Death and Dying

Last year, I read the New York Times bestseller “Me Before You”, a novel about active euthanasia.  Even though I don’t agree with the message, it was well written and thought-provoking.  This year it’s been made into a movie and is now in theaters (I haven’t seen it yet).  This week in East Tennessee, there were two well known ladies (one known nationally and one locally) named Pat who died in their homes after struggling with terminal illness.   I had started thinking about euthanasia and writing this blog over a year ago and decided now was an appropriate time to share it.

Euthanasia comes from the Greek roots “eu” which means good and “thanos” which means death.  What it has come to be equated with is the act of putting to death a person or animal suffering from an incurable condition.   But in a broader sense, it can refer to allowing a person or animal to die “a good death”keeping them comfortable and withholding extreme medical measures so that their last days are not spent hooked up to machines in a hospital.

Doctors and families often feel compelled to give treatment just because they can or because it is available.  Sometimes this treatment causes additional pain, suffering, or bad side effects. It may prolong life while making the quality of that life worse.

“My patients have all taught me valuable lessons about what a “good death” might look like. Each one has reminded me that there is more to medicine than placing a line to monitor the heart, or performing an intubation. Just because more tests and procedures exist does not mean that we should perform them all each time. Sometimes the most powerful healing of all comes through the simple act of sitting and listening to our patients with compassion.  We know that 75 percent of Americans would prefer to die at home. Only 20 percent actually do. We also know that 80 to 90 percent of physicians would not want CPR or mechanical ventilation at the end of life. Doctors actively choose to forgo the suffering that takes place in our ICUs, because we’ve seen it and we know better.”  Shoshana Ungerleider, MD from Vox blog post October 19,2015

In a Stanford University School of Medicine study, 88% of healthcare providers said they would forego aggressive treatment and CPR if facing a terminal diagnosis.  Many patients receive very expensive treatments in their last days even when they had previously stated they’d prefer to avoid life support. Many end up spending more on healthcare in their last few months than they have in their entire lives up to that point. This can have a huge impact on the families of these patients, as they wrestle with the ups and downs of high-risk treatments and resuscitation efforts. As one widow put it: “And at no point did any doctor say to us, ‘have you thought about not treating?'”

The most important thing we can do about death-and-dying conversations is to say that they are open-ended. They don’t have to be about what patients don’t want but instead can be about what they do want. Patients need to have some sense of whether they are the type of person who wants aggressive intervention or wants people to back off if they are in a situation where recovery is unlikely.

Patients do not need to get into every detail of what interventions they do and do not want but instead can simply have a general idea. As their doctors, we can ask them to do two things: Pick someone to be their decision-maker and have a conversation with that person to determine whether the patient trusts their values in a situation where the patient cannot speak; and second, we can encourage patients to have a discussion with their family about what their wishes are.

You do not have to cover everything in the short amount of time during an office visit. Instead, the most important thing you can do is set patients up to designate a decision-maker to control their care, particularly if they have a life-threatening illness or disease. Also, you can encourage them to talk about these things with their family, because those are the people who will be coming in to the office if your patient gets seriously ill.

This is not an easy subject.. Maybe if we can understand that we do not have to have all the answers, but that we can direct people toward resources—including their family and friends—it will be easier on everyone who has to have this very difficult conversation.  Arthur Kaplan, M.D. Medscape 4/2016

Many physicians, when they are in the position of being a patient themselves, opt out of harsh treatments that offer a few extra months of life.  Since they are more familiar with the full details of their treatment options, they often choose those options that maximize their quality of life. Most patients fall somewhere in between the two extremes of doing everything vs. doing nothing when they are faced with end-of-life situations.  Those of us who are health care professionals need to help patients and their families by discussing with them the various treatment options and what they can expect from each so they can make an educated decision that is best for the patient and one they are comfortable with.

Death is such a deep burden on us because it was not part of God’s original plan for us.  He created us as eternal creatures and it was His intention that we would live in a perfect world in fellowship with Him for all eternity.   You all know what happened to change this plan: ever since Adam and Eve, we all have been asserting our own free will and going our own independent way.   The original couple were sent out of Eden and death became the final destiny for all.

Thankfully, that is not the end of the story.  Just as God provided animal skins to cover over Adam and Eve’s shame, He provided His Son as a sacrificial offering to cover over our sin and shame.  In this way, He is both completely just (punishment for sin is given) and completely merciful (by taking that punishment on Himself).  The only catch is that we have to acknowledge our sin, accept this free gift of redemption from Him, and then start living as a child of the King.   Some choose to put this decision off and do their own thing a while longer, believing there will be time in the future to turn to God.  Others choose to never accept this gift.   Those who do accept this free gift have the sure hope of eternal life as well as peace and joy in this life.