Wednesday, October 05, 2005

Assisted Suicide

In the great state of Oregon (or to you folks in Washington State the “California Barrier”) they passed a little law about Dr. Assisted suicide. (And of course some folks there started fighting to force the government to pay for it… but that’s another story). I don’t like it because of how it turned out in the Netherlands. Strangely the people who were poorest and had the most expensive conditions to treat always seemed to get fast tracked for “death with dignity” and those people who were just as terminal but not as costly didn’t. That to me is the biggest reason to not have such laws on the books.

But the voters passed Euthanasia in Oregon and the question is can it be applied constitutionally. Well if the court upholds the ludicrous decision they made on medical marijuana they will have to say it isn’t constitutional. That is not what I plan to rant about on the subject today.

Dignity is something patients don’t have in most health care institutions. This is not a planned thing but when you lose the ability to do proper hygiene after using the restroom it is very hard to have any form of dignity in the conventional sense of the word. Many people make very large salaries trying to make up for the indignities a patient in a serious health care situation have to endure by being hyper respectful of other areas of their personal dignity. This doesn’t always work but they try their hardest.

Death with dignity is not about an issue of the personal dignity the patient feels in their active dying process but part of the dignity the patient feels in the medical process to address their condition. So some one dying before the cancer takes them isn’t any more or less dignified then some one who is taken down by the cancer while in his hospice bed being adequately medicated for his pain. Now the person in the hospice bed could have had medical care from start to finish that respected him as a person, or he could have had care that said “why don’t you just die old man” And likewise the person who choose to punch out early could have been treated properly as well. Dignity is based in the ability of the patient to make unbiased analysis of his situation. Hardly something you can do when heavily medicated and unable to move.

But the biggest issue of death with dignity if the stories my mother and many others of her co-workers have told me from working hospice has little to do with the patients’ state of care. The biggest factors impacting the dignity of the patient are their relationship to their families and their ability to make peace with their eventual fate. Factors such as medication and some aspects of care do play a role but if a patient is unable to make his peace with death, and has a family covetous of the disposition of his estate he will not have dignity even under the best care possible.

Most people in this world are deeply guilty and regretful of many choices they have made in their life. And as the life comes to an end the weight of those guilty transgression and personal regrets come back to roost as you are in your final stages of death and dying. This is why in hospice the care is provided to the family to help the person lift off those burdens of their life. Telling them that things are ok and that it is ok for them to pass on and end their dying. While religion can help, religion and the promise of a god based on faith can never lift the spirit as one you have wronged saying to you on your death bed “I forgive you.” If you are in a death or dying process outside of hospice you are lucky if you or your family receive this. And you probably in that lucky scenario only received this because your nurse was well trained in issues of death and dying.

The weight of years of guilt and regret lead to anxiety which keeps you from sleeping, which keeps medication from working well, which keeps your immune system from working well. If you neglect the patient’s spiritual and emotional issues they will become unable to live any longer. Taking the patients life from them early denies them the process of letting go that spiritual and emotional harm, it prevents them from dying with a peace knowing that their soul will go to a better place as it leaves this earth.

Some other issues do play a factor. The care of pain in this country is simply atrocious. And it is atrocious not because we do not have the technology or medicine to cure it, but because we have biases in the medical profession about pain. In addition to the biases of doctors about tending to the patients pain, even when it is a standard of care we have a government that more and more is willing to say a doctor is criminal for providing adequate pain relief for a patient.

When a patient is given enough just to be able to stand his pain the same emotional stresses you find when the patient suffers under his guilt and regret come home to roost. Hospice provides in some areas adequate pain treatment but in other areas hospice is either not funded adequately or is unable by law to care for the patient properly.

When the patients mind is put in the alchemical brew of a family who wants them dead, a hospital that wants them out of the bed so they can turn a higher profit, pain that is inadequately treated is it any wonder people just want death to come even if calling to Grim to come and take you away isn’t the healthiest thing for you to do? This is why I shudder at the call to “Death with dignity” assuming that only suicide can be a dignified form of death for a patient suffering from a terminal illness.

I think to my old DeMolay Chapter Dad. Dad Collins beat back one cancer he thought, but as often happens the cancer reoccurs in another part of his body. The Radiation and Chemotherapy made him ill. But you could see in his eyes the same joy of spirit that he had lived with his entire life.

His son Earl had more often then not been a disappointment but as his father slipped further and further into Illness young Earl filled the gap his father left.

When our DeMolay chapter was teetering on the brink as much as he was from his cancer Earl made his way in looking almost skeletal to fill out the paperwork to help keep the wheels turning and breath a few more minutes of life into our mother chapter.

Earl didn’t let death or the horrible cancer take away his dignity. He didn’t live a perfect life but in the end he had made peace with his life and died meeting his good with peace.

I think of him, and I only pray I can meet my eventual death with the kind of spirit he showed.

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