House Calls of Death

He was serious alcoholic. His disease was so severe, his addiction so powerful, that 21 stints in rehab had failed. His marriage had fallen apart, his children had been taken in by his parents, he was unemployed, lonely and miserable. He was 41 years old and in his mind his battle against alcohol had been permanently lost. He gave up any hope of recovery and went to his primary care doctor looking for a special kind of help. On July 14 of this year his doctor gave him the “help” he requested. His doctor killed him.

The patient, Mark Langedijk, lived in Holland, the country with the world’s most liberal euthanasia laws. Physician administered death is common there, in 2015 more than 5500 Dutch citizens had their lives ended at the hands of a doctor. That calculates to about one of every 2000 Dutch adults. In Holland, having your life ended by a physician is not a rare event. 

The law, as originally introduced 16 years ago, was purported to be about allowing patients with terminal diseases to choose the timing and means of their own passing, a way for patients doomed with incurable and progressive illnesses to control their destiny and avoid needless suffering.  That is not the current reality. The scope of conditions for which physicians are allowed to give lethal injections has widened considerably. A young woman in her 20’s struggling with post-traumatic stress disorder from child sexual abuse was recently determined to have mental suffering severe enough to justify ending her life. A physician injected her with heart stopping medications.

An increasing number of states in the US have passed laws for physician assisted suicide, which makes the Dutch experience all the more sobering. All of these state laws were advanced with the same arguments and promises given in support of the laws in Holland.  Opponents of these laws who feared widespread and inappropriate use of euthanasia were accused of lacking compassion for the suffering of others. Proponents of these laws consistently argued against “slippery-slope” arguments, saying that controls and limits were included in the laws to make sure they would not be abused.

The reality is that slippery slope arguments are always valid. When society moves in a direction it typically continues in the direction. The debate is not about whether we will move towards greater use of euthanasia, that will happen. The only question is the steepness of the slope and the speed of our descent. When a society crosses the line and says that some lives can be terminated they have embraced a system in which society has the right to determine which lives are worth living and which are not. The stories from Holland remind us that once that line has been crossed,  that over time more and more lives will be determined unlivable and more lives will be ended by physicians.

If there is no course correction, Americans will one day wake up in a world where death doctors are performing house calls, a thought which should be sobering to us all.


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reference- The Daily Mail November 30, 2016



When a Patient Wants to Die

What if he asked me to help end his life?

George was dying. I did  not expect him to last more than a few weeks. The esophageal cancer had spread to his liver and to his lymphatic system, mutated and spread beyond the reach of all known treatments. His esophagus was narrowed to the point where solid foods were impossible to swallow and he was starving. The impact of the cancer on his digestive system had resulted in intractable nausea. None of the four anti-nausea medications he was taking had made a difference. Every day was miserable. All pleasure was gone from his life and he was simply waiting to die.

He signed up for hospice care to ease his passing. He was too weak to come to the office so I went to his home to see him. He was a shell of the man he once was. He was once obese but was no longer. He had lost over 100 pounds, his clothes hung loose and his face was drawn.

During the hour I was in his home we discussed many things. He asked me many unanswerable questions-, wondering what caused the cancer, what would have happened if the specialist he had seen had made the diagnosis earlier when he first had trouble swallowing. He asked how long it would take for him to die. Having provided care to many hospice patients over the years I told him that only a foolish doctor would deign to predict a time of death. Death comes when it comes. Sometimes in comes in days, other times it comes in weeks. All I could promise was that I would be there for him, that he would not suffer.

Waiting can become the hardest part of dying. Once the inevitability of death has been accepted, when the goodbyes are said and the prayers have been made there is nothing else to do but wait, to watch each change in symptoms and wonder what it means, to wonder if the final countdown clock has started to tick or if it is just another meaningless change. 

For many patients and families the waiting is unbearable. As the suffering increases and the end approaches it is natural to ask, “Can we just do something to end it?”

Because physician assisted suicide has been illegal in California I have never had to directly answer the question. This could change at any moment, as the governor has signed a bill that would legalize the practice. When the law is implemented it will be legal for me to give patients like George a lethal dose of medication. The question of "When?" will become answerable and the agonizing days of waiting avoided. Family and friends could know the time and place and plan accordingly. Everyone would feel a sense of control.

And my role as a physician would change forever.

For patient's like George  it seems straightforward. He had at most a month or two to live, and his suffering was real. Why not provide definitive closure for such patients? What is the harm in providing a quick and easy passing?

George's case provides an answer to these questions. Under the law as written, George would have been a candidate for assisted suicide 4 months ago, when he was first diagnosed with the aggressive cancer. If he had not elected to attempt treatment his life expectancy would have been less than 6 months and he would have met the conditions of the law. Any doctor could have ended his life any time he wanted. He could have been given a large dose of morphine or other medications and the months of suffering avoided.

He also would have avoided hundreds of conversations with friends and family, including the spiritual conversations he had with me and others. A professed atheist, he specifically asked for prayer and if I would advise him spiritually as he went through the process of dealing with his disease. That 4 month process changed him. He became a different man with a different perspective. I would not have wanted to take that from him, nor should anyone.

Many will say that it should be the patient’s choice. In a godless world where man is the ultimate arbiter of his fate this makes sense. If there are no enduring consequences, if there is no ultimate meaning in life, if there is nothing good that comes from suffering, these choice advocates are right.

But we do not live in a godless world and man is not god, as much as many may wish that we were. Death reminds us of that.

As a Christian physician I will not play the role of God, I will not help a patient end his life. What I will do is relieve his suffering. I will aggressively treat his pain without reservation, even if that requires middle of the night visits. I will come to his home to pray for him, sit with him and comfort him, and do all I can to facilitate a death that is filled with dignity and comfort, knowing that each moment, even the ones filled with pain, provides an opportunity for love, reflection and faith.

- Bart

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