PHYSICIAN ASSISTED DEATH ? — How’s “Termination of Suffering”

The debate over physician assisted suicide (PAS) is hampered by its terminology.  For some, suicide is always an evil.  

I personally don’t have a problem with the term but other’s prefer physician assisted death (PAD)_.  There is legal precedence now accepted in four states.  It began in Oregon and is making its way through the NJ legislature. (not sure where at present).  Criteria are extremely strict and the process is highly regulated.  Physicians who sign on to the program can prescribe a lethal dose of  medication.  The patient must be physically and mentally capable of ingesting the drugs.  There must be no clinical evidence of depression.  

The Oregon experience seems to contradict the fears of many who oppose such legislation.  Massive numbers of individuals did NOT sign up for the program.  Only about 10% of those who qualified and received the drugs actually took their own lives with them.  Palliative care and Hospice use actually increased in Oregon (as opposed to opponent’s beliefs) and there was no deterioration in the patient-doctor relationship.

Kevorkian exhibited the right intentions but his efforts were not well thought out.  He was actively challenging the law and forced the country to take notice.  His active euthanasia was too provocative for the population to accept.  He was not particularly careful about screening out those who were severely depressed and not truly terminal.

 Perhaps there would be even more acceptance if our labelling of the program would change.  Termination of Suffering says it all.   Perhaps we should change the term to PATS (physician assisted termination of suffering).  I hope no one truly believes that hopeless suffering servers some higher spiritual purpose?

Who in their right mind would object to that?  How naive of me.   There are those who will.

THE BLACK JEWELRY BOX — Unexplainable Experiences

A devout skeptic, my metaphysical journey was first triggered by hearing first hand the personal experiences of ordinary individuals who had unexplained experiences.

 What was so compelling was the context of these experiences.  They were told to me in deepest confidence.  The experiencers were rather reluctant to share what had occurred for fear of appearing strange or foolish.  Yet I knew many of these individuals for years.  I knew they had nothing to gain by fabricating these stories.  They were compelling yet unexplainable. There was a level of credibility to them that drew me in.

 I still find them compelling and worthy of investigation.  Although they remain unexplainable, they point ever so subtly to a level of reality which transcends every day awareness.  Do they “prove” survial of consciousness after physical death.  Hardly. Yet taken as a whole they cannot be easily dismissed.

 The following was told to me by a patient and acquaintance of many years.  His credibility is without question.  I have altered the names and details of the story but the core of it remains intact.

 I was cleaning out my Mother’s house prior to the official closing.  After she died we tried to empty it of all its objects.      First we held a garage sale.  They we donated what was left to a local church.  Some of it became garbage.  We went through her possessions is great detail, many times, as did the numerous visitors.  We were particularly seeking to find her black jewelry box which she claimed had become lost.  She had suffered from some dementia before she passed.  She cherished the modest jewelry she kept inside and my family had bought it for her.  It was essentially gone and we began to believe it would never be found.  Now I was the last one to visit the home.  I walked through the rooms one last time.  I removed the mezzuzahs from the door posts.  I spoke out loud to my Mother thanking her for all she did for us and that now she was moving on as were we.  There was a deep silence that followed.  For some reason I glanced one last time into the empty living room.  The jewelry box was there!  It was literally impossible for that to be so.  Dozens of people had marched through the home.  Our family checked every square inch of it for that box.  But there is was.  Here’s the photo of it.  We have it securely with us  now.  I thought you would find this interesting.

   To say the least.

 

THE TRIBAL GENE — Our Dark Nature

It goes like this. We are tribal creatures. Deep down in the recesses of our DNA we evolved with the propensity to associate in small groups and to regard them as our kin/family. We immediately perceive outsiders as a threat and are capable of annihilating them without remorse.  We do not see them as ourselves. Although they are like us, exactly like us, we are capable of de-humanizing them. We feel no guilt or remorse regardless of what and how we destroy them.  After all they are a threat to our existence and the existence of our tribe.  How do I know this to be true?  Look at the world today.  Look at the world yesterday, or a thousand years ago or probably since the inception of Homo sapiens sapiens.  And perhaps further back to our primate ancestors who we share with contemporary chimpanzees.  They, too, are capable of ripping apart fellow chimps found within their territory.  They, too, create military-like bands which fight to the death for their tribe.  The tribal gene was necessary for our survival.  Today it threatens the world.  Our tools are powerful, and the subsequent destruction they can inflict can destroy the planet.  But the instinct to use them runs deep within us.  When we teach our children to hate we merely reinforce their inherent tribal instincts to do so.  This is not about religion.  We point to radical Islam today, to Hamas inculcating hatred into their children.  We are shocked when Palestinian mothers dress their children in homicide bomb outfits.  But we should understand why and how this is so.  The tribal gene leads us to sacrifice our own lives for the sake of the tribe.  We see this in the heroism of the battlefield as well. We know that religion alone is not the culprit.  Hitler was successful in his creating of the German myth of tribal supremacy.  The Jews and others were clearly of another tribe and by definition a threat to be dealt with by any and all means. Racism is tribalism  but even within the same race African tribes annihilate each other by virtue of the same tribal impetus.  There is rarely a sense of guilt when members of the other tribe are destroyed.   And so it goes.  Is there any hope to at all?  The answer is yes.  The approach is shockingly simple.  We must recognize our true nature.  We need to be aware of this tribal imperative.  We need to re-define what a tribe is and our relation to it.  We need to recognize our common humanity and teach this to our next generation.  We are ONE tribe.  It is the Golden Rule expanded to recognize the biologic truth.  Our DNA speaks to it.  But we must fight the impulse to break down into small units.  Our tribal gene pushes us to find differences amongst each other.  Our neocortex provides us with the ability to think.  We need it to direct us away from instinctive reactivity.   Is any of this realistic?  Perhaps not.  But we have nothing to lose at this point by trying.

WANT TO HAVE YOUR CHARTS?– Then What?

Access to medical records seems like a perfectly fine idea.  After all they are your records.  I have always been a supporter of that contention.  Problems occur, however, under conditions when medical records are released to patients without explanation.

Patients have had access to their lab work for years. Abnormalities that are noted by these print outs may have no real clinical meaning and yet will induce immediate and unnecessary distress.

 Now patients have access to radiology reports with detailed discussions of findings.  Many of these are “incidental” meaning they have no clinical significance.  But does the patient know that?  No and they should not be expected to know.

What then occurs in the real world is a frantic attempt to read, comprehend and analyze medical terminology by the lay public who do not possess medical knowledge and experience. The inevitable results–internet searches, panic, despair and immediate calls to doctor’s office to make sense of it all. Patients want immediate phone discussions or internet responses.  That sounds just great.  The problem is that communication which is not in person is much more difficult and often leads to more confusion.

 I would prefer to discuss medical records/ radiology documents, pathology reports, endoscopy papers, lab data etc. etc. face to face in front of my patients.  Then I could immediately put their concerns to rest, or offer explanations, or suggest subsequent testing or referrals.

So hurrah for full disclosure. Let’s bring some practical sanity back to the situation.   Now I understand the impracticality of ALL discussions in person.  When a quick call can dispel immediate fear, I all in favor of it.  But when then there is further confusion or significant complexity, the examination room, not the phone or internet is the best place to do so.