As we listen to the debate about Medically Assisted Dying, and hear the appeal for Physician Assisted Dying, let’s step back a few years and learn from what once was.
What would the picture look like if we allowed people to die when their bodies were dying, if we did not prevent death, and if we do not push medical extremes to the extremes?
Dying is a natural experience. We have become so good at preventing death that we have forgotten to allow dying to occur when a person stands on deaths doorstep and the door opens.
Years ago an older friend was dying. She lay in ICU after a heart attack and following resuscitation. She struggled to breathe. She struggled to talk. She was able to request no further attempts at CPR. I am not sure if she was aware that within the ICU there was a buffet of possible interventions. Knowing how unhappy she was living with very compromised respiratory function prior to her heart attack, I did not want her to have to live life even more compromised without offering her that decision. I wanted so badly to advocate for excellent symptom management to settle her breathing struggle. I wanted her to know that she had the option to die naturally and comfortably. I wanted her to know that if she stabilized and survived this episode that it might be months or years of rehab followed by a very possible reduction in functioning, before she would have another oppotunity to die naturally. I wanted to say to the health care professionals “DON’T BLOCK HER EXIT“.
More recently I talked with an older family member to help him identify his goals of care, and help his children understand the type of care and interventions he wanted. I participated in a brainstorm session, and provided some phrases and ideas that I hoped would help him clarify his preferences of what acute interventions he might like if his condition declined and he was unable to voice his opinion. I used the same phrase “Dont’ block the exit”. He really liked that phrase. He has quoted it dozens of times in the past months. “Don’t block my exit!”
Yesterday a colleague and I discussed our Advance Care Plans. She said “If I have a stroke, and am unable to eat, I would like to be allowed to die. I do not want rehabilitation, I do not want a feeding tube.” “Don’t block my exit.”
After my mother was diagnosed with a terminal cancer she said, “I am glad that they can not offer me any surgery! I am 81 years old. I have had a good life. There are not enough public funds to use scarce resources to extend my life by a few weeks, months or years. I have had my turn”. She was glad that there was no attempt to “block the exit!”
I remember a man in his late 70s. His wife had recently died. He said he would be happy to follow her in death. He fell, had a brain hemorage, called 911, was admitted to hospital and had brain surgery before his family was even aware of his admission. He was in the ICU for several weeks. Technology, medications, feeding tubes all helped to prolong his life.
His children gathered, requested that life supports and any measures preventing death, be removed. However his surgeon felt that because he had called 911 he had requested and given permission for acute measures to be followed. It was more dificult to stop the acute interventions than it was to start them.
This man stabilized, was discharged from hospital to long term care. Interesting, the health care team and the system that prolonged his life are not there to visit him and provide the intensive loving care that they initially provided that stabilized him and extended his life. It may be many months or even years before another “EXIT” occurs.
My question: If we were allow death to occur naturally, (with the support of hospice palliative comfort measures) would we have the same need to hasten death at a later time?
It is crazy making to block the exit when death presents itself, and when a person is willing or wanting to die, only to need to legalize and hasten death at a later time.
It is time to education the public and health care proferssionals: