EUTHANASIA HAS LOST ITS STING

Press, 12 August 1980, Page 17

EUTHANASIA HAS LOST ITS STING

Euthanasia refers to the bringing about of a gentle and easy death, especially in the case of an incurable and painful disease. This is often taken to mean that the patient sliould he << given something 99 to .hasten death. Modern-medical opinion simply.:says that euthanasia by artificial means fsnot necessary; Nature itself and the suppressing of pain will be enough. : / Story by J)OUGLAS McKENZIE.

Letting nature take its course . ..

A . Christchurch doctor is full of admiration for the way that people suffering from an incurable disease accept the realisation of early death. ’ Medical attention has shifted to a role of neither seeking to prolong life for its own sake nor to thwart the natural -process of decline where death is inevitable. “Euthanasia is not necessary. in an active -way because people will die anyway,” the doctor says. “As long as you give pain relief I don’t think that giving an injection to-hasten death is reasonable.”

He endorses the principle that the object of medicine is not to prolong life but to mitigate suffering.

Requests to doctors by patients for an early death are probably less prevalent than imagined. The doctor referred to can remember only one such request in the whole of his career, and this was when he was a student. He says that he

considered it but did not assent to it. The patient had been suffering from incurable cancer.

The important change today which brings a greater element of peace to death for long sufferers and nourishes their bravery is the supportive care in their own homes. This support comes not only from their families but also from professional nursing;,and the doctor has special praise for the Nurse Maude Association. Apart altogether from the solace that the incurable patient will gain from being in familiar surroundings and in the constant presence of his family, a powerful advantage of being sent home from, the hospital is that he can sink according to the ordinary course of the disease without bolstering which becomes only a futility. “In hospital it is difficult to avoid certain treatment,” the doctor says. “There is oxygen by the bed; haemoglobin tests will be

made, and as a result the patient may be given blood. He will look marvellous for a couple of days.” None of this will go towards a cure, only towards a prolongation of life. “Do everything you can if there is a change of winning; if there is no chance you must face it.” The incurable cancer patient will begin to suffer from anaemia, and, having no appetite, will fall into severe weight loss. The doctor would not attempt to alleviate these conditions.

“The anaemic patient is so weak that he feels pain that much less.”

The crucial thing is that, in spite of this attitude, the patient is not allowed to feel neglected. “These patients who know they have an incurable disease are happy to accept no more treatment than pain relief provided they feel that doctors and nurses are going to keep seeing them — that they are not dumped.” The corner stone of the

treatment at this stage is not medicine but nursing. All the patient wants is constant loving care and attention. If he wants a drink he should be given it at once; if he wants another ampoule of morphine this should be supplied at once.

The doctor points out that there was nothing illegal about not treating a patient. And a patient has the right to refuse treatment.

It was necessary to give the option to the; patient and the family. They must understand that treatment only to keep alive might be painful and long, and they could expect to get little out of it.

Once the patient who could not be cured came home from hospital it was important that the care did not then appear endless. A family which could concentrate its care and affection for a month .or two could not be expected to feel the same after, say, a couple of years.

One dictum has it that a doctor must relieve suffering not “strive officiously”- to keep the patient alive. Handled in the right way — which would include the right surroundings and nursing care — there was no cause of cancer where the pain could not be subdued.

“Pain is a personal thing; it depends so much, on surroundings,” the doctor adds. Anxiety , is a factor in its intensity. The doctor quotes the example of wounded soldiers on an assault beach who suffer great pain while there is risk of being under further shellfire, but whose pain miraculously eases once they are taken out to the evacuation ships. Until quite recently, at least, the attitude towards incurable patients was scientific overactivity instead of everloving care and “masterly inactivity.” The doctor refers to pneumonia as “the old man’s friend,” an illness

which takes patients off peacefully. He says that the problem was where doctors overtreated cases apd radical surgery ' was undertaken which could never do more than delay death quite briefly. This action is less common now than it was 10 years ago. A series of operations might lead to severe mutilation and still no cure could be brought about.

To combat cancer, surgery might remove a woman’s breast, follow this by removing lymph glands, part of the chest wall, the adrenal glands, the ovaries, and even the pituitary gland in the head — virtually de-sexing the woman. An . extreme case, of course, but one not unknown.

It might give a patient an extra 18 months to life, but six of these months would be spent in hospital.

Cost does come into the argument; although the view seems to be that society is not ready to talk about this yet — or,

at any rate, to make decisions about treatment based predominantly on the cost.

“The high cost of dying is still not a factor, but this limitation may come,” the doctor says. This may be compared with the theoretical cost of maintaining life on the top of Everest. Technically there is no reason why a heated cabin.could not be put there and its occupant supported indefinitely. But would the enormous expense be worth it? The practical application of this comes into the handling of those cases of injury to the brain which are so serious that the patient would remain a vegetable regardless of the number of years he was connected to life-support machines.

. This is the "switch off” or “pulling the plugs” syndrome. The doctor says that in New Zealand the matter is always dealt with reasonably and practically.