[Dion]

Dealing with terminaly ill patients and why it's hard emotionaly

48 years old, with curly blonde hair and no signs of the physical wasting away that so often occurs with advanced cancer. But her bowel was completely blocked from a rare and aggressive form of bladder cancer. She had uncontrollable vomiting and excruciating abdominal pain.

Dr. Manuel “Manny” Borod realized death was near, and that she was suffering. He knew she had to make a decision.

She was awake and lucid when, with her full consent, he injected her with a drug normally used to make surgery patients unconscious. She would sleep until she died – in her case, almost a week.

Borod hugged her tightly before he started the infusion. Then he walked alone to his office, closed the door behind him and cried.

“It was hard,” says Borod, head of the division of supportive and palliative care programs at Montreal’s McGill University. “We all said goodbye to her. It was very difficult for the entire team.”

Borod's concern over euthanasia

Borod, one of Canada’s top palliative care doctors, worries that legalized euthanasia would make terminally ill patients even more frightened to see him than they are now.

He worries that too many people deemed “in an advanced state of irreversible decline” would be put to a premature death, since doctors are often poor at predicting survival times.

Borod talks about a patient of his with ALS

If she had asked for euthanasia when she was first diagnosed, and if Bill 52 were then law, she would have satisfied all the legal criteria for assisted death, Borod says later in the privacy of his office.

“And I think it would have been bad,” he adds. “I think she’s had a good quality of life. She worries. It’s clearly not the life she wanted, but I think she and her husband enjoy their life, still.”

When Cohen nears the end, “we have the tools that we need. We would sedate her if she was having trouble swallowing, if she was having trouble breathing — if she had so much existential distress that she didn’t want to live anymore,” Borod says. “We have that relationship: I know what she wants.”

Borod's profound unease with Quebec's Bill 52

Borod says his profound unease with Bill 52 isn’t a “religious thing,” or a right-to-life issue. Rather, the proposed criteria for Bill 52 – which would permit patients of legal age who were mentally competent, and suffering an incurable serious illness with “constant and unbearable physical or psychological pain,” to seek doctor-hastened death – are too broad for his comfort. Could they, for instance, apply to a concert violinist who had a stroke that paralyzed one arm, and who decided this was so unbearable he wanted to end it all?

“I know that many of my colleagues would feel that they can’t do this,” Borod says

http://www.calgaryherald.com/health/...702/story.html