[Mb-civic] Treating the pain by ending a life - Dr. Mark Siegel - Boston Globe Op-Ed

[William Swiggard]

  Treating the pain by ending a life

By Dr. Mark Siegel  |  January 19, 2006  |  The Boston Globe

THE US SUPREME court ruled this week that doctors in Oregon should not 
be charged with a crime for overdosing patients in the name of treating 
pain and hastening death. This decision should be applauded and must not 
be circumvented by new laws.

Ten years ago I assumed the care of a woman with advanced pancreatic 
cancer that had spread to her spine. She was a well-known writer, and we 
quickly became friends. I would travel to her apartment and visit her 
for hours there, something I'd rarely done before and haven't done 
since. She had a close group of friends who visited her constantly, and 
an Irish nursing agency that cared for her impeccably around the clock. 
At first her cancer wasn't causing her pain, though it paralyzed her 
below the waist and bound her to her bed and wheelchair. Still, she 
enjoyed the visits, mine and everyone else's, until the fateful day when 
the cancer spread to her bones and began what was clearly an escalating 
pain. I dialed up the morphine to compensate, until the day came when 
the amount of morphine necessary clearly hastened her death. I was able 
to predict roughly the time she would die, and her friends said their 
goodbyes. I used morphine in the name of relieving suffering, not as a 
murder weapon. No one who knew her seemed upset by the trade-off, a 
tortured life for a peaceful death, and all thanked me for my care at 
the end.

Morphine and other narcotics suppress breathing and lower blood 
pressure. It is not unusual for physicians to use these drugs to relieve 
suffering and thereby accelerate death in terminal cases. What is 
unusual is for doctors to be prosecuted for overdosing their patients 
deliberately in the name of this cause. Oregon has been the focus of the 
Bush administration's attempts to criminalize the activity, but this use 
of medications to knowingly end a tortured life is not confined to 
Oregon. It has been part of a physician's end-of-life role for many 
years, whether it is formalized in the law or not.

Any effective physician has two fundamental roles. The first is to 
prolong life. The second is to ease suffering. In most situations, 
easing suffering is part of prolonging life, as when we guide a patient 
through an accident or a surgery and treat pain as part of ensuring 
survival. Sometimes, though, our two roles collide, and a decision must 
be made as to which to prioritize. This decision is made, in part, by 
considering long-term outcome as well as the wishes of the patient. It 
is never a perfect situation, but we physicians have been making this 
determination for eons, and we cannot be penalized or prosecuted and 
still be expected to function.

In the Netherlands, active euthanasia is legal, which means that a 
cancer patient who is still ambulatory and thinking clearly can ask a 
doctor for a lethal injection. I am not in favor of this policy, not 
because I believe that a person doesn't have a right to end his or her 
life when given a terminal diagnosis, but because I question the role of 
a physician in facilitating this outcome. Such a role should not be 
assumed, because it is not strictly a part of relieving suffering.

But this is not the same thing as the Oregon law, which allows a 
physician to participate when pain predominates, when a patient is in 
agony, when reducing morphine cannot bring back quality of life. When 
the only choice is pain or death, doctors routinely -- with their 
patients' advance approval -- help them choose death. The US Supreme 
Court is wise to acknowledge one of our fundamental roles. We are not 
''Kevorkian-izing" our doomed patients when we help ease their path from 
this world.

Dr. Marc Siegel, associate professor of medicine at NYU School of 
Medicine, is author of ''False Alarm: The Truth About the Epidemic of 
Fear" and the forthcoming ''Bird Flu: Everything You Need to Know About 
the Next Pandemic."  

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/01/19/treating_the_pain_by_ending_a_life/
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