Death by Doctor

Posted by on Nov 18, 2014 in Education, End of Life | 19 comments

Death by Doctor

If you follow my writings, you know I appose Physician-Assisted Suicide.  It is not a spiritual or religious issue; we live in a Country where religious decisions are personal and private.  I do not have a general objection to the concept of suicide; there may be a time when it seems to be a reasonable alternative.   No my vehement opposition is more basic; I object because it contains the word “Physician.”

Mend when possible, and treat suffering always. However, doctors do not kill.  To confuse the role of the executioner and the healer is to risk transformative chaos in the physician-patient relationship.

The damage that medically-assisted-suicide can do was pointed out harshly during an especially difficult series of conversations with a family in pain.  Such end-of-life, advanced disease, prognosis verses potential discussions are common; I have them every day.  Nonetheless, the request, which evolved from this particular conversation, revealed the Kafkaesque nightmare we invite when we involve doctors in actively ending life.

 

Entering Room 7 of the intensive care unit, the gentle sighs of a respirator and barely audible toll of the cardiac monitor greet me.  The patient is on his back, tube passing between lips, chest rising rhythmically with the machine’s breath.  Despite brain damage and the IV drips which enter his body thru a spider nest of IV tubing at the base of his neck, he turns briefly toward me during my exam, although his eyes do not focus.  Arms wasted and bruised, legs swollen, urine drips into a bag stained red, he appears relaxed, no grimace, no strain, no apparent pain, not short of breath. This is a blessing, because damage from the ravage of disease means that simply to be awake can be agony. 

Close are his wife, grasping his right hand and two daughters, who are holding hands together. His elderly mother, in a chair to his left, is squeezed next to the ventilator’s silver cabinet. They respond to my entrance, the wife with a brief, half smile, half grimace.  We watch him in silence for a while and then file out, walking down the hall to the conference room.

“How are you doing?” I ask.  “Have you gotten any sleep?”

“We’ve been taking shifts,” Answers the younger daughter, face puffy, hair thick.

“Have you all had something to eat?”

“Just coffee, this morning,” Responds his wife, obviously exhausted, blouse wrinkled, mascara stains on each cheek and sleeve.

“It is very important that you eat.  When we’re done here, you should all go down to the cafeteria and have some breakfast.  You can use the break.”

Nods around, but eyes on the table or the opposite wall, where a cheap framed print of a lighthouse, somewhere, not here, beckons.

“Did you have a chance to discuss what we talked about yesterday?”

“Yes, we talked a lot.”

“What do you think?”

“Well, we had a couple of questions.”

“OK.” 

“First, just so we’re clear, you said that this cancer is always incurable. That there is no special center, no expert, no research, where we should take him?”

“There is never anything wrong with getting a second or even a third opinion, but there is no research that has not had success as yet with his cancer.  Also, he is too sick for any experiment and too weak to move. Finally, there is no conventional treatment which can cure him.”

“But, you said chemo can sometimes help.”

I hesitate.  “I said that when the cancer is this advanced, there is a small chance that chemotherapy might make a small difference.”

“How small?”

“It might shrink the tumors, a little.  Maybe it could extend life for a couple of weeks or months.”

“No, I mean how small is the chance that the chemo will help?”

“Probably, not more than 5 or 10%.   I also said that he was too sick for chemo.”

“Why?”

“His liver and kidneys are so damaged, his immune system is weak, and his nutrition is  depleted, that he would probably not tolerate the chemo.” 

“What would happen?”

“He would get mouth sores, diarrhea, fevers, bleeding and probably it would finish off his kidneys. In the end he would die.”

“How likely is that?”

“How likely is it that the chemo would kill him?” 

“Yes.”

“Maybe as much as 80%.”

Silence.  Outside, in the hall, overhead, I hear my name paged.  I ignore it.

“Well, we talked about it and this is what we decided.  We want you to give him the chemo.”

“I am not sure I understand.”

“Well, it is worth the chance, so give him the chemo.”

