Tuesday, March 15, 2016

End-of-Life Issues: Hospice, a Lingering Death, and Palliative Care

When physicians recognize that their patients who are near the end of life are suffering severe pain, they prescribe palliative care—that is, patients are made as comfortable as possible with medication, while they linger—awaiting an inevitable death.  Comatose patients, for example, may have feeding tubes inserted into their stomachs, and, unless fortunate, are housed in "nursing" homes while awaiting their end.  It is not a pretty sight.
            Prolonging a life that is clearly at its end is based on the idea that life of any quality is precious, and being alive is better than not being alive.  In the Judeo-Christian tradition it is believed that all life is given by God (Genesis 2:7, 21-22) and that the taking of human life is prohibited by Exodus 20:13: "You shall not kill" (usually understood as "not kill unjustifiably").  Hence all life is cherished and must be continued—including even the lives of those who are not able to reverse a painful terminal illness caused by disease.  Such persons are sedated by narcotics that hopefully render them impervious to their worst suffering, while their lives continue slowly to dribble away.  Persons who are fully cognizant of their situation and who desire help from a physician in ending their lives before the terrible suffering of their inevitable end, may or may not be able to find the help they need.  I am assuming that the decision to end life by choice is to save themselves and their loved ones the indignity of the unnecessary suffering.  There are likely other reasons as well; for example, they fear the suffering.
            Public opinion is decidedly opposed to what many consider suicide, euthanasia, "mercy killing," or even murder. Southern Baptists, for example, devote one Sunday each year to study what they call "sanctity of life" issues (sanctity means holy or sacred).  For Catholics suicide, euthanasia, and murder (1 John 3:15) are "mortal" sins (the term is taken from 1 John 5:16-17), meaning it is a serious sin for which one is condemned to hell if the sin is not forgiven.
            Christian tradition uniformly condemns suicide, although neither the Hebrew Bible nor the New Testament prohibits it and throughout antiquity suicide was "accepted, admired, and even sought after" (A. J. Droge, "Suicide," Anchor Bible Dictionary, 6.225).  The Hebrew Bible does narrate several accounts of suicide, and those committing suicide are neither criticized nor commended by the biblical writers (Judges 9:54; 16:29-30; 1 Samuel 31:4-5; 2 Samuel 17:23; 1 Kings 16:18).
            Currently physician-assisted suicide is legal in four states (California, Oregon, Vermont, and Washington); one state has legalized physician-assisted suicide by a court ruling (Montana); forty-one states prohibit it, and in four states the situation is unclear. (http://euthanasia.procon.org/view.resource.php?resourceID=000132)
            My personal view of this situation is that being conscious even with pain, is better than being insentient; or put another way, life lived with physical difficulties and pain is better than a death that instantly banishes all pain—for as long as there is life there is hope!  But I must also admit that I have been at the bedside of those who were suffering a lingering untimely death (specifically my sister and my mother, as well as others).  It seems to me that being at the extremity of life and being fully conscious of the inevitable fact that my own life is dribbling away in suffering is a very different thing than living with difficulty and pain.  Hence I cannot fault those who might choose a quick death over a painful lingering death.
            What is the state's interest in prohibiting, rather than regulating, physician-assisted suicide?  Should the state even be involved in enacting laws that prohibit people from ending life with dignity (as they might see it), and forcing them to choose between either unconscionable suffering or spending their last days in a drug induced virtual coma?
Opinions vary and are hotly debated.  How do you see it?
Charles W. Hedrick
Professor Emeritus
Missouri State University


Kay said...

I agree - and am happy to hear that you are of the same opinion - that a life lived with pain is better than no life at all. However, I do still feel that it is each person's individual right to choose if they do not want to suffer the indignities of a lingering and painful death. I do think it should be regulated to the extent to prevent loopholes or abuse, but I also feel people should be able to choose that route if that is what they think is best for their situation.

Anonymous said...

Charlie, thanks for bringing this important matter to the forefront. Personally, I am a fierce advocate for keeping the government out of personal and family life decisions, whether its who I can love, which sex I identify with, abortion, whether I can take my own life or get help doing it, and so forth.

Despite whatever laws exist, physician assisted suicide occurs in many ways, one of which would be a hospice program, with family approval, providing the patient with increasingly strong pain medication (for example) until the body succumbs, or simply with-holding life support interventions. Perhaps even removing a feeding tube, or other artificial life sustainer in the hospital, with the family's support, has been done.

Diane Rehm's book, On My Own, recently published (Feb. 2016) is the story of finding her way after her husband's self-chosen death. Mrs. Rehm has been a public-service award winning talk-show host for National Public Radio for many years, and will retire at the end of this year. (Reviews are found at Amazon.)

I've heard Mrs. Rehm interviewed on this matter. Her husband John, suffering from Parkinson's, begged to be helped to die, but without cooperation from the medical care givers events culminated in his taking matters into his own hands, simply refusing to take water, food, and medication for the final two weeks. Mrs. Rehm sees herself as an advocate for her husband's right to make that decision, but she hasn't as yet committed to endorsement of any right to death movement.

Gene Stecher
Chambersburg, Pa.

Anonymous said...

