Euthanasia

There has been much discussion about the pros and cons of euthanasia, especially given the Covid crisis. The best work on this problem of assisted dying was done by Professor James Rachels. I shall but reiterate some of his work.

The crux of the matter of euthanasia is when the patient or person should die and who should make the decision. If the patient is of a right mind --you know what I mean--, then the choice is up to the patient. With respect to when the choice should be made, the answer is that when it is apparent that death is in the best interest of the patient, then the value of an end to life is greater than the value of an extended life.

There are complications.

Rachels has a good story to make his point about who should make the decision and when it should be made. Suppose an all powerful being comes to you and says that you will die in one of three ways, and that it is up to you to choose which way you will die. In the first case, you will live until sixty, but develop terminal throat cancer. On the day after your birthday, a physician and whomever you may wish to invite will visit you and give you a tonic that will put you peacefully to sleep and then you will die unconscious. In the second case, at sixty, you will again develop throat cancer, but spend the next six weeks in terrible agony dying in such pain that you have to be restrained. In the third case, everything is the same as the second, save that the physician brings you pain medicine so that you can spend as much comfort time with friends and family as possible. The pain killer works but not always and more and more is needed to do the job. In the end, however, you will be so full of the pain killer that you will die unconscious or you may ask to be given the lethal dose of the painkiller which will result in your death.

Ok. Which alternative would you choose? Well, I would probably choose the third. Why? It gives me as much time as possible with friends and family while controlling the pain as best possible. In the end, I would ask for the final dose, rather than lying in a vegetative state for maybe a day or two, thus costing my family, the hospital and insurance company more money for no good.

James Rachels died of bladder cancer. He finished a book on ehtics while in the hospital. I'll leave it to you to determine which choice he made.

The moral of the story is that it is obvious that at a certain point, death is in the best interest of the patient. Now, suppose that society only lets you choose option two. You are condemned to a terrible death, trapped inside your ravaged body while others merely shake their head in commiseration. (This may be the case of Mrs. Schiavo. Though we may think that her expressions are of pleasantness, they could be of pain; the expressions that we have seen on tape are not clear enough. If it is the case that she is condemned to pain through our "good intentions," it is a fate worse than death, for there is no way out for her. That's tantamount to torture, even though society means well.) This is the state of our laws today.

Let me tell another story.

Suppose you found me running an animal center. You find a room in the back where there are many suffering diseased and injured animals. You ask me, what in the world is this room all about. I reply that I do not believe in putting animals out of their misery, but I give them everything I can to prolong their lives and make them as comfortable as possible. I have no doubt that you would have the sheriff shut me down as soon as possible. Strange that animals are protected by the law better than humans. Consider the following.

A Good Vet

by David Roberts IV

I could hear the slightest whisper of a moan coming from her hospital room in the palliative care ward where I stood at her door, scanning her chart, waiting for my breath to come back to me. I had made her the last patient on today's very busy schedule.

This was a hard one. Eighty-six years old. A good family friend. Debilitating stroke from an inoperative brain tumor. She had been a writer and artist, one of the best in Birmingham, and had given our driven community her golden sunshine of ideas and images that cast healing light to darkened corners of a gritty southern city that could never break free of its past. Now, here she was, dying slowly, losing memories she held to dearly, no longer guiding her fingers with pencils or paint over paper and canvas, struggling with cancer's relentless robbery of her self.

And, me. Trying to do the best I could to make her loss bearable.

I walked into her room of many colors. Tall vases of red carnations, white daises, yellow daffodils, hand colored cards of friends' self-portraits wishing her well, paintings of soft waves on calm seas: all rested or hung from every nook and corner of the ten by twelve room, save for the whirring, blinking, stainless steel vitals machine that monitored her.

Her silver gray hair was combed smooth, her face pale white but not blanched. A cotton sheet rippled pointed edges and rolling folds over her thin frame. She motioned me over with a slight movement of her hand, a hint of a smile on her face.

"How are you, Jeanette?" I asked in my best physician's voice.

"You should know, John," she said softly.

