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Allow Doctors to Support Patient Wishes

Why should anyone—the state, the medical profession, or anyone else—presume to tell someone else how much suffering they must endure while dying? Doctors should stand with their patients, not against them.

- Dr. Marcia Angell

This statement gets right to the heart of the matter, doesn't it? People deserve more options at the end of their lives and doctors should be allowed to help their patients get the end-of-life care they want.

Dr. Angell is former editor of the New England Journal of Medicine and a senior lecturer at Harvard Medical School. Her quote is from a guest article published in the Health & Wellness section of the Boston Globe. Throughout her life, Dr. Angell has had extensive professional and personal experiences with difficult end-of-life care decisions. These experiences have shaped why she supports safe and legal assisted dying through Death with Dignity laws.

From time to time, she encounters medical colleagues who disagree with her positing, "a doctor's role is only as a healer." In the article, she addresses this concern:

When death is imminent and dying patients find their suffering unbearable, then the physician's role should shift from healing to relieving suffering in accord with the patient's wishes. This is not a matter of life versus death, but about the manner of dying, and it's not primarily about doctors, but about patients.

Another common claim Dr. Angell has encountered is, "Good palliative care can relieve all suffering, so permitting assisted dying is unnecessary." She counters with several facts:

Probably most dying patients, even when suffering greatly, would choose to live as long as possible. That courage and grace should be protected and honored, and we should put every effort into treating their symptoms. (Palliative care in Oregon is among the best in the country.) But not all suffering can be relieved. Most pain can, but other symptoms can be harder to deal with—symptoms such as weakness, loss of control of bodily functions, shortness of breath, and nausea—and the drugs to treat them often produce side effects that are as debilitating as the problems they treat. Even worse for many patients is the existential suffering. They know that their condition will grow worse day after day until their deaths, that their course is inexorably downhill, and they find it meaningless to soldier on.

This echoes how Dr. Kate Morris explained the Hippocratic Oath in one of her interviews in the documentary How to Die in Oregon:

"First do no harm" is going to be different for every patient. Harm for some patients is saying, "No, no, no. You've got to do this the way your body decides as opposed to the way you decide."

Death with Dignity laws are about giving patients more options for their end-of-life care. As Dr. Angell explains, "No physician is required to participate in assisted dying; he or she may refuse for any reason whatsoever. This is a choice, not a requirement, for both patients and physicians."

The entire process is voluntary for all involved—patients, physicians, and pharmacists. Truly, why would anyone feel it's their place to deny a dying person as many options as possible? Whose life is it anyway?


Posted by Nora Miller (not verified) on August 11, 2012 at 03:03 p.m.

Thanks Melissa for highlighting Dr. Angell's very cogent appeal in favor of MA's Death with Dignity bill. I especially like her repeated reminder to doctors that this is not about them, but rather about the patient. Yes, the doctor is involved and may even be required to make a choice at some point, but in the end, this is always and only about the patient, the dying person. If there is ever a time to set aside one's ego and be totally available to another person, it is when that person is dying.

Posted by Carrie (not verified) on January 14, 2013 at 02:16 a.m.

I am in agreement with Dr Angell that both patient and doctor should have a choice in what they participate in. I believe a doctor’s role is to relieve suffering and for me that includes following a patient’s wishes to end their life early. I would like to pass on my best wishes to Dr Angell as she strives to achieve her goal. I think doctors are afraid of any possible lawsuit that may be filed against them or the hospital they work for. They are in a difficult position. My heartfelt well wishes go to all the patients who are currently enduring a long, slow and painful path to death.

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