy contact timeline. Courtesy Facebook

Legacy contact timeline. Courtesy Facebook

Facebook has added a new feature that allows users to indicate who will have access to their social media account after death.

Users in the U.S. now have the option of appointing a “legacy contact.” Once Facebook is informed of an individual’s death, the appointed contact will be able to download and archive the decedent’s photos, posts and profile information shared through the social networking service.

The “legacy contact” will neither be able to login as the person who died nor view private messages. Users can also choose to have their Facebook account permanently deleted.

“Facebook is a place to share and connect with friends and family. For many of us, it’s also a place to remember and honor those we’ve lost,” according to a press statement. “When a person passes away, their account can become a memorial of their life, friendships and experiences.” Users can change their preferences through the website’s security page.

Prior to the update, Facebook offered only a static “memorialized account,” which although viewable, could not be managed by anyone. Memorial profiles will remain, but the redesign now places “remembering” above the decedent’s name. The “legacy contact” may pin posts to the timeline or update profile pictures.

Facebook, originally designed for college students, now boasts more than one billion active users. In recent years, memorial profiles have become places where family and friends grieve and interact with each other.

In 2013, Google began offering a similar tool allowing users to decide who will have access to their “digital file cabinet,” often consisting of photos, files and emails.

“I think it’s great that Facebook, which I consider a powerhouse in the social media world, is taking additional steps to let loved ones actually control the page of one who has passed,” said Ronette Leal McCarthy, legal counsel to Elements, the cremation company and end of life care advocate. “I also find it incredibly exciting, because this is another way for death to be discussed among users and younger people.”


Mementos Mori: Chicago Shadow Puppets Explore Death And Disaster

Posted on Saturday, January 17th, 2015 at 9:37 am by lifemediamatters

Photo by Marc Perlish

Photo by Marc Perlish. Courtesy Manuel Cinema.

Hundreds gathered at the Museum of Contemporary Art Thursday evening for “Mementos Mori,” a riveting exploration of death, disaster and chaos. Presented as part of the Chicago International Puppet Theater Festival, an innovative group of performers used paper puppets, live music and overhead projectors to tell three overlapping stories in which death targets unsuspecting individuals.

Manuel Cinema, a Chicago-based puppet company, offered a “meditation on how digital culture is changing our relationship to death and dying.” Death, disguised as a young and stylish blonde, is only notified of her next target by a smartphone app called “Reapr,” a play on the adult matchmaking service Tinder.

Her three victims– a twenty-something delivery woman, an unemployed middle-aged smoker and a grandmother– struggle with day-to-day tasks until she arrives to claim them. Death is impartial and may arrive at any moment, whether it comes as a result of a heart attack, a car crash or complications of old age. Much of the silent production focuses on a seven-year-old girl who must confront her own mortality.

“Mementos Mori” is a play on the Latin phrase meaning to “remember death.”

The audience remained transfixed throughout the brisk 90-minute performance. Audible gasps and sighs echoed during some of the more emotional moments.

“I’ve never seen anything like this before. I am fascinated by death and read a lot about it,” said Amanda Mobley, a 25-year-old strategist. “It’s fascinating to think about what happens to you after you die, and what it means to be alive. The technological aspect of the play is interesting, because everything we do now will live forever on the Internet.”

Many left the theatre tweeting and sharing their reactions on other social media platforms.

Mementos Mori runs through Jan. 18. Tickets are available here.