Health
The euthanasia debate
Image: The Dying Gaul, Wikipedia, here
I would like to make a contribution to the ongoing euthanasia debate by relating some of my experiences as a physician of more than 40 years.
The proposals to introduce euthanasia legislation flies in the face of the historical evidence supporting this system. Why have so few countries implemented euthanasia laws after extensive debate?
In essence it is a wrong health care model.
More importantly to implement such legislation means propping up a health care system which is failing and thus contributes to “correcting the defects in health care delivery”.
There have been no significant improvements in improving patient outcomes particularly at the ‘end of life’ in health care around the world.
It is an attempt to provide a balanced “patients” perspectives on dying “when we listen to them”. Also my core ethics on the topic were drawn from the readings of Dr Viktor Frankl who wrote “Man’s Search For meaning” in a German concentration camp during which his wife was gassed 6 weeks after their internment.
Here is Dr Hannan’s Introduction to the article:
Dr Viktor Frankl, the creator of the theory of logotherapy, formulated his concepts of this orientation to psychological therapeutic techniques while interned in the concentration camps during the Holocaust.
The title of his chapters in the book, The Doctor and the Soul, such as ‘The Meaning of Life’, ‘The Meaning of Death’, ‘The Meaning of love’ and ‘The Meaning of Work’, provide a deep analysis and explanation how we as human beings can have ‘meaning’ in our lives regardless of the phase of that existence or its circumstances.
During his internment under atrocious conditions Frankl was able to add ‘meaning’ to his existence. In his text Man’s Search for Meaning he stated, ‘Ultimately, man should not ask what the meaning of his life is, but rather must recognize that it is he who is asked. In a word, each man is questioned by life; and he can only answer to life by answering for his own life; to life he can only respond by being responsible’.
One of the memorable stories in Frankl’s book is that of a young person lying in bed with a permanent paralysis who was able to find meaning through the seasonal visualization of a single branch of a tree and its flowering and death over time.
The following text is dedicated to some of those wonderful people who have journeyed through my life as a Palliative Care physician over a 12-year time frame and who chose to share with their carers rich perceptions of their lives in the known finiteness of their existence.
They have given us reasons for continuing to maintain our role as carers in the hospices and homes of this world. They give great credence to the words provided by Oliver Sachs, ‘it is not what disease the patient has, but what patient has the disease’.
Here is one story, Gloria’s, as told by Dr Hannan:
Gloria was in many ways more unusual than other patients because she expressed feelings relating to dying that I had not seen in 11 years as a Palliative Care physician. She had an uncommon tumour that involved the lower part of her biliary tree (the bile drainage tubes from the liver). This caused her jaundice and loss of appetite and intense nausea that was greater than the pain from her liver. When I first met her she made me aware that she had known me as a colleague’s secretary some 20 years previously and thus expressed a confidence in me as a physician. In my 11 years as a physician involving care of the dying, I had not had a patient in whom the person’s pain could not be relieved or controlled so that their life was comfortable. My clinical assessment revealed no obvious cause for her persistent, distressing nausea and pain. Investigations of her bowel confirmed this.
Her recurring statement was ‘I am afraid of dying.’ Over the previous 11 years I had been unable to recall a patient saying this.
Having been given permission from Gloria to sit on her bed and talk, I learned from her the tragedy of her 69 years of ‘pain’.
Her story is filled with conflict and guilt. She was a child with five other siblings. She had two brothers and three sisters. Her father was a miner who had suffered an injury at work. Gloria stated that her life at home was horrible and full of tension. Her mother and father were always in conflict. At one stage she said she loved her father but was frightened of him. She said her parents had a sexual problem. She did not know what it was. It did not trouble her, she said. Did your father abuse you? No, was the response. What was your father like? He used to get into bed with me every night and tell me he loved me and would snuggle into my back. ‘What about your sisters?’ I don’t know she replied.
‘Please don’t tell my husband’, she pleaded.
‘No, your confidence in us is complete and sacrosanct.’ What of your children, I inquired?
‘I have two and they are grown up, my daughter lives not too far away and my son lives interstate.’
‘Are you close to them?’
‘I built my life on making them dependent upon me and when my son left to travel in Europe I was lost as I had no one and my daughter had married. Her first marriage was a disaster as she found out her husband was homosexual and her second marriage also failed.’
‘I have not spoken to anyone about this before.’ (At this time she now had stopped vomiting and her nausea was less.) Gloria stated she had held these emotions for 69 years and it was so hard to let go.
‘So why are you afraid of dying?’
‘Because, he (my father) is waiting for me. (Marked nausea and vomiting) I want to die yet I can’t let go.’
As the subsequent days passed she was reunited with her children. (Her daughter was now aware via her mother of some of her childhood experiences.) Within three days of the first encounter in the hospital she went home to be at peace with her family. She died at home without pain and nausea three weeks later.
Download End of life stories that give meaning to the individual’s existence:
Dr Terry J. Hannan MBBS;FRACP;FACHI;FACMI
Consultant Physician
Clinical Associate Professor School of Human Health Sciences, University of Tasmania
Department of Medicine, Launceston General Hospital
Associate Professor Terry Hannan; a bio:
• Web-based commentator on e-health in Australia and Internationally as the Informatics Insider at www.austemrs.com.au
• 1984-1992- Medical Director of the transfer of the Johns Hopkins Oncology Clinical Information System from Johns Hopkins to an Australian tertiary hospital (POWH/PHH). One of the first successful international translocations of a complex EHR/EMR system.
• 2000-2006-Co-Founder of the Mosoriot Medical Record System an Electronic Medical Record (EMR) project in Kenya that preceded the AMPATH and OpenMRS e-record systems. OpenMRS is currently the largest open-source web based EMR for developing nations. Main focus has been on end-user acceptability of eHealth technologies.
• Multiple peer-reviewed publications on Health Informatics.
• 2012-Moderator for Health IT in GHDonline (www.ghdonline.org )