“Let me be clear.  The chemo will probably kill him and it will be nasty.  The chemo is very unlikely to help him, and the benefit would be very small.  If we give him chemo, it would be like planning to kill him, with the tiny chance of a very small shrinkage of cancer.   We probably would increase his suffering. He would still have an incurable cancer and he would still die.”

“Look.  This is what we think.  In some parts of the country, it is legal for a doctor to give medicine to kill a patient.  This is better than that.  We will give him medicine to probably kill him, but maybe, just maybe, there would be a miracle and he would get better.”

 

For hundreds of years healers have relied on the ethical idea of “double effect.”  That is the concept, especially important with pain medication in dying patients, that if your goal, in your heart-of-hearts, is to treat pain or other suffering, that if there is a side effect which harms the patient, for example a pain medicine slowing breathing, it would ethically acceptable.

What this family was requesting is the antithesis and has no ethical base.  I might suggest it is inhumane.  Plan to kill, plan to cause suffering, but hope that a miraculous event will occur.  This idea stands in direct opposition to the most basic concepts of quality of life and compassion.

This inversion of the goals threatens every patient and every relationship.  This establishes a bizarre precedent where we can justify any action, any side effect, because we aim for the worst and simply pray for something good to happen.

In that sort of a world, there is no risk we will not take and no amount of suffering we will not condone.  Transplant a new heart into someone with Alzheimer’s.  Take off two legs, two arms in a diabetic with pancreatic cancer.  Dialysis on a 102 year old with end-stage heart disease.  Death and suffering would be confused or equated with healing.

We did not give my patient chemo.  After I got over my shock, I spent a long time explaining to the family that what they were requesting is that we not only greatly increase suffering, but that suffering would be our most achievable goal.  Eventually we agreed to try and achieve what was most likely and most merciful.  Comfort, for whatever time he still has, and perhaps the chance to share a few moments with the ones he loves and who love him.

Many times I have heard the question, “do you believe that physician-assisted suicide” is the start of a slippery slope?  Do you think it will lead to killing people who are not terminally ill, but are weak, depressed, poor or simply different?  With proper controls, that seems unlikely.

However, perhaps this story warns that we risk another fall, another slope.  Perhaps we may lose track of our hopes, goals and the ideals of healing.  Slip away from the closeness and mending powers of the physician-patient relationship. We just might find ourselves falling into a darkness that threatens each of us.

19 Comments

  1. Beautifulky written. What do you think of the case regarding Ms Maynard’s case in particular ?

  2. This is a touching example and deserves thought and consideration but it goes no where near addressing the dilemma of a fully mentally capable man or woman deciding in their own right that they either have had enough or do not want to suffer a particular course of medical action.

    No one should be forced or coerced into administering drugs that will cause the end of life to hasten however the intensely caring and compassionate nurses and doctors who are ready to shoulder the responsibility deserve support and we the public, deserve the right to die at a time and place of our choosing. ..without putting our families and friends in fear of prosecution. And of course I say this with an understanding that strict precautions should be in place.

    In England we are exploring how a panel of judges might be involved in the future to help ensure that no one is being pushed into a decision to end their own lives against their will.

  3. I have an incurable cancer that doesn’t respond well. I live in a state where it’s legal to get meds to pick my time to pass. Radiation worked well, but didn’t get it all. I don’t know how long it will be dormant. I’ve been told that my lab work won’t especially reflect the severity of my cancer. When I decide to go-I don’t want to argue with doctors like you. I should not have to hire lawyers. I should not have to go to court houses and set for hours. There isn’t even adequate parking around the court house. Why should taxpayers or my family have to pick up the costs associated with appealing the way you want or envision?

    Out west we have a multistate group, where doctors volunteer to prescribe for us. I can’t imagine anybody being forced into prescribing the lethal dose. If every doctor refuses to help a patient, then it might come to court orders to force somebody to prescribe the necessary dosage.

    I had 5 ear abscesses at the same time. The pain meds didn’t work. I covered my face with pillows and screamed and screamed, and they could still hear me, I was clawing and shredding the sheets. I do not look forward to having my brain ate out. I do not want my children and their children listening to me scream in pillows. I do not want my family to see me this way.

    Do you know what we say about doctors that want the patient to hang onto the bitter end? The doctor and medical staff is squeezing every possible penny out of the patient and their family. This includes hospice.

    It does seem that if a patient requests this right, when it’s a legal options, that you could have the decency to refer the patient to a more accommodating physician.

    • Meyati, Thank you for your input. You of all should be able to do what you want with your life,
      Of course not according to one of the self proclaimed critic, with his personal facts on what is dehumanization. So that means, no one should have an easy way out because of his theory. And because of the few, so fearful of death themselves, they have prevented the majority of others of having a humane peaceful death. Or should I say passing.

  4. Things should have never gotten this far. Good you talked them out of chemo. Why is he not in hospice? Why was there apparently no earlier conversation about end of life and what the patient wanted so that his family was not put in that situation? Do. Not. Agree. With. Your. Stance. On. Assisted. Suicide. But then again we already had that conversation in another blog post of yours. Your right is to believe what you want. Not your right to force your preferences with this on the patient. And yes, assisted suicide is a choice that needs discussed and accepted or rejected just like any other choice with respect to end of life – where you are perfectly free to state that you are unequivocally against it and if the patient is for that they need to find another doctor for end of life care.

  5. I agree with Liz. My Mom made her transition in the loving care of a Hospice facility. I do not think of giving morphine, withholding “care”, or whatever else as “death by doctor”. Honestly, I think of it as “rescue by doctor” to alleviate suffering. But, it is, of course, a choice made by the patient and her doctor.

  6. “Many times I have heard the question, “do you believe that physician-assisted suicide” is the start of a slippery slope? Do you think it will lead to killing people who are not terminally ill, but are weak, depressed, poor or simply different? With proper controls, that seems unlikely.”

    “However, perhaps this story warns that we risk another fall, another slope. Perhaps we may lose track of our hopes, goals and the ideals of healing. Slip away from the closeness and mending powers of the physician-patient relationship. We just might find ourselves falling into a darkness that threatens each of us.”

    I don’t think those are two slopes; they’re one and the same. I don’t think we risk sliding down those slopes. We’re already headed in the direction of human devaluation in medicine and the comments on this blog demonstrate the popular, hyper-autonomous sentiment. However, I do not think medicine can be in the business of providing both healing and killing. We see this demonstrated at the beginning of life, where those who provide abortions may also help in saving or helping pregnancies. This mixed agenda provides a confused ethic that metastasizes to the rest of life (e.g., by establishing value based on a person’s abilities, rather than their inherent worth). I’m not trying to shift the focus onto a contentious topic like abortion, but rather show that if one claims we have inherent worth, it raises uncomfortable questions about when we’re imbued with that worth. Rather than wrestle with that issue, the moral intuition of many leads them to believe there are lives “worth living” and others that are not (often based on levels of ability, or perceived experience). This is the fabric of dehumanization.

    Re: Liz’s comment:

    “Your right is to believe what you want. Not your right to force your preferences with this on the patient.”

    I am against physician-assisted suicide (PAS) and euthanasia. I’m also against plain ol’ suicide as well (which, I would contend, you should support if you support PAS). But let’s not drag the discussion into the world of relativism. Ethics is a field in which we discuss how we behave and interact with the communities in which we live and work. Is it good for a community to promote suicide? Is it good for a community to encourage its health care workers to help people kill themselves, or even for those health care workers to actively kill people? What do these ethical decisions say about human worth, dignity, the value of suffering, and the value of palliation?

    Furthermore, while we’re discussing rights, let’s not forget that when someone is offered a “right to die,” they’re also offered a choice to die (articulated by Velleman in the Journal of Medicine and Philosophy). Prior to that, they may have just lived by default, like you or I. Most people do not go through life consciously choosing to live and avoid suicide; they just live by default. However, once someone offers them a choice, the one thing they cannot do is continue living by default. They must make the choice. And if they make a choice, they’re responsible for it. And if they’re responsible for it, they must justify it. Imagine showing up at your work place and having your colleagues ask you why you didn’t kill yourself last night. This is the position in which the weakest and most vulnerable among us might find themselves if we do not carefully delineate exactly why PAS/E is a good for our community.