"Well, I do. Are you comfortable?"

"No. Not at all." Her emerald-green eyes looked at me, scouring my face for hidden replies that I did not want to give. Her thin lips pressed together.

"What is wrong?" I asked, walking up to stand at the end of her bed. She was propped up in a half sitting position.

"I want to die. And, you're not helping me."

I straightened. I am a white oak in a strong wind. Not bending because I was trained not to bend --to hold fast in any turbulence.

"I'm doing everything in my power to make you comfortable."

"You're not listening to me, John."

"We removed the feeding tubes yesterday as you requested. When you get uncomfortable, we have drugs that will enable you to make it through." I wrapped my white lab coat around me, crossing my arms.

"Make it through to what?" She steepled her fingers.

"A good end."

"That's what euthanasia means, but substitute death for end." Her fingers folded into a laced fist.

"Yes."

"This is not a good death. I am losing my memories. I battle to remember my husband, my children, my paintings, the way to mix a deep black from alizarin red and.... You see. I can't remember the other color. I had been mixing them for over sixty years. It's gone." Her hands made twirling moves as if stirring paints on a palette.

"Everyone loses memories, Jeanette."

"Don't patronize me, John. You're too close to do that to me. Our families have been together for years. Years. I watched you grow up and followed you through med school."

I could feel it behind me. The dark curse laid on physicians --how to be and not be friend and technician.

"I'm not double-talking, Jeanette. Death robs us all of memories. Sometimes quickly, sometimes slowly." The sweet scent from a gardenia bouquet drifted to my nose. And clashed with the clamor of a crash cart being hurried down the hall.

"Well, I want to go out with a bang, not a whimper. I want to have my mind's pocketbook full of the memories I cherish, rather than an empty no deposit no return bottle at the bottom of a waste can."

I took her hand, feeling its warmth against the glacier tips of my fingers.

"I'm doing all that I can."

"No. I've already told you that you're not."

I shifted my weight from foot to foot.

"What more can I do?" I asked, feeling the arrow of truth speeding towards my flimsy shield of hospital protocol.

"Kill me quickly," she said. Her green eyes blazed into mine.

"Jeanette. You know I can't do that. I am obligated to do that which is in the best interest of my patients." I could feel sweat underneath my white lab coat start to soak my armpits.

"You have a dog?" she asked.

"What?"

"Does your family have a dog?"

"Yes. Puddles. A golden retriever," I said. Has the lack of food and water started to impair her concentration so soon? She knows Puddles. Has for years.

"You and your family love Puddles?"

"Yes. Puddles is very dear to us. She's been with us for twelve years. The kids were raised with her. She's like a second mother to them."

Rain started to pelt the window. I went over and eased the blinds closed a bit more to reduce the patter. Gray storm light easing through the slats cast colorless, twisted streaks on the off-white window frame.

"What if Puddles had what I have? What if I were the vet treating her? What would you ask me to do?" she said, emerald green eyes fixing me, until I looked at the floor.

"Look at me, John. What should I do as a good vet?" Her hand clenched mine.

"I would ask you to..." Words stuck in my throat.

"Say it."

"To put Puddles to sleep."

"Suppose I told you I would not kill Puddles quickly, but let her die by starving and dehydrating her. Of course, I would give her drugs so that she didn't suffer so much along the way. Moreover, she would be comfortably locked away with other animals in a back room dying ward. That scenario would be in her best interest." She paused. "What would you think of me as a vet?"

I backed up and leaned against the shadowed wall.

"That you were violating the trust we had in you."

"Say that in words that I can understand, John."

"I would think that you were doing something so terrible that I would have you up for license removal for ethical violations." I felt my hands clench into trembling fists. The room tightened its pressing claustrophobic grip, closing in around me.

"Tell me. What's the moral difference between me and Puddles?"

"You're a person. I can't let persons needlessly suffer, or kill them," I said.

"You're killing me slowly in a way that is causing me incredible suffering. Real care doesn't distinguish between Puddles and me. Can't you see that death is in my best interest? You said that you would do what is in my best interest as my physician. John, just kill me. Soon. I know that you're smart enough to figure out a way to do that. Please. Soon."

