Patients and/or their proxies
who are seriously considering voluntary death
or merciful
death
need as much information as possible about the alternatives.
Choosing immediate death might not be the best pathway.
Pain
control is an option that would be appropriate
for almost any patient.
The doctors can explain the various means of controlling symptoms
that might be tried in this patient's case.
Sometimes uncontrolled pain is driving the patient to prefer an early
death.
In fact, the pain itself might be driving the patient toward an
irrational suicide.
Nursing
home care or some other assisted-living
situation
might be worth exploring if the patient knows
that he or she cannot continue to live at home
because that has become too difficult for other members of the
family
or because it is no longer possible to live alone.
Some specific nursing homes might be visited
to see if these might be good alternatives to choosing death now.
Bad nursing homes are
all too common.
But there are some good
nursing homes.
The patient and/or family should not make their life-ending decision
based on a false image of
what nursing-home care is.
Hospice
care is also a valid alternative to
immediate death.
The patient might not like the idea right away,
but some printed information about hospice philosophy and practice,
a visit with a representative of a hospice program
and/or a visit to a residential hospice
might offer some new perspectives on the hospice option.
Often patients are poorly informed about palliative
care at the end of life.
They might associate hospice-care too closely
with the hospital treatments they
are familiar with.
And they have decided that they want no more invasive medical
treatments.
But the comfort care
offered by a hospice program is not nearly as
burdensome
as the endless round of tests and procedures performed in the hospital.
When the patient understands all of the benefits of palliative care,
he or she might agree to give hospice-care an honest try.
(A trial
period of actually receiving palliative care is another
safeguard.)
HOW INFORMATION ABOUT PALLIATIVE CARE
AND OTHER ALTERNATIVES TO DEATH
CAN DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Persons who are feeling desperate because their
lives are ending
are sometimes tempted to commit irrational suicide
because they have incomplete or inaccurate ideas about the process of
dying.
If they can be calm enough to listen to
a presentation of the alternatives mentioned here,
they might decided that killing themselves immediately
is not the best pathway towards death after all.
Both patients and their proxies are sometimes
attempting to make their end-of-life decisions
overshadowed by a particularly terrible death they have all witnessed.
If they believe that this patient will have the same horrible death,
they might be tending toward what would really be a premature death.
However, the case of this particular patient
might be different enough from the terrible death they want to avoid
that none of the suffering they fear
need necessarily be a part of this patient's pathway towards death.
Definitely considering some good alternatives
to voluntary death or merciful death
can help some patients and their families
to choose a pathway towards death
that is definitely better than choosing immediate death.
Created March 1,
2007; revised 8-26-2008; 9-10-2008;