    Re: meyati’s comment:

    “The doctor and medical staff is squeezing every possible penny out of the patient and their family. This includes hospice.”

    I don’t want you to “hang on until the bitter end.” I don’t want you to suffer at all. But I don’t think the circumstances justify killing (either killing oneself or having someone else kill you). Humans are not dignified in murder; indeed, human dignity is degraded in such acts because it demonstrates that our worth is relative to a standard. There are lives “worth living” and lives “not worth living,” and we determine that worth by some standard that is ultimately arbitrary and subject to change. Who changes the standard, I wonder?

    • Josh – my father committed assisted suicide. And once someone does that, to come to terms with that, you have to consciously reject that choice from there on out. That, by the way, is why I think suicide rates are higher in families where someone has already committed suicide. Of course society does not let you grieve normally when some one commits suicide – it is considered a “dirty” death and thus somehow the grieving have less “right” to grieve, less right to compassion…

      How is choosing to stop treatment, refusing to eat, drink… and no one doing anything about that any less suicide than if someone actively takes something? The outcome is the same.

      • “my father committed assisted suicide. And once someone does that, to come to terms with that, you have to consciously reject that choice from there on out. ”

        I’m sorry that happened to you. That’s awful.

        “How is choosing to stop treatment, refusing to eat, drink… and no one doing anything about that any less suicide than if someone actively takes something?”

        To clearly define our terms, suicide is killing oneself. Killing is intervening to end a person’s life. When someone refuses treatment, they are not committing suicide. What they are doing is accepting whatever benefits come from lack of intervention (E.g., not being poked, prodded, scanned, operated upon, etc) while acknowledging that this may shorten their life. In many instances, interventions may not even lengthen a person’s life but only make them more uncomfortable, so stopping treatment does not significantly change the outcome of disease.

        There is a huge difference between stopping treatment and PAS/E. The cause of death in the former is whatever disease they had (e.g., dying from an infection, from cancer, etc). The cause of death in the latter is a lethal overdose (self-administered or given by someone else). One is letting die, the other is killing. It’s a morally relevant distinction.

        I will say if one dies because they refuse to eat or drink, this depends on their disease. If I, as a healthy person, stop eating and drinking with the intention to end my life, that’s suicide. However, if we stop feeding a person with advanced dementia it’s in recognition of the fact that even if we continued to feed them, it may cause them more harm by increasing their aspiration risk and causing a pneumonia. By that same token, we do not allow someone with anorexia nervosa to starve themselves to death because we believe they have impaired decision making capacity (like someone with depression that’s threatening to shoot themselves).

  7. as a member of final exit, and Death with dignity, I really resent you not wanting to help end someone’s suffering. Who else is to do it, and how. are we the non medical supposed to put a pillow over them, or shoot them, Would it not be more merciful if you would prescribe a overdose, of course it is not legal in LA. Right.
    but it should be. Since when does the state have the right to oversee our lives.
    We all die, get it. Can we die on our own terms? Apparently not.

    • “I really resent you not wanting to help end someone’s suffering.”

      Nowhere in any of these posts on this website does Dr. Salwitz make himself an opponent to palliation. He even says “treat suffering always.” It’s a horrendous deception to assert that “ending someone’s suffering” is synonymous with helping them to kill themselves (or killing them directly). You neglect that it also ends the sufferer.

      I wonder where you stand on other topics of suicide. Why do we not end the suffering of those with depression this way? Is suicide not dignified when someone is struggling with depression? What about folks with transient problems? Why is it morally relevant that a person should have a terminal illness?

      “Who else is to do it, and how.”

      Maybe we should stop thinking about how to kill the weak and vulnerable among us, and instead think about how to palliate their symptoms.

