Death with dignity.  Is that merely a hollow phrase, or is it possible to obtain even under the most dire circumstances. 

In a NYTimes articleby Katie Hafner the issue is discussed once again.  It touches on Washington states's Death WIth Dignity act which allows prescriptions for lethal doses of barbiturates under certain circumstances of prolonged suffering. 

 Dr. Richard Wesley who suffers from ALS (known as Lou Gerhrig's disease it is a progressively debilitating disease in which muscular activity degenerates) is specifically discussed as is the issue of physician-assisted dying.  The fears that Oregon and Washington would be inundated with individuals seeking such assistance in the dying process has not materialized. 

The article quotes several physicians who represent different positions on this issue. While Dr. Steven Kirland, Dr. Wesley's pulmonologist is in support of Dr. Wesley's right to choose the time and place of his own death, other physicians such as Dr. Kenneth R. Stevens, emeritus professor of radiation oncology do not.  "I didn't go into medicine to kill people" was Steven's quote regarding this topic. 

Sadly there are many physicians who agree with Dr. Stevens.  To me this is a pathetic response to one of the most important issues facing our society today.   My response to him would be–Of course, doctor, no physician is empowered to "kill" people.  But what about keeping patients free of suffering.  Isn't that the highest mandate of our profession?  And what about healing?  Dr. Stevens, as is true of many of my colleagues fail to understand the deeper meaning—healing means to "make whole".  In the dying process, healing means making someone comfortable, reducing pain and suffering. If that process facilitates death itself, so be it.

 In metaphysical terms, dying may be the highest form of healing.  Whether or not one accepts survival of consciousness after death or not–the highest degree of human to human interaction is compassion and empathy.  How would each of us choose to die?  It is not through suffering, I can assure you. 

It is interesting that the article fails to mention the work of Dr. Kevorkian.  Although vilified and demonized by many, he was a pioneer in a field that still makes most of us uncomfortable.  But such a reaction should not dissuade us from further discussion and debate. 

But this discussion is belongs as part of a broader debate–how do we treat patients at the end of life?  Just because we can order tests, do procedures, perform surgery….should we?  Why do so many of still die in hospitals, in ICUs and not at home with Hospice and home care?

None of this is easy but that doesn't mean it isn't important.  It is of paramount concern.  Billions of dollars are spent at the end of life when there is no realistic chance of altering what is inevitable and imminent.

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