To Cure, sometimes; to Comfort, always; to Euthanize…? Posted on 19th Jun 2009, 11:56am by admin

By Dr. Gabriel Seow

The euthanasia debates are round the corner. It is a true moral and ethical problem and we doctors will do well to ponder and ponder again on this most important issue.
The consideration of euthanasia will greatly challenge & even redefine all our traditional principles of beneficence, non-malfeasance, patient advocacy and patient autonomy.
This conversation between a doctor and his son may very well be our own!
Son: “How’s work today Dad? You look awfully happy!”
Dr Dad: “You bet, son! I did something good today! I helped one of my patients out of his suffering!”
S: “Wow Dad, that’s great! I really wish to be a doctor some day! You people use your talents and endure your sleepless nights of research just to come out with a means to help your patients! That’s noble! How did you help this patient, Dad?”
D: “Well, this poor chap had a cancer (you know what a cancer is right, son?) that had spread to all parts of his body. There was no cure for him and he was in great pain and had given up the fight!”
S: “…and Dad, you discovered a cure for his cancer! “
D: “Well, nope, I…”
S: “I know, you managed to ease his pain, right, Dad?”
D: “Well, I tried but…”
S: “Let me guess, you talked to him and encouraged him and told him a joke and made him laugh…”
D: “No son. I gave him an injection so that he’ll rest forever and never have to suffer again.”
S: “You mean…you killed him?”
D: “Not exactly. I administered euthanasia. You could say I euthanized him, which is very different from killing.”
S: “What is the difference? It says here in the dictionary: “a painless killing””
D: “Well for one thing: it is painless; the patient doesn’t feel a thing…”
S: “But how do you know that for sure? They can’t tell you after they are dead!”
D: “Science tells us… anyway it’s like taking a sleeping pill; you just feel tired and then fall asleep.”
S: “What if they change their minds half way and are too sleepy to tell you… maybe he wants to say something to his wife that he’s just remembered?”
D: “Well, he’ll be too dopey to think or remember anything anyway.”
S: “He wouldn’t be if you didn’t give him the injection… I still don’t see the difference, won’t you go to jail for killing someone? I’m scared Dad.”
D: “No son.”
S: “But you just killed someone!”
D: “No, son I didn’t. He gave me the permission: in fact he was begging me to do it as a favor! What’s more the law now permits me to do it! I won’t go to jail, don’t worry son!”
S: “But Dad, why did your patient want to end his life?”
D: “He was in great pain. Maybe he didn’t want his family to suffer looking after him. And besides he felt he could not afford the treatment…”
S: “Or maybe his family doesn’t love him; maybe they made him feel that he was a burden to them.  If I am dying will you also inject me?”
D: “Of course not son, don’t be silly.”
S: “Why not? You’ll also be ending my suffering?”
D: “That’s different, you’re my son and I always want you to be around to the very last second.”
S: “But I can’t understand this. Why can’t your patient just jump off a building or slit his wrists like in the movies! Why must they make you do it for them? It’s like making you an accomplice.”
D: “That would be suicide, the patient kills himself. That is a crime.”
S: “You mean that that it is wrong for people to kill themselves but it’s OK for a doctor to kill them!”
D: “Well, the patient has an incurable illness and is undergoing great suffering!”
S: “Dad why do people commit suicide?”
D: “For various reasons, I suppose. But mainly because they feel that they are undergoing a terrible trial for which there appears to be no hope.”
S: “Are these good reasons for a person to kill himself? “
D: “Well, I suppose the reasons vary for different people…”
S: “But when these people try to end their lives, it’s wrong just because they don’t have an incurable illness?”
D: “Well, they could have tried seeking help, or go to a counselor…maybe they could obtain a solution or some insight?”
S: “Do counselors succeed? I mean, do they always manage to find a solution to things?”
D: “No they can’t be expected to find solutions to all problems. But yes, in many cases, they manage to give an insight or hope enough for these poor blokes to go on living. Some of course go on to kill themselves despite all the help offered.”
S:  “Dad you told me that you once stopped a patient from killing himself by talking to him all afternoon; couldn’t you have done the same this time?”
D: “But in this case, there was no cure, just suffering, meaningless suffering. And besides, now that the law allows it, it’s less of a hassle for me.”