      “Since when does the state have the right to oversee our lives.”

      There is a right to privacy, but it’s not an unbounded, unfettered right to privacy. The state makes many laws which “oversee” our lives. Laws impose themselves on our freedom for the good of the communities in which we live.

      Is it good for a community to promote suicide? Is it good for a community to encourage its health care workers to help people kill themselves, or even for those health care workers to actively kill people? What do these ethical decisions say about human worth, dignity, the value of suffering, and the value of palliation?

      • You miss the point. It is not about another person deciding to end a sick person’s life. Or of our society (ies) encouraging a culture of suicide. It is about supporting those who are in great pain both mentally and physically to take control of how and when they leave us. When death is inevitable. So that they do not need to resort to a violent death, to be found by someone who loves them.
        And yes it is a rare grace and privilege to help a family or group of friends or indeed an individual to gather and hold the sick person in their arms goodbyes clearly said as they let go. These health workers are special and in my limited experience kind and loving beyond words.
        Palliative care is wonderful for those who want it and should be improved and worked upon. However palliative care is not the universal answer. Not every death is a good one on the doctors ward.
        Human worth and dignity is found in providing the drugs for a sick person to administer themselves once they have completely explored every avenue and are certain without a doubt that this course of action is what they truly want. It is not about asking one person to kill another..it is about supporting with love a very terrible but considered decision.

        • “You miss the point. It is not about…”

          Before we can even begin to discuss what this might be “about,” we must define what it is, and what physician-assisted suicide is… is suicide. Suicide is self-killing. Euthanasia is… actively killing someone. Whether we like the word “kill” or not, and the moral baggage that comes with it, isn’t a matter of our preference. That doesn’t change the definition of those acts: they involve killing.

          “It is about supporting those who are in great pain both mentally and physically”

          Sounds like palliative care.

          “to take control of how and when they leave us.”

          Sounds like a form of radical autonomy that should not be encouraged or endorsed. Because it really is about promoting a culture of suicide; of feeling ashamed of being weak, disabled, or sick; of seeing burdens in compassionate care.

          We’re all going to die. Some are dying right now, others will die 80 years from now. The fact that we’re going to die doesn’t impose any morally relevant data on the question of whether we should kill ourselves right now.

          “So that they do not need to resort to a violent death”

          We should help people kill themselves (or kill them directly) so that they avoid a violent death? Why not prevent the violent death?

          “However palliative care is not the universal answer.”

          I agree. We should not over-medicalize death. But killing is no answer at all; it is a non-answer. It destroys the question (that is, the plight of the sufferer). It does nothing to aid in suffering, or aid in dying well.

          “Human worth and dignity is found in providing the drugs for a sick person to administer themselves once they have completely explored every avenue and are certain without a doubt that this course of action is what they truly want.”

          How is human worth found there? What about doing that constitutes something that imbues worth to a person?