Pain is no fun. I disagree that living with intense pain is better than the nothingness of death, which I equate to the times I have lost consciousness. That's from experience But, I keep on going despite severe pain because I enjoy my interests and curiosity – I really enjoy learning – and because a few people need me. Suicide is selfish. Not an option because I have seen the effects on the living.

I do have a living will and “do not resuscitate” instructions for those around me. I don’t think the state has any interest in prohibiting or regulating physician-assisted suicide. I had to pay several hundred dollars just to get a say in the matter! (And in my state, the living will has too many restrictions to suit me.)

Dennis Dean Carpenter
Dahlonega, Ga.

Elizabeth said...

I'm very familiar with the "Sanctity of Life" stance of many denominations, including Baptists... I also hear the term "Pro-Life" thrown around quite a bit. My question is what do they mean by "life?" All life? What kind of life? Human life? Born or unborn? Both?

You specifically mentioned what these groups are against: suicide, murder, euthanasia, abortion, etc. Since I've never been to a Sanctity of Life sermon, I have a few questions. (If you can't answer them all, no big deal):
1) Are they for or against the death penalty and why? 2) Is only human life sacred? What makes human life more sacred than any other life form and why? 3) Is only unborn life sacred? If so, where are the church-sponsored rallies to support already-born babies birthed by drug addicted parents? I've never seen one of those parades in Washington DC. 4) Where are the scriptures stating exactly when a human life becomes human? How do we know when it becomes a person and not a clump of tissue cells? 5) Do you find the subject of your blog to be a moral issue or an ethical one?

"Sanctity of Life" is a very commonly used term and is thrown around by many well-intentioned clergy and laymen. I don't always know what they specifically mean when they use it, so I usually try to clarify their definitions. Thanks as always Charlie! Elizabeth

PS: Gene, I couldn't find that survey you referenced at Pew Research- but I certainly found some other interesting ones! Thanks again.

Charles Hedrick said...

Good Morning Elizabeth,
I cannot answer your questions, which I take to be motivated by frustration with the imprecision of thinking in right-to-life groups. I simply do not know the data and the questions are overly broad.
I have already commented on question #4 several years ago. Go the blog archive near the bottom of the right hand side of the page. On October 20, 2008 I posted an essay entitled "(Mis)using the Bible in Anti-Abortionist Arguments." See if that essay addresses your question to some extent. Be sure and read the comments to the blog. They are very interesting.
And I will be happy to answer your question 5 if you will explain the difference between a moral issue and an ethical issue as you see it.

Elizabeth said...

Good morning Charlie!
My understanding is that morals are individual beliefs about right and wrong and are determined by religious traditions/writings. Ethics are socially acceptable practices determined by groups in professions, education, business, etc.

If your morals are derived from religious beliefs and the Bible is your code, sometimes the issue at hand is not clearly found in the bible. Is there another book of moral teachings other than the bible that is widely referenced? When the bible is silent, most try to make an ethical decision based on society's standards with regard to medicine. Arriving at such a decision is a deeply personal and private process. Elizabeth

Charles Hedrick said...

A beautiful day today--if a bit on the cool side. Good Morning Elizabeth.
In general I do not see much difference between morals and ethics, since they both deal with actions judged either acceptable or unacceptable in community or personally. But in either case I was asking a political question: what is the state's interest in prohibiting rather than regulating physician-assisted suicide? But if you pushed me, I would likely say that it is unacceptable behavior to force a person who is dying to choose between unconscionable pain on the one hand and spending their last days/hours in an insentient state in order to satisfy public opinion, on the other. And now we are talking about ethical behavior or morality.
There are other "Scriptures" or collections of holy writ and/or ethical behavior--for example in Chinese culture, the Tao Te Ching. But I don't know of another collection in the West that is as influential as the Bible. In antiquity Homer's Illiad and Odyssey were read for religious insight. Each world religion has a collection of literature to provide insight and guidance. See John B. Noss, Man's Religions (New York: Macmillan, 1967 [8th printing]). There are likely later editions.


Elizabeth said...

It's very cool here too, Charlie, but at least the sun is out for now. Out of curiosity- do you believe someone can just die when they choose? Some people say we have much more control over that than we are led to believe. Maybe there isn't only a choice between physical suffering or insentience... Perhaps there are other options that we can choose for ourselves. I've heard of many examples of people just knowing it's there time to go and they lay down and just- go. My great-great grandfather is an example. Queen Elizabeth I is another. My friend volunteered for hospice for 10 years and can name numerous examples of people choosing to depart this life before being sedated with morphine. Politically- it would be very bad "optics" for the state to allow any type of euthanasia. Conspiracy theorists would have a field day and would gin up all kinds of outrage and politicians would not want to deal with that. Elizabeth

Charles Hedrick said...

Good Morning Elizabeth,
The short answer is I do not know, and have no "belief" about it. I would need more than anecdotal evidence about what it is possible for the mind to do to the body in order to form an opinion the issue. However that said: it is well known that there are such things as psychosomatic illnesses (and healings)--the mind either induces or makes illness worse, or causes physically ill persons to improve. Whether the mind's ability can extend to shutting down all the bodily functions, I do not know. Perhaps another reader can point us to such a study.