This is Part III of “What is suffering and what can we do to relieve it?”
To recap again: suffering is distress with no end in sight; and the goal of medicine has always been to prevent and relieve suffering. Below are three more options to consider as the end of life [EOL] approaches.
Facing a terminal illness, families need to understand the Principle of Double Effect: when the goal is to relieve suffering (it’s not to cause death), but our treatment to relieve that suffering unintentionally results in death, it remains a morally, ethically, and legally acceptable action.
Option 4: Palliative sedation. This should be available in every Palliative Care [PC] and hospice program. If the only way a person can be comfortable is to be asleep, then it is acceptable to induce a state of sleep with drugs, which can be maintained until they die [usually within four to 10 days].
Option 5: If your grandfather is suffering and can’t bear the thought of being a burden to anyone, or of losing his independence or dignity, or of losing control of his life, he could choose VSED – Voluntary Stopping Eating and Drinking. Everyone has the right to refuse any care, including nutrition, so it is ethically acceptable because he remains in control and decides what will happen: by choosing to not drink fluids or eat anything, he will become dehydrated and die within 10 days – people don’t starve to death. Starvation can be uncomfortable, whereas dehydration’s only issue is a dry mouth, which can be treated with moist sponges.
Option 6: Physician Assisted Death [PAD]. This needs mentioning because it has just been in the news: a young woman with brain cancer moved to Oregon so she could qualify for their program and subsequently died Nov.1, 2014. Oregon was the first to offer PAD; it is now in another four states (Washington; Montana; Vermont; New Mexico). The documentary “Dying in Oregon” describes the program: who participates, why, and how many actually take the lethal drug dose (only about half do), etc. After meeting criteria, patients obtain a prescription [usually a barbiturate] to be taken at a time of their choosing. The film is well worth watching.
Patients and families should know that Hospice of the Shoals does not promote PAD; we have these other options—particularly palliative sedation, which is chosen by many families—to prevent suffering and allow death with dignity.