A Plea for the Dying Patient
It seems that the latest anxiety for many of us is not the conflict in the Persian Gulf nor the unification and economic stability for the Soviet republic, but it is here at home. The new and real dilemma is how to deal with the terminally ill patient.
There is a new book, Final Exit, printed by the right–to–die Hemlock Society. It is a suicide manual for those terminally ill. The newly released book claims to be written for those whose suffering has become unbearable and wish suicide. A highlight of the book speaks about ways physicians and health care professionals can terminate or assist patients in suicide. In the 190 pages of this book are revealed different methods in reaching death or, as they call it, final exit. Despite the growing right–to–die movement, the book still comes as a shock. Now is the first time that any person can walk into a bookstore and pick up a book telling them how to commit suicide.
Many in the professional field claim that living in a terminally ill state is futile and that when the physician’s knowledge fails to cure, he ceases to be a practitioner. The physician is to heal and when he cannot heal his job is over. However, this is not true.
The 12th century great Jewish physician and philosopher, Moses Maimonides, states that the job of the physician is to heal, medicate and dispense life. Just as G–d created food and water for life so, too, has G–d created medicine and treatment. He endows man with the intelligence to discover and apply different medications to the medically ill regardless if the patient will make it or not.
Lately, we’ve seen families and doctors speak about the quality of life which spawned a new cliché, “dying with dignity.” Strangely, the idea of dying a dignified death has become the new criteria for life.
Something very appalling has happened. If it seems to be undignified for the living to watch the suffering of the patient, then we have the right to terminate the patient’s suffering. Paradoxically, when we speak about dignity we now mean dignity for the living and not the one dying. This is very wrong! We see people speaking about their loved ones, using terms as, “Look at him laying there not being able to move.” They realize the fate of his illness and his incapability to feed or care for himself. “How undignified he must feel!” they think and proceed to terminate the life supports.
Now, perhaps things are a bit different than they appear. If the patient is in the position where he is really that sick, it is very possible he doesn’t feel that taking care of himself is most important. He would prefer to be given a chance to die quietly and fade away in the company of his loved ones. His greatest dignity is that he knows that there is someone who loves him to the very last moment. Just because he can’t articulate the message doesn’t mane he wants to die.
By way of example, a few weeks ago I received a phone call late at night. An engineer called about sustaining his old father who was in his late 90’s and had suffered from a stroke. The physicians wanted to know what he, the son, felt would be best for his father. Being a religious person he called me and said that he wants a rabbi to help him with the decision.
In establishing that this man already was on a respirator and was connected to life support I told him to have hope, pray and keep on sustaining. For two months the elderly man wavered between life and death. Towards the end he had his respirator removed. Quite unexplainably he was able to call his son by his name and then he passed away.
When I asked the engineer after the funeral, “Was it worth it?” he answered, “Definitely! To be able to be close to my Dad and hear him call me before he passed away was worth all the medicines, expense and personal suffering.” The two months of dying brought more dignity and love to the father and son than ever before.
I remember visiting a patient who was in a hospice program. I discussed the writings of the Austrian psychiatrist, Dr. Victor Frankl, a holocaust survivor and founder of logotherapy. We spoke about experiencing meaning through suffering; how it added dimension to one’s personal life; how it’s almost impossible to explain it to people who have never suffered. The unique approach by Frankl is how one outlives the suffering by finding purpose and that purpose can easily give dignity to the terminally sick. I know the patient felt at peace and very dignified. However, she told me that as she gets sicker, not being completely in control she would be neglected. “Until my last breath, I want them to do everything possible for me. See to it, Rabbi,” she pleaded.
True, there are not ultimate answers for suffering but there is a quest for meaning. To borrow a phrase from Dr. Frankl, “Sometimes the unfinished are the most beautiful symphonies because their music never ends.”
Physicians must remember that their responsibility is in healing and not in abandonment. If healing means to sustain, then this is what the physician must do. It is only of late that physicians and health practitioners have become entangled with questions of life and death ultimately forcing families to make unqualified decisions.
When dealing with the sick and hooking them on the life support line, we shouldn’t think of it as a cold hold button soon to be disconnected but, rather, as music on hold, as a time and opportunity for the patient and family to make everlasting peace and make the proper good-byes. Think of it as holding on to one another and, as the time draws near the finish line, all was done with grace and dignity.