Location: A simple man leading a complicated life....
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One of Canada’s top palliative care doctors openly talks about Euthanasia
Dealing with terminaly ill patients and why it's hard emotionaly
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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
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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
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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
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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
Its never going to be an easy thing, but its high time we really seriously went at tackling this issue, and sure some doctors will be uneasy, some will even refuse, fine that is to be expected.
The fact that Quebec is one of the first provinces to get involved is telling me it is probably not the way to go.
It's telling me that Quebec isn't totally crazy after all.
I'm a huge supporter of Euthanasia and wish we afforded the same options to people that we do our dogs and cats. My mother spent the final 15 years of her nursing career working in a hospice helping people through the final stage of their life, and her opinions have certainly worn off on me. We've/she's also taken my Aunt with lung cancer and my Grandmother into her home to make the final months/years more comfortable. Being that close to the dying process (I was 13 when my Aunt lived with us) was certainly an interesting experience.
There are certainly extreme complexities with allowing doctor-assisted suicide, but there's complexities with our current system as well. Doctors would certainly have to be afforded the option to not perform the procedure should they not feel comfortable with it.
The article makes some points that I don't totally understand, perhaps I misunderstood the criteria of the bill or perhaps the article had to boil down some of the explanation. He claimed that a violinist that loses his arm could claim that his pain is irreparable, so that would place him in the category of people able to go through with it. As I understood the criteria, it wouldn't.
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I would think that the criteria is going to have to be very specific in terms of the disease, chance for a cure etc no depression factors or mental illnesses, and probably be backed or signed off by someone other then just the attending doctor. I would also be more comfortable if the decision was made by people who had no financial gains, beneficiaries etc.
However I will say that when its time for me to go, I hope that put a crate of C4 under my bed and push the button so there's no chance of me coming back as a zombie.
I can see it possibly working if the task was limited to a group of highly qualified physicians with impeccable credentials. I have the utmost respect for doctors, particularly all that I have dealt with, however, all doctors are not created equal.
Also, as mentioned, a doctor would have to be qualified to assess the mental state of the patient to ensure he/she was not suffering from depression, psychosis, etc.
In addition, possible outside interference by parties, that stand to gain by the act, may also cause problems.
some cases there is a gray area, but in others all the person experiences is excruciating pain day and night and it begins to change their mind. I've seen it happen where a nice person loses their identity because of the pain and they become a shell of their former self seething in agony all day every day and there's no chance of recovery. If that's where someone is at I don't see a problem with it if the person approves. There are some afflictions out there that cause more pain than most people even realize is possible, watching a person degrade into a state of perpetual agony should be avoidable if they so choose, at least in my opinion. Sure that doctor cried after going through with it, but there has to be some relief knowing the suffering is over.
Some people may argue against on a religious basis but I would argue forcing someone to live in pain is morally egregious and a misinterpretation of religious dogma. When you see in someone's eyes they are no longer the same person you realize how bad it can actually be.
some cases there is a gray area, but in others all the person experiences is excruciating pain day and night and it begins to change their mind. I've seen it happen where a nice person loses their identity because of the pain and they become a shell of their former self seething in agony all day every day and there's no chance of recovery. If that's where someone is at I don't see a problem with it if the person approves. There are some afflictions out there that cause more pain than most people even realize is possible, watching a person degrade into a state of perpetual agony should be avoidable if they so choose, at least in my opinion. Sure that doctor cried after going through with it, but there has to be some relief knowing the suffering is over.
Some people may argue against on a religious basis but I would argue forcing someone to live in pain is morally egregious and a misinterpretation of religious dogma.
Wouldn't modern drugs be able to control most pain?
Wouldn't modern drugs be able to control most pain?
This is really a yes and no answer. Up close and personal experience with it, I've seen pain that is not controlled by even Dilaudid.
I'm of the same opinion about this, as I am about abortion. A person's body is their own and they should be free to make whatever decision they want, regarding it, whether I or anyone else agrees with it, or likes it. Otherwise, it's not free choice.
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depends what they have, if they are afflicted with something like trigeminal neuralgia or certain kinds of metastasized cancer the drugs are going to make them no longer cognizant and they will just be a biological vestige no longer capable of forming coherent thoughts. This is just my experience in life and I'm no doctor so who knows, I've just known people that drugs did not help and it probably would have been best to help them end their life sooner because the last few months were hard on the person suffering as well as the relatives, it can be traumatic seeing someone so physically degraded they are no longer who they used to be. I'm talking the extreme cases here where all there is left is pain.
I have always looked at this from an equal treatment of people with disabilities. If you are healthy enough to kill yourself you should do it yourself. If you are too disabled to do it assistance should be provided for you. Equal access to suicide should be treated as anyother disability or access issue. However if you can kill yourself I don't think it is the states role to help you do it.
Location: A simple man leading a complicated life....
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Dr Balfour Mount: Reflection on palliative care and euthanasia.
Legalization of euthanasia and the risks...
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Doctors, who were unable to admit to the family that there was no hope for the patient offered another chemotherapy, not knowing what else to do. "Requests for euthanasia often result from a rejection of the aggressive and inappropriate care," says Dr. Mount, for whom euthanasia is totally incompatible with palliative care, although he concedes that both aim to reduce suffering. "The length of life is beyond our control, and it is not for us to decide," said Dr. Mount, for which the legalization of euthanasia would place the most vulnerable in our society at danger as people with disabilities and the elderly, sometimes feel like a burden to their family and society.
Precious time....
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The last weeks of life are "the most precious time of family life" because this is when people resolve the unresolved cases where we can say the love and attachment that is brought to the family. "This is an important moment of sharing that can soften the death of the person who is dying and who can make the next 40 years calmer and happier for those who survive. This time holds tremendous potential that is lost if the person were euthanized," said Professor Mount lamenting the fact that death is a topic taboo in our society. "We must help people to dramatize death. It must make them see death as a natural phenomenon, a normal event," he said.
Teaching patients....
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This patient has taught me that you can not judge the suffering of others" because, even in his terrible physical condition, dying became the best moments of his life. In his case, "his family probably suffered more than him," said Dr. Mount. The search for "meaning" in our lives is probably what most concerned about dying, says Dr. Mount. Some, like the skier Chip, find it within themselves. Others find in a narrow "connection with others." Many people establish this ("healing connection") with "music or some other form of art, or with nature", while many others find meaning through a "spiritual connection with reality Supreme" which can be "quantum completeness or god." In his study, Dr. Mount noticed that people who had found the sense of completeness lived a great inner peace and were not overwhelmed by anxiety and fear of death as those who had not found it. And to help them, Dr. Mount reiterates the importance of controlling their symptoms and to create an environment around them in their own image - and not one that is believed to be the best for them - allowing them to feel safe. He finally stresses the need to listen to the patient in order to help them find the kind of connection that soothes. [...]
Such nonsense, they fear these really unlikely scenarios so its best to just not do it at all and allow so many to die suffering horribly.
Some great docs on why Euthanasia should be an option to terminally ill patients:
The last one is very powerful, to suggest that those who use Euthanasia don't experience the last and very powerful times in their last weeks is nonsense. As you can see, he resolves and leaves his family with dignity and ends his last days with grace.
One of Canada’s top palliative care doctors openly talks about Euthanasia