          • Not to gang up on you, Josh, but I think you are playing too much of the ethical/legal/medical language “game” and watering down your own position. Changing the names to make the action(s) more publicly palatable is the same thing that’s been done with the previously mentioned doctrine of double effect. The doctor’s “intent” when placing a patient in terminal/palliative sedation does nothing to change the “actual act.” Whether it’s appropriate or not, we need to call it what it is…euthanasia, even killing. If it’s suicide, it’s suicide and nothing more. Refusing food & water is suicide under all circumstances. No one has yet been able to live without either. And people have been doing this for centuries without playing word games to explain it. I found your reference to withholding food & water from an advanced dementia patient (only because it “may” have negative consequences) particularly chilling over anything else that was said in this post. This would be no different than snatching a last sandwich from a starving homeless person because his throat “may” be constricted from not eating for a while and he “might” choke. Who will be the person to make that decision for someone else when that someone else is going to get all sorts of grief if he makes it himself? One could easily make a logical argument that under the circumstances currently in effect for (most) hospice enrollment, i.e., agreement to give up curative care and likely some needed medications, is a form of suicide on the patient’s part and slow euthanasia on the hospice’s part. But we don’t say that. We say that the patient is choosing to “let nature take its course” and the hospice is “supporting them on their special journey” and offering them a “dignified death.” Remove the fancy words and what do you have left? But to say that none of what’s been said, and that is contrary to your beliefs, does anything to aid in “dying well” is absurd. First, no one seems able to agree on a definition of what it means to die “well.” Second, even if an agreed upon definition is made, the only person who knows if they died well…died. No one has yet to come back and say either “Yes, that was a good one” or “No, maybe we should have tried something else.” All we really have are the subjective opinions of bystanders and/or active participants. These people know no more than those witnessing the carrying out of capital punishment if the recipient in either case died “well.”No matter how we word it, the decision rests solely with the person who is dying just as the decision to participate or not (legally or illegally…yes doctors do it too) rests with the bystanders/participants. In the areas where suicide has been legalized (with certain conditions) there has been no overwhelming rush to sign up. In those same areas, hospices state they still oppose the “actions” but yet have found a way to work with those patients who are either partaking in or contemplating ending their lives. There is a “C” word involved but do you suppose it’s “compassion” or “cash?” In the end, stripped of all the slick words and doublespeak, what is it we are really talking about? We all know the answer.

  8. don’t know if it’s my connection but that last post is one long string of single words which makes it very difficult to read..any chance of fixing that?
    I’m really interested to catch the meaning.

  9. Here it is in better form:

    Not to gang up on you, Josh, but I think you are playing too much of the ethical/legal/medical language “game” and watering down your own position. Changing the names to make the action(s) more publicly palatable is the same thing that’s been done with the previously mentioned doctrine of double effect. The doctor’s “intent” when placing a patient in terminal/palliative sedation does nothing to change the “actual act.” Whether it’s appropriate or not, we need to call it what it is…euthanasia, even killing. If it’s suicide, it’s suicide and nothing more.

    Refusing food & water is suicide under all circumstances. No one has yet been able to live without either. And people have been doing this for centuries without playing word games to explain it. I found your reference to withholding food & water from an advanced dementia patient (only because it “may” have negative consequences) particularly chilling over anything else that was said in this post. This would be no different than snatching a last sandwich from a starving homeless person because his throat “may” be constricted from not eating for a while and he “might” choke. Who will be the person to make that decision for someone else when that someone else is going to get all sorts of grief if he makes it himself?

    One could easily make a logical argument that under the circumstances currently in effect for (most) hospice enrollment, i.e., agreement to give up curative care and likely some needed medications, is a form of suicide on the patient’s part and slow euthanasia on the hospice’s part. But we don’t say that. We say that the patient is choosing to “let nature take its course” and the hospice is “supporting them on their special journey” and offering them a “dignified death.” Remove the fancy words and what do you have left?

    But to say that none of what’s been said, and that is contrary to your beliefs, does anything to aid in “dying well” is absurd. First, no one seems able to agree on a definition of what it means to die “well.” Second, even if an agreed upon definition is made, the only person who knows if they died well…died. No one has yet to come back and say either “Yes, that was a good one” or “No, maybe we should have tried something else.” All we really have are the subjective opinions of bystanders and/or active participants. These people know no more than those witnessing the carrying out of capital punishment if the recipient in either case died “well.” Yet we have come to a rationalization that those who are executed died without suffering (barring a few rare, may I even say ~my own disliked~ “anecdotal” cases).

    No matter how we word it, the decision rests solely with the person who is dying just as the decision to participate or not (legally or illegally…yes doctors do it too) rests with the bystanders/participants. In the areas where suicide has been legalized (with certain conditions) there has been no overwhelming rush to sign up. In those same areas, hospices state they still oppose the “actions” but yet have found a way to work with those patients who are either partaking in or contemplating ending their lives. There is a “C” word involved but do you suppose it’s “compassion” or “cash?” In the end, stripped of all the slick words and doublespeak, what is it we are really talking about? We all know the answer.

