And Rightly So!

I came across this article about assisted suicide, human euthanisia…and it’s enlightening to say the least. The core of the issue has been out of control pain for those who are living out their last days. PAIN can be controlled. While I respect this author’s writing and opinion here, I do not believe that pain is the single issue of this debate. Especially in the Netherlands and other “modern” nations. Over there I firmly believe this is also about ecomonics and socialism.

Physician-assisted suicide is the sort of sensational issue that’s tailor-made for talk radio shows and rants on the op-ed page. Witness the reaction to this month’s U.S. Supreme Court decision upholding Oregon’s physician-assisted suicide law and speculation about whether California will pass a similar one.

But many doctors who specialize in treating dying patients will tell you that it’s just a fringe issue. The subject we should be focusing on may not make a very good TV movie, but it would be much more relevant to people facing the final days of their lives.

The medical term for it is “palliative care,” a system of treating symptoms — physical and psychological — that plague seriously and terminally ill patients. If you want to know the real scandal confronting dying patients, it’s the lack of comprehensive palliative care in most hospitals.

Many terminally ill patients choose not to be admitted to hospitals. They often choose Hospice care, in their own homes. This is a benefit available to anyone and everyone, and irregardless of one’s ability to pay for these services (Hospice charges very little to begin with and often their services are free).

The Coda Alliance, a coalition in Silicon Valley dedicated to improving end-of-life care, is one of many patient advocacy groups trying to reframe the debate. The fact is, if dying patients are neither in pain nor suffering extreme mental anguish, they are very unlikely to request physician-assisted suicide in the first place.

“Palliative care doesn’t just mean treating someone’s pain, nausea or shortness of breath,” Coda’s medical director, Dr. Elizabeth Menkin, told me. “It also means dealing with a patient’s fears and loss of a sense of belonging. Good palliative care addresses all these symptoms.”

Palliative care involves many specialists too…not just doctors and nurses. Nurses provide almost all the hands on care though, and when they have been trained in Hospice skills, they are experts at their trade. Too often though, even in todays world, medical people are ignorant when it comes to drugs for pain control. The old myths still infest the minds of modern day caregivers.

Dr. Steven Pantilat, director of the palliative care service at UC-San Francisco Medical Center, said if patients inquire about physician-assisted suicide, he sees it as a red flag that something is wrong with their treatment. “If you treat someone’s pain and depression, the requests for physician-assisted suicide go way down,” he said. “That’s what the research shows.”

Pantilat explained that a small group of terminally ill patients is most concerned about controlling exactly how and when they die. That is very different from the majority of patients who simply want to be spared the extreme physical and psychic pain of a lingering death.

Our society still isn’t very good at dealing with death, and the “never-say-die” medical culture concentrates so exclusively on curing disease that treating a patient’s “secondary” symptoms gets low priority. “We only focus on symptoms as clues to the diagnosis,” Menkin said. “Once we have the diagnosis, we don’t care about the clues.”

Maybe the suicide freaks in the Netherlands, the doctors who are making A LOT of money killing others, should be concerned about these red flags. It means they have failed their patients. VERY rarely does a patient have to be in any pain, period, at all. The medications of today’s world can work wonders. We won’t hear about this though in these countries where all these things cost money. America is a society that in general disrepects it’s elders, who are closest to death in the timeline of life. As the baby brat boomers grow old though this might change.

There are signs that this is beginning to change, but not fast enough. Only 23 percent of California hospitals have palliative care services, and it’s often offered only when all other treatment options have been exhausted. “This shouldn’t be an `either-or’ decision,” Menkin said. “Excellent palliative care should be part of the usual treatment.”

Patient advocates offer this prescription for treating the problem: Train many more doctors, nurses, pharmacists and social workers to have expertise in palliative care. Make sure every medical student graduates with a basic understanding of palliative care. Make it easier for patients to enroll in hospices, and don’t force a decision between curative and palliative care. Also, insurers must cover palliative care as part of standard medical treatment.

It’s a complicated mission, but it should be much higher on our national agenda than the battle over physician-assisted suicide. We should be talking about ensuring that dying patients can find peace, comfort and meaning at the end of their lives before we debate whether they should be allowed to kill themselves.

I agree with this. Kill the reasons for people wanting suicide over life, even if that life is only expected to last a few more days, hours, minutes. Life counts and we should strive to be a nation that respects this.