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Sunday, June 27, 2010

The End of Life

A couple of days ago my friend, Dick Edwards, died, at the age of 72.  A Norwich University graduate, he had a full career in the US Army, and then worked for DRC.  Dick and I were Division Chiefs on the Joint Staff in 1989/90 —he in EurDiv and myself in StratDiv.  We had offices next to each other at the DRC "Mothership" in Andover.

Dick's wife found him on the floor and called 911.  After an hour of resuscitation efforts she asked the rescue team to stop.  Dick had been in the hospital a few months ago with heart and breathing problems.

I was saddened, but not surprised, and Dick's wife made what I see as an informed and ethical decision to let Dick go—to accept that he had died.

On Sunday last The New York Times had an article by Ms Katy Butler, a woman whose Father had had a stroke and then needed an operation for an unrelated problem.  The surgeon, after some pre-operation examination, required a pacemaker be installed before he would operate.

The kernel of the article is that while her Father was going down hill physically and mentally, that pacemaker was preventing nature from taking its course.  The Father suffered and his wife, the caretaker, also suffered.  The author wanted it to be easier to turn off her Father's pace maker.  This is a borderline issue.  It is artificial sustainment of life, but once hooked up, who has the right to turn it off?

My own Mother, who suffered from cancer for over a decade, had a "do not resuscitate" order.  The last time I saw her was on a long weekend in 1983.  I left her on Sunday, flying back to Virginia, from California.  That night her hip broke.  The next day it was reset and the next day she passed away in the hospital.  I remember her telling me that when she passed away that her ashes would have been spread over the desert before I could get back to Palm Desert.  She had a plan and it was executed just as she had explained it to me.  Her network of friends made it happen.

My Mother did not go for euthanasia, but rather went with a conscious decision to avoid heroic measures to maintain her life—a "do not resuscitate" order. 

In various locations people, through their government or by direct vote, have elected to allow euthanasia.  One such place is the Netherlands.  Last week The Daily Telegraph has an article on Euthanasia in the Netherlands.  In 2009 there were 2636 cases of Euthanasia reported in the Netherlands.  This is a definite increase from 2003.
In 2003, the year after Holland became the first country in the world to legalise the practice since the fall of Nazi Germany, there were 1,815 reported cases.
The gist of the overly short article is that while the resort to Euthanasia is increasing in the Dutch nation, palliative care is diminishing.

This is not a good sign:
Anti-euthanasia groups say, however, that the sharp increase is probably [be] linked to the collapse of the palliative care system in the Netherlands following the legalisation of euthanasia eight years ago.
Phyllis Bowman, the executive officer of Right to Life, said: "I am sure that the increase in numbers of people opting for euthanasia is largely a result of inadequate pain control."
People forced by "circumstances" to opt for Euthanasia is not a good thing.  One wonders to what extent a state of mind on the part of the medical profession has resulted in people finding that Euthanasia is their only option.

Those who say we should have a national conversation on "end of life" actions are correct.  But, it needs to be a very wide ranging conversation and it needs to allow for many different points of view—both within the conversation and as legislation is drafted in states and at the national level.  A variety of options need to be available.

Regards  —  Cliff

2 comments:

ncrossland said...

Dick was a great guy and he is already terribly missed.

The "problem" with having a national conversation on end of life options is that of determining who gets to be in the conversation, and what is the weight of their input. That the government has and deserves almost zero trust by the populace is indicative of the energy behind the issue. Obamacare and the rumor of "death panels" is perhaps the best example of that energy. While I don't envision a public allowing the formation of faceless bureaucrats behind the door of some darkened Federal chamber to decide who lives and who dies this week, ala "1984," in fact the centralization of funding for medical care in the form of Medicare and Medicaid results in a form and degree of rationing, which has the same effect as a "death panel." But then, one can argue that personal financial ability has always been a factor in living or dying.

At the end of the arguments, the fact remains that we preach responsibility for one's actions and yet, at the most critical juncture of one's life, we jerk away the ability to take that responsibility. We don't like death, and we like even less anything that promotes or accelerates death. This is evidenced in physician training and practice. Docs don't like to talk about it.....and some WON'T. It is an admission of their personal failure to promote and prolong life...but they aren't ever going to win that war anyway. The real dilemma comes with the inescapable conclusion that every living being has its own timetable for life and death, and mortal intrusions only invoke needless suffering at the end.

My grandmother and my own mother seemed to sense their impending departure from this life. My grandmother rose from her hospital bed at 2 AM and shuffled out to the nurses station to thank each of the staff there for their wonderful care. Having accomplished that task, she returned happily to her bed. She died within the hour....peacefully. My mother went through a similar journey....dying quite peacefully in an ER. The ER doc on duty commented to my attorney brother who was present through the whole chapter that she had never witnessed such a "beautiful death."

I think that next to a successful and enjoyable life, what we all want is a beautiful death...and I suspect that the only source for that lies within each of us.

kad barma said...

My grandfather suffered a stroke at 95, and would have passed away had it not occurred on a Monday morning. (The day of his scheduled housecleaning). In the years that followed, from his wheelchair in the nursing home, he would calmly and consistently repeat, whenever asked about his health, that he was meant to have gone that day, and that he regretted every minute since he had not. (His wife of 55 years had died 20 years earlier).

I have always thought, since then, that I should not have a cleaning lady.