Listening to Patients' Wishes
"When a horse breaks his leg, they put him down; why can't you do that to me?" The patient who asked me this recently is a 76-year-old man dying of gastric cancer who had pain from pressure ulcers he developed as he became increasingly debilitated and had no one to help get him out of bed. He also had haunting memories of caring for his parents as they died in pain decades ago. I explored how he was suffering; I suggested what we could do for his pain and what resources we might be able to gather to help him at home. I listened as he told me about his time with his parents. He was not satisfied.
And I left our interaction wondering what we would do next to help him. Two days later, we had a family meeting with his closest relatives, a niece and a nephew, and I asked how he was feeling about our conversation and wanting us to help him die. "Oh, that was just then. I feel OK now." I asked whether it was the pain medications or the newly developed plans for a nursing facility. "No, just not feeling that way anymore," he told me.
A second patient was a woman in her 40s who was dying of lymphoma. She was not dying as fast as she wanted to and requested our help in hastening her death. Evaluations ensued by our palliative care service, our psychiatry service, the ethics service, and multiple chaplains and she persisted in this desire. We all thought we had ideas about how to address her suffering; none were effective. Finally, after several days of intensive pain control and continued conversations, her desire for hastened death waned.
What made the difference? I asked her afterwards. The difference was, she told me, the result of the "sitter" who was called in because of caregivers' concerns—not about physician-assisted suicide, but because of worries about the patient's risk for "traditional" suicide.
Why did the sitter make a difference? Because, the patient told me, "she just sat there," "she read to me," and "she went and got me something to eat." What could be simpler? The patient proceeded to have several more months with her family.
Medscape Internal Medicine © 2014 WebMD, LLC
Cite this: Joshua M. Hauser. Physician-Assisted Dying: A Clinician's Perspective - Medscape - Sep 25, 2014.