S: “Is suffering meaningless? Mum told me she suffered lots when she gave birth to me. And when I had my appendectomy you told me to be brave and said that no one goes through life without suffering. You said that all suffering has meaning, it makes us grow strong and it makes the people around us strong.”
D: “Well, suffering can certainly bring out the best in some of us!”
S: “Dad what actually happens when a person dies? What happened to your patient when you gave the injection to kill him?”
D: “To ‘euthanize’ him, you mean.”
S: “Ok ‘euthanize’; what happens to a person when he dies?”
D: “Well, he ..er..his heart stops beating, the brain receives no oxygen, the neuronal circuitry shuts down and he dies. Sort of like turning off the power supply, you know. He ceases to exist.”
S: “It’s strange: one moment you’re alive, next you cease to exist. I’ve often wondered, the person may die but his individual cells remain alive: I mean that’s why we can take his kidneys & eyeballs and give them to others who need them right?”
D: “Er, what’s that you’re trying to ask?”
S: “Gimme a minute, it’s confusing me too. Trying to voice my musings…I mean if the organs are alive then, what exactly is death? What’s that thing that makes a person alive one minute and dead the next? I mean the dead man looks & feels exactly the same one minute ago when he was alive…what has changed?”
D: “Go on, son…”
S: “I mean, we don’t really know what life is, do we Dad? To know that something is alive or dead is different from knowing what life is, right?”
D: “Uh huh…”
S: “And if we don’t know what we are dealing with, is it OK to mess around with it?”
D: “Well…”
S: “And can anyone take his own life; or permit another to take his life?”
D: “Why not? A man’s life belongs to him; he is the master of his own life- he decides what he wants to do with it!”
S: “If a man is truly a master of his life, then even on his deathbed he should be able to just decide to live on forever and pesto! he will go on living forever, right? I mean he would be able to control when he dies and when he should live on.”
D: “Unfortunately, we can’t do that!”
S: “Then we are not masters of our life? Who is?”
D: “Well…”
S: “If I am not master even of my own life, am I allowed to take it or make others take it? And should I take another person’s life just because he asks me to?”
D: “Hmm…That’s deep son!”
S: “I’m scared, Dad! Because of a change in ruling: a doctor can now kill- I mean euthanize- his patients.”
D: “Don’t worry son. A doctor can choose not to perform euthanasia.”
S: “Oh good Dad, then you can stop euthanizing your patients? It’s certainly easier to simply jab them to silence them forever, but it seems like a mighty strange for a doctor to do!  I mean, doctors are supposed to save lives, not take them, right? Maybe all these patients need is some encouragement, some jokes?  I’d rather my dad to be real doctor rather than a euthanicist, if there is such a word. Imagine if everyone kills himself or asks for death the moment they face any difficulty, who will there be left to fight? There will be no more heroes! Besides, I’d be afraid every time you fed me my medication: it might be the last thing I took! “
D: “You can always trust your ol’ dad!”
S: “Yes I trust you. And your patients too, they entrust you with their lives.”

Our patients trust us to take good care of them. Holistic medicine encompasses the medical, mental, physical, psychological, social and spiritual dimensions of care. If we are true to its practice (not easy!), we can be quite certain that few, if any, of our patients will opt for euthanasia. Perhaps the question we ought to be asking ourselves is simply the 5th question in Murtagh’s diagnostic model: “Is this patient trying to tell me something?” and then take it really seriously! For a patient’s wish for death is the ultimate cry for help and not for death itself. Then we will help him, so that he needn’t ask for death! What a privilege it is if they allow us to journey with them through the arduous final lap of their earthly sojourn with fortitude and serenity.
I feel that euthanasia is our definitive admission of defeat. It undermines the heroic discipline of palliative medicine and is a gross insult to our most esteemed colleagues in this field.
The 180 degree role reversal of a doctor from being a champion of life to its executioner is somewhat schizophrenic if not disturbing, even from the public viewpoint.  For if we skip the euphemisms & strip euthanasia down to its core, what are we actually dealing with?
There is a certain sanctity in the doctor, who like an ever faithful friend, accompanies and supports his dying patient to the very end. There is a certain majesty in the patient who serenely accepts and faces his end with the dignity befitting Man who triumphs even death.