We stared at each other for eternal seconds.

"Can I think about that, Jeanette? That's a lot to ask."

"Don't take your time," she said. "Minutes are agonizing for me."

"I understand," I said, as I checked her pillows, held her hand, smiled, then left through the ever open door. "I will be back by before I leave."

She nodded and smiled.

I went down the hall to the doctor's lounge. Got a cup of coffee in a white foam cup. Put it to my lips, then back on the gray Formica table. Looked at it steaming fresh for five minutes, white vapor wisps rising in feathered curves giving off a surprisingly robust smell. Two minutes went by as I stared at the cup. Steam stopped. Coffee started to go lukewarm. Bit of oily film formed over the surface. Another five minutes, it was cold black and bitter to a quick taste. Brown stains on the white foam dotted the place where I had put my dry lips. I quickly poured the black liquid with a few trailing bits of grounds into a nearby sink, crumpled the cup, and threw it into a dome shaped, aluminum trashcan.

Two hours later, I went to her room. She was asleep. So peaceful.

I went home, hugged my kids, ate a lasagna dinner that my wife Fran had prepared, watched a Thunderhead Hero video with all of us crowded on our stuffy brown sofa, laughed as Puddles licked the toes of my foot when I put it out to scratch her raggedy ears Told Judy and the kids that I needed a shower. I let the soft rain pour over my mind. Shower is the best place: my wife, kids, and even Puddles can't hear grief. No matter how much soap I used, I didn't feel clean.

Next morning, I found out Jeanette had another stroke sometime around midnight. Completely paralyzing her.

Thornton, the resident neurologist, said that she might be able to hear or see, but that her eye reflexes were not good. It wouldn't be long. Maybe, a day or two, given that all sources of sustenance had been removed as she had requested.

She lasted four more days. Her resilient body would not give up easily, reluctantly letting its trapped life trickle out of its cocoon cage. The white sheets covering her frail body would tremble as her breaths would come in hurried gasps, to settle back into a whispered sigh. The fragrant flowers took on the smell of funeral wreaths. She bore out her sentence with her eyes closed, never speaking a word.

I visited her room those four days as she slowly descended into the depths of blackness. There was one moment, next to her last day, when her green eyes flickered open and looked at or through me.

I hoped to God that she didn't see me.

So, again, if death is in the best interest of the patient, is chosen by the patient for good reasons (mainly, to end the pain of a terminal illness), then it makes no sense to merely let the patient die. Unnecessary pain makes a delay slip into the category of cruelty. A lethal dose of painkiller should be administered. In Covid 19 cases, decisions are complicated by the fact the virus is novel --not enough data has been acquired to understand the various courses of attack it takes. However, there is data to know that patients on ventilators after an extended period have only a 20% survival rate. The 80% who die usually suffocate, fluids filling up their lungs. A terrible way to die. It is possible to determine with a high degree of certainty which intubated patients will die. In such cases, should a patient ask for termination, should medical personnel agree, it is proper to administer a killing dose. There is a complication in that the intubated person is often unconscious or not fully mentally functional. Nevertheless, the good vet analogy applies.

Of course, a sticky question is, who is to do the administration? There are good reasons not to have physicians and nurses do perform euthanasia.

Pros: Physicians and nurses have the knowledge required to successfully administer a lethal dose of chemicals to end a life peacefully.

Cons: The concept of death in the best interest of a patient runs somewhat contrary to the teaching and overall attitude of medical practice. Psychological hinderances could hamper a medical practitioner, especially should religious beliefs are incompatible with such actions. Paradoxically, family members may be opposed, even admitting euthanasia is a best outcome. Moreover, public opinion may be distorted by social media practitioners who make sophistic arguments against euthanasia. Such has been the case with vaccines. Speaking of sophistic argument, it is an underground thesis that the economy would be better off letting Covid 19 run its course, thereby eliminating a large section of older persons who are drawing heavily from Social Security, Medicare and Medicaid.