To know that there is absolutely nothing I can do, to watch the family suffer, it crushes my heart.
What would you do?
I wanted to discuss this because even though it does not contain physiology, genetics, or biochemistry, it contains a perspective that, as medical professionals, we all need ... compassion.
Okay...a little biology...glioblastomas arise from tumors of the astrocytes--a "glue-like" structure that supports the brain. The tumor is located in the cerebral hemispheres.
So here is what moved me to post this: Brittany has chosen to "Die with Dignity"--- where a physician gives the patient medication to end their life.
It won't be long before many of us are faced with patients like this.
What do you do?
Her cancer will quickly ravish her body, and mind...her quality of life will drop sharply, and in the end she will be a shadow of her previous self.
What advice would you give?
Brittany has chosen November 1, 2014 to be her final day....surrounded by family and friends....and to be at home. My heart goes out to her family and my prayers are with them.
These are the challenges we face tomorrow. Today is the time to prepare, to ask yourself:
What would you do?
http://www.people.com/article/Brittany-Maynard-death-with-dignity-compassion-choices?xid=socialflow_facebook_peoplemag
I could see this being a big ethical dilemma for some people, but in my heart, I find the answer quite simple. Brittany exhibits clear mental capacity. She is electing to "die with dignity" and choosing not to allow the diminishment of her capacity to a state that jeopardizes her standard of life. We as humans, I think, should be able to make these choices for ourselves. I can understand some religious viewpoints that maintain that this is "against God," against nature," "against the universe," or what have you, but what would you think would happen if we take away this option from Brittany, and like in some states, did not provide it to patients? Would patients come to the same end-goal in another, less dignified, manner? Would Brittany's Family and Friends view this act as dignified if it was enacted in a less peaceful and humane way? I think, as people, we inherently have the choice if we should live or die and as physicians we are to help facilitate this inherent choice in any way that we can.
ReplyDeleteJames I am really glad you posted something because this gets us thinking about this inevitable fact that we will face. I have a little experience with people who are at the end of their rope, I worked as a CNA and as I have done some hospice volunteering. Some of the people I took care of were as you said shells of what they use to be, basically living breathing vegetables. Unable to take care of themselves and also were unaware of their existence or of anything that was going on around them. For me this was incredible difficult to emotionally deal with. I could not help but feel sorry for these people. I would like to think if I were in their shoes I would hope that someone would have the willingness to let me go. I feel that by taking care of them I was prolonging their life, only for them to get terrible sick and die in very unpleasant way. So, I can respect her choice to want to go out on her terms.
ReplyDeleteThis is an incredible hard choice to make as a future health care professional, it is our job to enhance life not end it. But could we be enhancing what's left of our patients life and their families lives by ending it? If you have a great answer to this question I'd love to hear it. Until then I like to think I will do what's in the best interest of my patients.
I agree with James Gilbert, as a health care professional, my job will be to extend and improve the quality of life not to end it. Even if ending it is better than what the disease will do. When you take the Hippocratic oath you are pledging that you will do no harm to your patients and swearing that you will not give any lethal dose of medication, even if asked. I do not know what specifically she is being prescribed, but if it is able to take her life, these physicians are breaking the creed they took.
ReplyDeleteBut are you doing harm to your patients by making them suffer when there is no positive longterm outcome? The Hippocratic oath has been revised in the past to compensate for modern medicine and I believe that it will be again soon. With that said, there is definitely a difficult line to draw as to when assisted suicide is an appropriate path to take.
DeleteMy response to that would be that it is unethical for me to withhold treatment whether it is for or against my moral beliefs. If I withhold a treatment option because I view it immoral and thus it leads to greater harm, that is unethical and the two need to be separated. But death is not a treatment, it is a permanent solution. I wouldn't say I'd be doing her more harm because I would do my best to make her as comfortable as possible. Or she can see a different physician, because without having taken ethics yet or gone through medical school training, giving someone a suicide cocktail to me is not a treatment.
DeleteI read this article and it gave me several mixed emotions. It made me think about what if I were put into her position, what if I was her doctor, how would I react. I also do come from a religious background and definitely have to think about how that pays a part in this decision. The conclusion I came to was that I would need to look at the ins and outs of this disease and if there were any other alternatives. I would have to agree with James and want to extend and improve the quality of life of my patients. I would look at all of the different options I could use to help my patient to extend their life. This article also made me think about my grandfather who has Alzheimer's disease. He is quickly losing his memory and it is sad to see such a smart man is unable to remember anything for a long period of time. I know he will get to a point where he won't be able to remember how to eat, go to the bath room, and do all the normal daily activities we do without thinking. Would I as a physician offer a way for my grandfather to end his life before he loses complete control of himself and relies on the people around him to take care of him? I was talking to a friend who knows someone who has Alzheimer's and all this person remembers is her life in a concentration camp during the Holocaust. How awful is it that this person lives every day with only these memories? This person doesn't remember her family and completely relies on the nursing home to take care of her. Is this a situation where ending her life would benefit the patient?
ReplyDeleteAs a physician there are so many ethical decisions that have to be thought of and I believe it is very important to think about the kind of physician you want to be and the kind of care you want to provide to your patients now before getting into medical school.