FIVE MEDICAL METHODS OF MANAGING DYING

by James Leonard Park


    If we will die under medical care,
our deaths will be managed
using some combination of the following
six medical methods of managing dying.

    If our deaths are not thoughtfully managed,
we might be 'treated-to-death'.
Perhaps 20% of deaths under medical care
occur while maximum medical treatments
are still being applied.
Dying in the intensive care unit (ICU)
would be the most obvious example
of being 'treated-to-death'.
The doctors and nurses do not give up
until we die despite their best efforts. 

    However, if we die from chronic illnesses,
our doctors will recommend some combination
of these medical methods of managing dying:
(1) increasing pain-medication,
(2) beginning terminal sedation,
(3) ending curative treatments and withdrawing life-supports,
(4) giving up food and water, &
(5) receiving gentle poison.

    Using gentle poison is a medical option
only in some locations at present,
but new right-to-die laws in many states and countries
have extended this quickest method of dying
to more locations where modern medicine is practiced.

(1) Increasing pain-medication
includes using drugs to control any suffering
we might be experiencing at the end of our lives. 
The specific medical problems
that are bringing our lives to an end
will shape which drugs should be used.
And our doctors are authorized
to increase these drugs already in use
to whatever level provides the relief we desire.

    When we are clearly dying,
there is no further reason to worry about
'drug addiction' or 'drug dependence'.
And usually we will not worry about the possibility
that these terminal-care drugs themselves
might shorten the process of dying.

(2) Beginning terminal sedation
is a step beyond increasing pain-relieving drugs.
If our suffering is so intense
that it cannot be controlled by any pain-meds,
then our doctors might manage our dying
by recommending that we be
kept unconscious
for the rest of the process of dying.

     We should say our good-byes
before terminal sedation begins,
because we will never again
have any interaction with other people.
Terminal sedation will guarantee
that we will 'die in our sleep'.
The drugs used to keep us permanently asleep
might be adjusted from time to time
if ever there is any sign of suffering.

    Terminal sedation as a medical method of managing dying
might also shorten the process of dying,
but in most cases, this is not a problem.
Everyone knows that death is coming.
And this method assures everyone
that the dying patient will never suffer anything.

    (3) Ending curative treatments
means giving up all of the medical methods
that have already been tried to save us from death.
Medical science has already done its best.
And our doctors explain that these methods
could not save us from death.

    There will be no more surgeries,
no more chemotherapy,
no more drugs to fight off the disease.

    When curative treatments are ended,
we might be moved to a different medical setting,
perhaps into some sort of hospice care.
Supportive and comfort-care replace
all of the acute medical treatments
that have now failed to save us from death.

    (3) Disconnecting life-supports
will probably also take place
whenever curative treatments are ended.
All of the 'tubes and machines'
that were being used to keep us alive
can now be switched off and disconnected.

    This medical method of managing our dying
will also include deciding not to use
some forms of life-supports that might have been tried.
For example, if we are dying from lung cancer,
what is the point of using a respirator at the end?
Such ways of helping us to breathe
will ease the distress of not getting enough oxygen,
but no breathing-assistance will cure the cancer.

    When disconnecting (or declining) life-supports
our doctors can recommend
methods of reducing the likely distress.
And they can tell us how long we can expect to live
without the mechanical assistance.

    (4) Giving up food and water
is usually also recommended
when all other forms of life-support are being abandoned.
When nutrition and hydration were being provided by tubes,
this medical method of managing dying
will be noted as part of disconnecting life-supports.

    Perhaps we have already given up eating and drinking
because we are dying from a medical problem
that prevents us from benefiting from more food and water.

    Or our doctors might recommend giving up food and water
if and when such measures provide no further benefit.
And when all fluids are abandoned,
the duration of natural dying can be predicted
to be just a few days,
depending on how much water we have stored in our bodies.

