“First do no harm.” That is part of the oath that all physicians take as we graduate medical school. I graduated in 1995, and I went off to Oregon to start my residency. Oregon had just passed a death with dignity law. As a result, my residency placed a large emphasis on making sure the end of life was treated appropriately and that pain was treated appropriately.
But, gratefully, it was blocked. (A federal court lifted an injunction against the law in 1997, allowing it to go into effect) How could I as a physician help someone take their life? How could I be sure they were not suicidal? As physicians, we try to stop suffering absolutely. In fact, we became so good at that we started an opioid crisis in this country.
We already often hasten death. We adjust medication doses to breathing rates when people are near death and sometimes give just a bit too much. Did our treatment hasten their death? Probably. It is a question that haunts us as physicians. That is vastly different than handing someone a fatal prescription. That last dose is usually given in hospice or home hospice by loving caregivers who have been at the bedside. Sometimes this occurs in the hospital. Either way, this is appropriate use of medication because we are treating the suffering in front of us. Opioids suppress breathing — that is how overdoses occur — and at the end of life that can be a welcome respite. For me, having taken the oath to “do no harm,” that is as close to euthanasia as I am willing to ever get.
What kind of slippery slope will we be on if these bills are passed? What pressure from outside sources — insurers and other family members — will there be? No amount of paperwork and hoops to jump through could assure me that giving patients a prescription to end their life is the right thing. Keep them comfortable; that is good medicine. We can still help alleviate suffering even with the restrictions placed on opioid prescribing to make the end of life humane.
Having helped families when their loved ones are dying, I can tell you that you do not forget that scene. It is often painful. But it is also healing. The process of dying is not something from which we should run. These bills strike me as doing just that. We try to control things we cannot, and death is another thing over which we do not have control — at least we are not supposed to. Whether you believe in the soul, an afterlife, or that this life has a purpose, this is not about invoking God or a supreme being; this is about the natural order.
I choose to believe this life has a purpose. Ending it before its time could interfere with that. Who am I to determine someone’s path, including what suffering they are to endure? That does not mean I will not do all I can to alleviate someone’s suffering short of helping end his or her life. That is what it means to be a healer. I keep the physician’s payer, often attributed to Maimonides, in my office. It speaks of the complications of the body and alleviating suffering.
“Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed.”
My job is to watch over and alleviate suffering, not cause death.
Cathleen London is a physician with a private practice, Door To Door Doctors, in Milbridge.