Bioethics in Practice: Death in the Hands of the Healer
At a time of extreme duress, it is only natural to seek reprieve. What happens when the only respite is death via the hands of the supposed healer? Physician-assisted suicide is not merely a political controversy, but one that strikes a sensitive emotional chord. This practice is an option presented to individuals with a terminal illness, in addition to a prognosis of six months or less to live. Because of its controversial nature, physician-assisted suicide is currently legal in seven states, not including New York. Though beauty is in the eye of the beholder, I do not believe that death should be held in the hands of the healer.
As a New York State Certified Nurse Aide (CNA), I often encounter patients in pain. During my time in CNA school, I learned how to measure vital signs, including pulse and respirations. While these measurements are quantifiable, pain, defined as physical suffering or discomfort caused by illness or injury, is purely subjective. Asking patients to rate their level of pain is something that I have done firsthand, especially working with the elderly. Pain is observable, but cannot be felt by another or measured. Because of this, when asking patients about their pain, I am trained to rely on the standard zero-to-ten scale. In this scenario, I trust the words of my patient. But when my patient tells me that the pain is so great that he wants to terminate his life, do I apply the same feeling of trust?
“The Psychology of Pain,” authored by two physicians, explains that focusing one’s attention on pain exacerbates it. Patients who have a somatic preoccupation with pain become hypervigilant to the sensations that they are experiencing. It has been found that attending to these sensations amplifies them to the point of becoming painful. To counter this psychological phenomenon, distraction is a highly endorsed strategy for managing discomfort. The process of distraction appears to involve competition for attention between a highly salient sensation, like pain, and consciously directed focus on some other information processing activity. Hansen and Streltzer report that burn patients undergoing treatments or physical therapy experience excruciating pain even after they have been given opioids. It has been shown that these patients report only a fraction of this pain if they are distracted with a virtual-reality type of video game during the procedure.
As a healthcare professional, I can attest that not every patient in pain spends his day assuaged with distractions. Compared to the complexities of medicine, it seems easy to fill a patient’s day with entertainment, but the reality of modern healthcare prevents this from being so. As a result, full- time patients spend more time on their own. If boredom contributes to feelings of pain, how accurate is the patient’s proclamation that his pain is a 10? Wesley Smith, an attorney and Senior Fellow at the Discovery Institute's Center on Human Exceptionalism states, “If we legalize assisted suicide, some patients will die instead of ultimately regaining their joy in living … But know this: if we are seduced into legalizing assisted suicide, we will cheat at least some people out of the universe’s most precious and irreplaceable commodity: time. Assisted suicide isn’t ‘choice;’ it is the end of all choices.”
While many doctors and politicians advocate that physician-assisted suicide should be banned without question, others see the opportunity from a different vantage point. As a healthcare provider, I seek to provide my patients with all of their needs. Fulfilling a need can be as simple as fetching an extra pillow, but this small act can be as graciously received as one triple its magnitude. There is inherent joy in giving a patient something that they need, and all the more so in fulfilling one of their simple wants. During my CNA training, I was instructed to give my patient a choice of which clothing to wear each day. Providing the patient with the opportunity to choose is a form of empowerment, and all patients are entitled to dictate the minor choices that arise throughout the day.
The Death With Dignity National Center agrees with this conjecture, proclaiming, “The greatest human freedom is to live, and die, according to one’s own desires and beliefs. The most common desire among those with a terminal illness is to die with some measure of dignity. From advance directives to physician-assisted dying, death with dignity is a movement to provide options for the dying to control their own end-of-life care.” If I am motivated by the joy of fulfilling a simple desire, then it should seem that I am even further inclined to provide my patient with their greatest wish.
The Annals of Internal Medicine, an academic medical journal published by the American College of Physicians, summarizes the ethics and the legalization of physician-assisted suicide in a few poignant sentences. “Society’s goal should be to make dying less, not more, medical. Physician-assisted suicide is neither a therapy nor a solution to difficult questions raised at the end of life … the principles at stake in this debate also underlie medicine’s responsibilities on other issues and the physician’s duty to provide care based on clinical judgment, evidence, and ethics … However, through high-quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live out life’s last chapter.”
In conjunction with this statement, the psychological roots of pain and pain management bring another dimension to this controversy. Not only does physician-assisted suicide alter the doctor-patient relationship, but the relationship between each healthcare provider and patient. A patient’s word must always be taken seriously, but there are times when a trained professional can see past the subjective pain a patient is experiencing. Because death is an irreversible and immutable decision, this controversial decision must be made with the knowledge that numerous lives hang in the balance. If physician-assisted suicide is to be nationally legalized, the words “I want to die” will no longer be just words, but a prescribable reality.
Photo Caption: End-of-life care is a complicated and heart-wrenching issue.
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