Sunday, February 3, 2013

Suicide Docs

From the Economist in October 2012 was an article on physician assisted suicide.  In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state.  Several safeguards are in place to prevent this from becoming the default death pathway (only 0.2% of total Oregonian deaths).  Also, I had no idea that Holland, Switzerland, and Belgium allow assisted suicide even in non-terminally ill citizens.  So you can be suffering from, say, severe acne vulgaris, in the Netherlands and be within your rights to seek immediate death from a certified death-administering professional.  Revelatory, indeed.  And heartwarming to read about on a Sunday. 

My main interest is in the doctors who are contracted to carry out these ghoulish deeds.  By physician assisted, I think what everyone has in mind is some sort of benign, humane, minimally invasive practitioner of life sapping.  You lie on a table.  Calming eastern mystic yoga music plays softly in the background.  The room smells of lilac and aloe.  A soothing voice whispers in your ear, "it's going to be alright, peace and love await you".  And then a white robed man with a Francis of Assisian face of compassion slowly injects painless sedatives until you pass out and then the final killing agent is administered while you are in a state of blanked nothingness. 

In general, this would be a job right up the ally of a motivated, profit-oriented anesthesiologist who has become disillusioned with clinical practice.  Pumping people full of mind altering, physiology warping drugs is what they do for a living.

But I was wondering how other professions could break into the market.  A general surgeon would not seem to be such a natural fit.  At least not when it comes to death by drug.  A general surgeon looking to make a few bucks on weekends killing people would have to offer a menu of alternatives along the following lines:
  • The Big Red---Thoracotomy performed after induction of general anesthesia.  Aorta identified and sliced transversely.  Included in offer are free disposal of exsanguinated blood and chest closure
  • The Double Tap--- Bilateral neck incisions made (either under local or general anesthesia, depending on patient financial situation), both carotid arteries dissected out and tied off.  Included is immediate EEG and consult from certified neurologist to confirm brain death
  • The Gateway----- Portal vein opened up after transecting the bile duct and hepatic artery.  Blood can either be suctioned off field or left inside abdomen.  
  • The Strangler----- Incision made as for tracheostomy.  Instead of tracheostomy, surgeon occludes trachea with fingers until death ensues.  Wound closed with absorbable suture in skin lines; lovely cosmetic result guaranteed for open casket viewing.
All kidding aside, I am not one to make judgements on a man's decision to end his own life.  It seems like a ghastly option but I've never been in a situation where I was suffering horribly with months to live.  On the other hand, the idea that a physician would participate in the hastening of death strikes me as intellectually incoherent.  Whoever it is that would devote himself to such a career is not, nor could ever be, called a doctor.  Those, like Kevorkian, who perform these procedures are not doctors.  They have chosen to become something else.  Arguments about the morality of what they do can certainly be fostered.  But they are not doctors anymore.  Not if the word is to have any clear, common sense meaning in the English language.


Paracelsus said...

"In general, this would be a job right up the ally of a motivated, profit-oriented anesthesiologist who has become disillusioned with clinical practice. Pumping people full of mind altering, physiology warping drugs is what they do for a living."


Kidding aside, I agree. Leaving alone the moral debate for now, I have to agree that death deliverers can no longer be called doctors. "Death doctor" is a blatant oxymoron. Not to mention a technician of some sort would suffice. Although the proceedings may go so terribly wrong with a tech, that the result would completely lack the very much sought-after dignity. Which would, in turn, require a doctor to fix.

Bianca Castafiore? said...

from where i lay, because it hurts too much to sit for longer than a few minutes, and standing has been out of the question for a decade, you guys are, besides being hysterically cutesy and coy, making only one cogent argument. you don't want to be associated with "them" (the other/autrui/those people) by sharing what you consider the homogeneous professional title of "doctor."

well, fine. call them something else, assume them to be radically and incomprehensibly different from yourselves, and sent one -- post haste -- to my house.

the only thing worse that my mind can conjure, and i recognize the limitations of my mind, than "suffering horribly with months to live," is suffering horribly for many years with many worse years to come.

Anonymous said...

That acne vulgaris example is really a far stretch. In the Netherlands the criterion used is hopeless and unbearable suffering (as judged by the physician). In practice this means that it is limited to those suffering from serious medical conditions and in considerable pain. By far the most common condition in those patients is cancer. Given the circumstances it may in many cases be the most humane thing you can do to help the patient.

