Each of us dies only once.
So it might not be enough to be counseled about the
benefits of
palliative care.
It might be necessary for us to put ourselves under the care
of a team of people who have helped many other people
in their last days of life.
Some systems of safeguards for life-ending decisions
require that a palliative
care specialist be consulted.
All doctors know something about taking care of the human body
when it is beginning to shut down.
But since most of medicine is devoted to curing diseases
and repairing physical
problems that have emerged,
only a few specialists have carefully considered
how best to take care of people who have no other wish
than to have a pain-free and peaceful death.
Palliative care can be offered in many different
settings,
such as nursing homes, hospitals, or hospices.
And depending on the specific problems at the end of the patient's life,
one of these might be more appropriate than the others.
Many people who oppose the right-to-die
say that adequate palliative care will end the desire for death.
And open-minded people of any persuasion
should be willing to give this claim a fair test
for each person who is drawing life to a close.
Perhaps a week in a hospice or other care setting
where 24-hour-a-day palliative care is being given
would be a fair test to see if this particular patient
wants to continue to receive this kind of comfort-care
or still wants to exercise his or her right-to-die.
A palliative care trial is an experiment
not a mandatory alternative to the right-to-die.
If palliative care does not
work satisfactorily for this patient,
that patient and/or his or her proxies
still have the right to choose a voluntary death or a merciful death.
A few days of good palliative care
will empower them all to make wiser end-of-life choices.
They can all carefully consider when and how
would be the ideal way for this patient to meet death.
When a meaningful period of palliative care has
actually been tried,
then there will be a paper-trail showing
just what kinds of medical care were used in this case.
Such medical records should not be made public.
But the fact of a palliative care trial can be used as good evidence
that all alternatives to immediate death were explored.
HOW A TRIAL OF PALLIATIVE CARE
COULD DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Sometimes physical or psychological suffering
is the main push toward irrational suicide.
When all forms of suffering are treated by the best comfort-care
specialists,
this should go a long way toward discouraging
formerly-frantic patients from asking for death before it is absolutely
necessary.
Likewise, the proxies who were thinking
that voluntary death or merciful death would be the best answer
might discover that many of the physical and psychological problems
that were leading them to choose death
have been adequately dealt with by the comfort-care now being used.
Sometimes the patient and/or the proxies
have an imperfect grasp of the disease or condition
that is leading them to consider a voluntary death or a merciful death.
So when they put the patient into a palliative care trial,
this will be another opportunity to discover the real medical condition.
For example, if the pain they thought was caused in an incurable cancer
actually has some other cause, which can be treated,
then they can avoid the mistake of choosing death too soon for this
patient.
Or if the trauma of terminal illness was leading to
a premature death,
the breathing-space provided by good palliative care
can allow all concerned to reconsider any decision for death.
Emotional as well as physical problems should be addressed.
And when everyone involved feels better about the approaching death,
they can make wiser decisions.
If the patient can be made comfortable
even tho death is not going to be avoided this time,
the last days can be meaningful for all involved.
And thus the palliative care did actually avoid a premature death.
Dying before it was absolutely necessary
can be avoided if the patient is taken care of physically and
emotionally.
And if all palliative-care measures do not bring
sufficient relief,
then all concerned can follow the other pathway towards death
that they have been keeping in waiting
just in case the palliative care did not prove satisfactory.
If the advocates of palliative care as an
alternative to choosing death
prove to be correct in this case,
then the patient and his or her family will be thankful
for the additional days—
or
even just hours—
that
palliative care
provides.
created February 1,
2007; revised 3-15-2008; 4-10-2008