    Even if we are not actively dying from one specific disease,
we might still decide that our meaningful lives are over
and that this method of managing our dying process
would be better than continuing all supportive care
until we die from natural causes.

    (5)
Receiving gentle poison
will make the process of dying even shorter. 
This medical method of managing dying
has only been authorized in a few places in the world.
But if the other medical methods of managing dying
have been found unsatisfactory for any reasons,
then the doctors can recommend a gentle poison
that will bring a quick and painless death.

    In the Netherlands, this medical method of choosing death
usually takes the form of a lethal injection given by the doctor.
But Dutch doctors can also prescribe death pills,
which are taken by the patient himself or herself.


    In choosing any of these
medical methods of managing dying,
the most careful safeguards
should be fulfilled for each decision.
We know that any of these methods
(or any combination of them)
will inevitably lead to our deaths.

    Thus before we select the best methods of dying,
we should settle any uncertainty about the wisdom
of
dying at this time rather than dying at some later time.

    Is our medical condition clearly terminal?
Have we exhausted all possible medical care?
Are we as ready for death to come?
Are others at the bedside ready for us to die?

    If and when we are ready to die,
we can end the medical battle to save us from death
and surrender to the inevitable.
What combination of these
six medical methods of managing dying
would be best for us
and for the people around us as we die?



Created January 20, 2016; Revised 1-21-2016; 2-9-2016; 5-1-2016; 5-5-2016; 



    This opinion article includes the following links
to detailed explanations of each
medical method of managing dying (MMMD).
Here they are again:

INCREASING PAIN-MEDICATION:
EASING THE PASSAGE INTO DEATH
http://www.tc.umn.edu/~parkx032/SG-INCRE.html


TERMINAL SEDATION:
DYING IN YOUR SLEEPGUARANTEED
http://www.tc.umn.edu/~parkx032/CY-TERMS.html


PULLING THE PLUG:
A PARADIGM FOR LIFE-ENDING DECISIONS

http://www.tc.umn.edu/~parkx032/CY-PLUG.html


VDD:

WHY GIVING UP WATER IS BETTER THAN

OTHER MEANS OF VOLUNTARY DEATH

http://www.tc.umn.edu/~parkx032/CY-VD-H2.html



VOLUNTARY DEATH BY DEHYDRATION:
SAFEGUARDS TO MAKE SURE IT IS A WISE CHOICE
http://www.tc.umn.edu/~parx032/VDD-SG.html


Gentle Poison:
The Demand for Quick Death
  http://www.tc.umn.edu/~parkx032/SG-GEN-P.html


    These Medical Methods of Managing Dying (MMMD)
are also discussed in the context of a hospice service
that embraces all legal, doctor-approved methods of dying:


Methods of Managing Dying
in a Right-to-Die Hospice

http://www.tc.umn.edu/~parkx032/METHODS.html


    The safeguards for making end-of-life medical decisions
were merely mentioned at the end of this article.
But here is a book of over 500 pages that
explores each of 26 safeguards for life-ending decisions:

How to Die:
Safeguards for Life-Ending Decisions
http://www.tc.umn.edu/~parkx032/HTD.html


Historical note about the numbers:
Originally this essay was called "Six Medical Methods of Managing Dying".
What is now number 3:

ending curative treatments and withdrawing life-supports
was originally listed as two separate methods.
But it is more common in medical ethics
to list these methods together, under such expressions as:
"ending life-sustaining medical treatments".
Thus, even tho these methods get separate paragraphs above,
they are numbered as one medical method of managing dying.
Here is the chapter that explores this end-of-life option:
http://www.tc.umn.edu/~parkx032/CY-PLUG.html




DEATH-CERTIFICATES SHOULD INCLUDE METHODS OF DYING

As modern medical care acknowledges more clearly than ever before
that we are using these medical methods of managing dying,
certificates of death might be expanded
to include a new line for
life-ending decisions or
medical methods of managing dying:
http://www.tc.umn.edu/~parkx032/DC-LED.html



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