In addition there are no "death doctors". Usually it involves the own family physician if at home, or one of the treating physicians when in the hospital (they may refer to other doctors if they feel they cannot do it). Many physicians, including almost all family physicians, will come across such cases across their career.

Attorney Andy said...

I heard about this story recently out of Belgium. Identical twins opted for physician-assisted suicide when they were told they were going blind because the thought of not seeing each other was too much to bear. I don't know if that story is tragic, weird, or heartwarming. They likely would have committed suicide anyway, so it seems reasonable to allow them to do so in a humane fashion.

Anonymous said...

At any time that I am done with being on this earth, I certainly don't intend on getting "approval" to leave it. LOL. That, is absolutely ridiculous.


Bianca Castafiore? said...

okay, bianca/profderien, is back! i can hear the groans from here.

i regret taking out my pain on you the other day, with my first, oh-so-lucid comment. but as i don't wanna be lumped with the crazies, let me try again.

before that, though, WHY is your blog attracting so many "spam" commenters? (because i request that comments to this thread be forwarded, i see them before you get the chance to delete the suckers.) this is happening more and more, but your blog is such an unlikely target -- and definitely not profitable for the spammer. dang, more mysteries to ponder. suicide and spam.

okay, back to "suicide docs"! what broke through to me were not the majority of comments, nor even your post, reconsidered. it was SCRN: "At any time that I am done with being on this earth, I certainly don't intend on getting 'approval' to leave it. LOL. That, is absolutely ridiculous."

indeed, that comment captures much: the overwrought, overweighted opinion of physicians of themselves; the underwhelming sense of self-determination chez the suicideur (why not mock the suicidal, as the migraineurs and chronic paineurs are mocked?); and above all, yes, the ridiculous nature of the whole discussion when medical doctors sign up to administer lethal injections (in georgia, i just read, the state contracts with a cheery bunch o'healers known as "The Rainbow Group"), and leave murder instructions daily in charts in the form of increased doses of "palliative care."

there is much ionesco going on, in other words, and oh, how we love to be superior.

me, to you, in my (imagined) unimaginable pain.

you, to me, in (imagining) your profession so pure -- and all of us, in figuring a suicide based on medically-approved, rubber-stamped, death-worthy angst differs from the overdoses and murder-suicides of the many sam stones coming home from afghanistan, iraq, and whatever other outposts of unimaginable horror are out there.

not to belabor the factual side of things, but i believe the doctors in these foreign, far away, different countries most often do what such doctors do in the USA and write a script, as divorced from the mess as the pilot delivering a bomb.

or god delivering a miracle. whichever.

i can see i've failed again, haven't achieved any theatre of the absurd, clarified erroneous assumptions about which "death-pathways" warrant ridicule and shocked faces, and which don't.

think i'll just cling to SCRN's confidence: "At any time that I am done with being on this earth, I certainly don't intend on getting "approval" to leave it. LOL. That, is absolutely ridiculous."

Daniel F. Kane said...

One can never separate the moral debate, right of conscience and the motivations of the typical physician entering the field. Most enter to help or at least do no harm. Most seeming offer an oath to never offer poison or abortion.

Accordingly, the euthanasia docs like abortion docs will be marginalized by most of the profession because their actions are antithetical intellectually motivationally and ethically.

There is not a right to euthanasia, there is only a right to ask for euthanasia. There is never a right to compel anyone to do something they do not want to do, including physicians.

However, State compulsion is on the horizon because it is a privilege to practice medicine and it can be a condition of licensure to do this and other acts.

Anonymous said...

Doctors are currently necessary for two reasons:
1) To determine diagnosis and prognosis.
2) To provide legal access to life-ending drugs.

Once diagnosis and prognosis have been determined and corroborated, legal access to life-ending drugs could be provided through other means (court order?), such that further physician involvement would not be necessary.

Gloria Lesher said...

Dr. Parks,
What is your opinion on Voluntarily Stopping Eating and Drinking? (V.S.E.D.) Is it a reasonable alternative for someone who wishes to end their life due to intolerable suffering/extreme old age? Is it a reasonably "gentle" death?
-Gloria Lesher

Jeffrey Parks MD FACS said...

I think VSED is fine. Patient autonomy always trumps what a doctor thinks is best. Moreover, it does not require the active intervention of a doctor.