    • “DYING WELL” ARE WORDS USED TO INDICATE PAIN HAD
      BEEN ERADICATED. A PATIENT’S SOUL IS RELEASED FROM THEIR SICK BODY AND TRAVELS TO ANY DESTINATION HE/SHE DESIRES.

      I WAS AN AVID LOVER OF ANIMALS ESPECIALLY CANINES
      THAT HAD BEEN ABUSED, THROWN OUT, OR THEIR FAMILIES COULDN’T AFFORD TO TAKE CARE OF THEM.

      I WOULD GET THEM THE PROPER MEDICAL CARE, THEIR OWN TWIN BEDS, AND ALL THE LOVE THEY DESERVED.
      THEY WERE MOSTLY ON PALLIATIVE CARE AS I AM.

      ANIMALS ARE VERY STOIC, BUT I KNEW WHEN THEIR TIME
      WAS NEAR. THEY WANTED TO GO OUTSIDE AND FEEL THE
      DIRT BENEATHE THEM.

      MY LAST LOVE, A BEAUTIFUL
      NEWFOUNDLAND, WANTED TO LEAVE. THE “C” WORDS ARE
      CANCER AND COMPASSION; THESE TWO WORDS SHOULD ALWAYS BE USED TOGETHER. THEY MIGHT HAVE HAD A
      SAD BEGINNING, BUT THEY KNEW THEIR ENDING WAS
      BEAUTIFUL. A SHOT OR TWO OF MORPHINE AND THEIR PAINS WERE GONE. A “GOOD DEATH”

      SO I AWAIT MY DEMISE. WHEN IS IT GOING TO HAPPEN?
      EVERY DAY THAT IS MY THOUGHT. HMMM….I STILL DON’T HAVE SYMPTOMS

      I DON’T FEEL IT IS THE PATIENTS ACTING NEGATIVELY ABOUT THE RIGHT TO DIE BUT THE CAREGIVERS. IT REMINDS ME OF WHEN ABORTION WAS ILLEGAL.

      IF I’M STILL AROUND IN JAN 15, IT WILL HAVE BEEN THREE YEARS SINCE DXED. IF NOT, NO A LA NATURAL . SHOT PLEASE

      HAVE A WONDERFUL HOLIDAY

  10. Thank you D Someya Reed for re-formatting your post. A rose by any name name would indeed smell as sweet. I hesitate to use the cash word as here in UK it’s all free anyway so doctors are not skimming off fees and I don’t get the impression that our good author of this much used blog is all that concerned about the pennies..nor do I find him lacking in compassion..But I do find his passion to prevent the conscious and controlled ending of life in a sane and adult individual completely baffling.
    Josh B none of us has the right to tell another person how they should feel. It’s all very well to say” Because it really is about promoting a culture of suicide; of feeling ashamed of being weak, disabled, or sick; of seeing burdens in compassionate care.” There are those among us who have taken a rational decision and do not want to subject themselves as they see it to loss of control of bodily function..whether or not they take this stance through some sort of shame or just plain disgust is non of our business..it is how they feel and no amount of therapy telling them how unjustified that feeling is will change anything.

    Once a terminal disease is clearly established and the end is certain I can see no logical reason for denying the person who is going to die the right to organise their own manner of parting. Yes I could use the word dying or killing Josh but it amounts to the same thing..the stopping of vitality and life of a sick person.

    I don’t think anyone is left in doubt when witnessing a bad death. Dr J you must have seen more than your fair share.

    Iris I too have experienced the love of dogs, cats and horses and know just what you mean. My chickens seem affectionate but with chickens one is never entirely sure! Your Newfoundland sounds special and may the compassion and evident love you felt for him or her come back to you now from all who surround you.

    Sorry to high jack your post JS but you do rather ask for it x

  11. I’m a trainee at RWJ Dr. Salwitz — worked together a couple times but a patient who saw you (and who I saw at another hospital) told me about this blog. It’s great! Thanks for this essay. It should be mandatory reading for any physician.

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