Medieval Thinking No Help to Dying

By Tom Preston, The Seattle Post-Intelligencer, May 3, 2006

Guest Columnist Tom Preston

The Oregon Death with Dignity Act has worked nearly perfectly for more than eight years, giving peaceful dying to 246 patients and backup security to thousands more, with no evidence of misuse of the law. Sad to say, unfounded fears and old taboos have kept Washington from doing as well for its residents.

This backwardness is largely because Americans don't understand how dying has changed, and their obsolete notions of acceptable ways of dying cause a lot of end-of-life suffering. Dying is not an isolated event but a process beginning with a fatal illness. In the past, dying was swifter, as with pneumonia, but our advanced medical interventions now extend dying for weeks, months or years. We no longer die "naturally" but live longer with chemotherapy, surgery, artificial pacemakers, organ transplants and more.

Modern medicine gives us extra years of good life, but when interventions such as chemotherapy or bypass surgery prolong life they also change how we ultimately die. People -- medical workers with their technologies -- fashion our new ways of dying, and too often patients linger with suffering before the end. Most Americans die in medical facilities, sustained for the last weeks of life with drugs, feeding tubes and artificial ventilators.

Doctors already directly help patients die, in order to stop pain and suffering, with legal and ethical methods such as morphine drips or continuous drug-induced unconsciousness, or by withdrawing artificial ventilators or other means of life support. The majority of patients today die after a human decision -- made by doctor, family member or other -- to stop further treatment that would only prolong suffering. The process of dying for most of us is a series of medical decisions culminating when someone decides how we will die.

The issue for most of us will be, "Who decides how and when will we die?" We have pre-empted natural dying with our medical interventions, so why shouldn't the patient decide the mode and time of dying, consistent with his or her values, rather than leaving it to the ravages of "doing everything possible" or the whim of the medical resident on call?

Many would say, "It is a violation of God's will, or the sanctity of life, to help someone die sooner than is natural." The sanctity of life principle evolved in the Middle Ages, when St. Thomas Aquinas equated God's will with what is natural. But the unending work of modern medicine is to prevent natural dying and to give us longer than natural lives. When a doctor maintains life with an artificial ventilator, he has created unnatural life, and when he turns off the breathing machine months later, life ends unnaturally.

We distort the meaning of the sanctity of life by saying we must sanctify all life, however artificial and harmful it has become. Is it God's will that we may not end a life after we have artificially extended it to a state of ungodly suffering?

In the totality of a medically managed process of dying, the last individual human act -- deciding how a patient will die -- is equally ethical whether sedating the patient until death, stopping life-support therapy such as kidney dialysis or giving a patient the means of voluntarily ending life with lethal pills.

A patient who self-administers lethal pills is not committing suicide. Suicide is of a person who does not have to die, and who has a treatable or manageable disorder. On the other hand, a terminally ill person (the law in Oregon requires terminal illness for aid in dying) has no means of cure or long-term management of his illness, is irreversibly dying and does not commit suicide by choosing one means of medical dying over another.

Further, a physician who prescribes lethal pills a dying patient may or may not use is not assisting suicide any more than when he stops life support or sedates a patient to the time of death. Nor is he "killing," a phrase used by opponents to generate fear of assisted dying. To kill is "to deprive of life," and a dying patient who self-administers pills achieves his goal -- he is not deprived or killed.

Once we have prolonged life as much as is reasonable without causing undue suffering, we have honored our obligation -- and that of the state -- to protect and sanctify life. Assisted dying for terminally ill patients is then ethical and merciful, and -- as in Oregon -- is safe. If ours is a humane and caring society we should make it legal.

Tom Preston, M.D., of Seattle is the author of "Patient-Directed Dying"; www.tomprestonmd.com.

Email this page to a friend Share on Facebook Share on StumbleUpon Print this page