- Probably most dying patients, even when suffering greatly, would choose to live as long as possible. That courage and grace should be protected and honored, and we should put every effort into alleviating their symptoms. But not all suffering can be adequately relieved. Most pain can be eased, but other symptoms are harder to deal with - weakness, loss of control of bodily functions, shortness of breath, and nausea - and the drugs to treat those symptoms often produce side effects that are as debilitating as the problems they treat. Even worse for many dying patients is the existential suffering. They know their condition will worsen day by day until their death, that their course is inexorably downhill, and they find it meaningless to soldier on. Why should anyone - the state, the medical profession, or anyone else - presume to tell someone else how much suffering they must endure as their life is ending?
- The right to refuse life-sustaining treatment presupposes that there is such a treatment to refuse. Suppose there isn't. Many dying patients might not be receiving such treatment because they can live without it. For example, although some patients with widespread lung cancer might need a mechanical ventilator to survive, patients with widespread cancer of the pancreas, which can also inflict terrible suffering, might not need that or any other treatment to remain alive while they slowly die in misery. Shouldn't they have the same right to hasten their deaths?
- In the 1960s, when I trained in medicine, dying was hardly mentioned in medical school or training programs, except as a failure of treatment. It was rarely spoken of to families, let alone patients, who were never to be denied hope for a recovery, no matter how dire the prognosis. Sometimes when patients were in obvious misery at the end of life, doctors would increase the dose of morphine, with the expectation that it would hasten death. But they usually didn't consult with anyone about it, and it was more a reflection of doctors' compassion and courage than patients' needs and desires.
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