Re: Dictator of S'pore, Lee Con You in hospital for severe pneumonia, dying soon. Yip
Though some just won't go despite signing paper
http://www.slate.com/articles/healt...od_death_with_the_help_of_a_doctor_and.2.html
I told him that there were two ways we could allow him to die. We could stop his tube feedings. Without water, I told him, he would die within seven to 10 days. Or we could disconnect his ventilator, which would likely cause his death within a matter of hours. In either case, I emphasized, we would keep him comfortable the entire time.
He said then that he wanted me to disconnect the ventilator. I asked him who he wanted to have present. He wrote that he didn’t want his family there. He wanted Al and me there and a few of his friends. We decided that he would spend the next day saying goodbye to people and that the day after that we would follow his wishes.
So I scheduled him to die on Friday at 10 a.m.
It seemed more than a little bizarre to arrange someone’s death the way I’d arrange a clinic appointment. I found myself wondering just how a person became capable of deciding to die when he wanted so badly to live. Documentaries like Dignitas and How to Die in Oregon have shown us people with terminal illnesses in physical pain so severe that their desire to live is simply and mercifully snuffed out. And though I could readily believe that profound disability like Michael’s had the same ability to remove the fear of death, I couldn’t actually imagine it. My own love of life is too strong, my fear of death too overpowering, to be able to envision calmly scheduling my own death within a matter of days after deciding life was no longer worth living.
The unfortunate truth, however, is the likelihood that I, or anyone else, will one day have to make a decision like Michael’s has never been greater. Medicine’s greatest victory has paradoxically made it far more likely that we’ll also suffer at the hands of its greatest failure: As we’ve gotten better at preventing the most common cause of death in America—heart disease—we’ve increased our exposure to the risk of death from other diseases that kill far less quickly and that arguably end up causing far more suffering. The older we get, the more likely we are to become ill with cancer, dementia, stroke, and other diseases that preferentially afflict the elderly.
True, we’ve also become better at treating these diseases. And even when we can’t cure them, we can help people live longer with them. But is this necessarily a good thing? Certainly, longer life in general is. But what quality of life are the elderly now able to anticipate? The truth is that we’re far more likely to face a fate like Michael’s—meaning extreme disability near the end of our lives—than we’ve ever been at any time in human history.
I have little doubt that what mattered most to Michael near his end is what will matter most to us all near ours: not just that we remain as free from suffering as possible, but also, and perhaps more importantly, that we maintain our autonomy—the ability to continue to make choices that determine what happens to us.
Autonomy isn’t just about freedom. It’s also about being in control. Or, more accurately, the feeling of being in control. It’s the feeling, not the fact, that has the power to make us feel better—that has the power to make us feel as if an unbearably awful situation isn’t quite as awful as it seems. Feeling in control of even one small aspect of an awful situation, in fact, is often the antidote to the suffering such situations create. It’s well-documented that patients given barbiturate prescriptions to end their lives often don’t use them, but are much relieved at being given the power to choose.
Which is why I told Michael that though I couldn’t prevent him from dying, I could give him the power to choose how and when his death would occur. (Though physician-assisted suicide remains illegal in most states, withdrawal of care is permitted in terminal cases if death will occur as a result of the underlying disease process and not as a result of direct physician intervention.) And in the thanks he expressed—painstakingly, over 20 minutes on his cardboard tablet—about being given back that control, I found the reason my interactions with dying patients have been among the most gratifying of my career. For when a patient’s death becomes impossible to prevent, I’ve never believed that there’s nothing I can do. On the contrary, I find I’m needed to offer what are arguably the three most important things a doctor can: a willingness to discuss the subject of mortality, guidance regarding end-of-life care, and a promise to do everything I can to limit suffering and preserve patient autonomy.
So at 10 a.m. that Friday, I showed up in the intensive care unit to guide Michael, Al, and their close friends through the process of allowing Michael to make the choice to die. I explained that we would turn off the monitors that showed the progress of his vital signs, start an intravenous drip of morphine, and, finally, when he was comfortable, disconnect the ventilator. And after we did these things—as his fellow SGI-USA Nichiren Buddhist friends chanted their mantra Nam-myoho-renge-kyo in the background and his eyelids started to droop under the influence of the morphine—I bent down and whispered to Michael that I understood how much he cared about the value he’d created with his life, and that I would do my best to make certain that his death would create value too. I would tell his story to others, I whispered to him, the story of a man who faced a devastating illness with humor, grace, and dignity, a man who became, it seemed to me, even kinder as he grew sicker, and who wrested control away from his disease at least partially by courageously deciding himself when and how he would “take the next step in his journey.” He’d achieved victory, I told him, in the only way any of us can: by refusing to be defeated in his heart by a disease he couldn’t defeat.
:o
