Posted on: Wednesday, February 9, 2005

Palliative care claims are a cruel deception

By David Shapiro

A large local medical organization runs a TV commercial comparing its system of patient care to a racing canoe.

The primary-care physician is the steersman, a doctor explains, while the specialists she consults man the paddles.

"There's even a place in the canoe for the patient," the doctor adds munificently.

This attitude that patients are mere passengers along for whatever ride doctors decide to take us on — incapable of steering the canoes of their own lives — is at the heart of the medical establishment's opposition to a Death with Dignity law for Hawai'i.

For the fourth year in a row, physicians helped persuade lawmakers to table legislation allowing competent patients with terminal diseases to request lethal prescriptions to end lives that become unbearably painful and without quality.

Leaders of Hawai'i's medical community say most "mainstream" doctors oppose physician-assisted suicide because it would violate their Hippocratic oath to do no harm, destroying the doctor-patient relationship.

But plenty of qualified and responsible physicians disagree.

They question which is really the greater harm: to allow hopelessly suffering patients to end their lives peacefully, or to force them to persist in misery, lost autonomy and failing bodily functions to serve other people's notions that nobility lies in toughing it out?

Doctors who oppose assisted suicide confidently assert that advances in pain relief, palliative treatment and hospice care leave end-of-life patients comfortable enough that suicide is unnecessary.

They flatter themselves. Many patients who suffer intractable pain would tell doctors that they're not as good at relieving suffering as they think.

Doctors often are timid about prescribing the strongest pain relievers for fear of attracting the attention of the federal government, which opposes assisted suicide but also discourages some regimens of aggressive pain relief involving narcotics.

One doctor told me that in the worst cases of pain, he can effectively medicate a patient into a coma until death comes naturally.

How is this possibly more in keeping with the Hippocratic oath than helping the patient to let go when he or she thinks the time is right?

Yes, there is excellent hospice care for many patients at the end of their lives, but it is not nearly as widely available as it needs to be.

Lack of adequate long-term-care options for the elderly and chronically ill is a crisis in Hawai'i that the Legislature has sidestepped for a decade.

Opposing doctors have a point when they say any assisted-suicide law would have to be perfect in terms of eliminating abuse. They feel the Oregon model upon which the Hawai'i legislation is based falls short.

The problem is, doctors making this point have done little to help write more safeguards into the legislation.

Perhaps the greatest safeguard on this and other medical issues would be if doctors became less reluctant to blow the whistle on fellow members of the fraternity whose judgment they seriously question.

Doctors, lawmakers, religious groups and others opposing assisted suicide are sincere in their beliefs on a complex issue of conscience.

They deserve respect, but must do much more to put their money where their mouths are.

Instead of just talking about viable alternatives to suicide, they owe it to the suffering to do a lot more to improve end-of-life care and make it universally available.

This means better physician training in pain management and palliative treatments, greater availability of hospices and decent long-term care so the infirm don't have to die to achieve comfort and dignity.

For opponents of Death with Dignity to claim we're already there when we aren't even close is a cruel deception.

David Shapiro can be reached by e-mail at

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