When thinkers and legislators try to imagine the
circumstances
that would lead them
to choose death for themselves
and/or for the people they love most deeply,
they sometimes use the expression "unbearable suffering".
This is a short, evocative term, easy to include in legislation.
But the facts behind this proposed safeguard are not
abstract and general.
Rather, "unbearable suffering" points to situations of persons
who have some disease or condition that causes great pain.
Furthermore, all medical attempts to relieve this physical suffering
have been insufficient and unsatisfactory to the patient.
Unbearable physical suffering is never the beginning
condition.
Rather, only after applying the very best in pain-relief
should any patient and/or group of proxies conclude
that the suffering of the patient has become unbearable.
Thus, this safeguard should be said to be fulfilled
only after a palliative
care trial.
Good pain-control can make the suffering manageable.
The patient and/or the proxies are able to agree
that some level of meaningful life is still possible
when the best methods of pain-relief are being used.
However, in some cases, especially if the disease or
condition is progressing,
even the best pain-relief proves to be unsatisfactory.
Perhaps the pain-medication is able to prevent most conscious suffering.
But the pain-and-medication cycle renders the patient so incapacitated
that the patient can do little else with his or her life
than wait for the next return of the pain when the medication wears
off.
And increasing levels of the same medication are often needed
in order to attain the same level of relief.
If the whole focus of the patient's life is more
pain
relief,
this might not be a sufficiently meaningful way of living
for the patient to want to continue in that pattern indefinitely.
Another option that might have been tried
is giving enough pain medication so that the patient is unconscious
most of the time.
And when consciousness does return for a few moments,
all the patient wants is more relief from the pain,
even if this means becoming unconscious once again.
If the patient must choose between existence with
pain
and unconsciousness without
pain,
this might be a sufficient reason to choose death
instead of continuing such an existence alternating between pain and
sleep.
Sometimes the unbearable suffering becomes so great
that the patient, the proxies, & the doctors agree
to keep the patient unconscious until death comes.
This is called "terminal sedation."
Terminal sedation is one form of life-ending decision
which is recognized as a legal option
wherever modern medicine is practiced.
Because physical suffering is largely subjective,
there can be no proof of pain provided by others.
But the relevant medical experts can testify
that such-and-such conditions usually are very painful.
And if the patient consistently says that he or she is in pain, the patient should be believed.
When unbearable suffering is a reason for choosing
death,
it will be mentioned and described in the patient's
requests for death.
When all relevant facts and opinions are weighed and
evaluated,
when a palliative care trial has been undertaken,
if the patient and/or the proxies conclude
that death at a chosen time
would be better than
continuing unbearable suffering resulting in death at some later time,
then this safeguard for choosing a wise death has been fulfilled.
Unbearable suffering sometimes makes chosen death a
better option.
HOW UNBEARABLE PAIN AFFIRMED BY THE PATIENT
DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
We know that some people do commit irrational suicide
as the result of untreated pain and suffering.
So all medical evaluations of the pain being suffered by the patient
should be aware of the possibility that the patient might turn to
suicide
if he or she does not get adequate pain-relief from the doctors.
But if after all reasonable methods of
treating the suffering
prove to be unsatisfactory to the patient,
then all concerned can be assured
that treating the pain has
been tried
and that it did not work
well enough
for the patient to decide to live with an acceptable amount of pain.
In short, the chosen death will not be premature
if all concerned have tried all the other appropriate methods
for dealing with the suffering.
If unbearable suffering is all this person will ever have
between now and natural death,
then reasonable and compassionate persons
can cooperate in a wise voluntary death
or a compassionate merciful death.
Such chosen deaths should never be called
"suicide" or premature deaths.
Created January 31,
2007; revised 3-15-2008; 3-26-2008