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Physiology and Health
Bioethics, palliative care, euthanasia
"Terminal Sedation" Is Not Death With Dignity
By Dr. W. Gifford Jones
January 26, 2003
How much will you endure when you're dying? Many patients say, "I want enough painkiller to prevent all pain." Others add "When there's no further hope of survival give me sufficient medication to end my misery". Recently the University of Toronto Joint Centre For Bioethics issued new guidelines for doctors who treat pain. But how much pain will they stop?
The new guidelines were developed by physicians, intensive care program directors, and coroners.
The guidelines state that there is no limit to the amount of painkiller that can be given to relieve pain. In fact, they say that doctors should not hesitate to increase the dose of painkillers even if it hastens death.
Another section of this outline states that patients may be rendered unconscious if this is the only way to ease pain. Moreover, they may be kept in this state for as long as it takes for a fatal illness to kill them. This is known as "terminal sedation" and the bioethics committee suggests this is the difference between palliative care and euthanasia.
But what sense does it make to keep loved ones in coma for days, weeks or even years with tubes coming out of every orifice in their bodies before they die? If this is dying with dignity I want none of it. And what about the family who have to witness this day after day?
Moreover, how can doctors draw a clear line between palliative care and euthanasia when they can prescribe painkillers that hasten death? Or keep patients in a vegetative state until they die. Surely this is just playing with words. It's better described as slow euthanasia.
What the committee proposes would be difficult enough to follow in a well staffed, specialized, palliative care center. But there are few of these centres in Canada. In the real world, the luck of the Irish is needed to obtain good pain control.
And I doubt these guidelines will resolve the fears of doctors. Many fear that hospital staff will complain they've given too much narcotic and are practicing euthanasia. The recent picture of one dedicated doctor being taken to jail in handcuffs for this reason is hard to erase.
Patients suffer needlessly because some professional people continually fight euthanasia. Margaret Sommerville, a law professor and a director of the McGill Centre for Medicine Law and Ethics, continues to oppose euthanasia.
In her recent book, "Death Talk", she asks us to think of "secular trust", whatever that means. She also adds that we should "sing the song of life, the lyrics of love". But she fails to inform us how these lyrics will stop the agony of terminal cancer.
Sommerville, like so many others, uses phrases that mean nothing and believe they have a moral right to tell us how to die. In their infinite wisdom they know something that eludes the rest of us.
In 1998 the Gifford-Jones Foundation gave half a million dollars to establish a Professorship in Pain Control and Palliative Care at the University of Toronto. These funds came from readers of this column and were intended to help people die free of pain.
If I had another half million I'd go the next step and establish a Society For The Prevention of Cruelty to Humans. This organization would fight for the right to end life when there is no hope of recovery.
Patient Assisted Death is now legal in Holland, Belgium and the state of Oregon. Patients requesting such help have to be of sound mind and facing a future of unbearable suffering. The doctor must be convinced that there is no other solution and he must seek a second opinion. What do you think?
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at letters@canadafreepress.com
