11.11.2011

A Different Slant on the End of Life

End of life determinations should be among our most personal and private matters. Unfortunately various groups, with a wide range of ideological dogs in the hunt, refuse to allow this. Sure, there are societal interests to be protected, but these really are about ownership, protecting the interests of at risk individuals, etc. Not whether a person has the right to determine the manner and hour of their death in the face of its impending certainty. Those who object on ‘philosophical grounds’ usually belong to groups that insist on extending their pet ideology into others' lives. One wishes they would find other hobbies.

Though there are no doubt other reasons, to me situations where one might chose to end their own life include intractable pain and loss of self.

All pain cannot be well controlled. I have been involved in the treatment of pain for around 25 years. While most people’s pain can be controlled, some can’t. Anybody who claims otherwise is either ill informed, part of a political agenda, or unaware of #2 on the above list.

Number 2, the loss of self, is rarely discussed in the context of pain management. Knowing what we know of neurochemistry and the pharmacology of pain medications and sedatives, it is clear that these drugs alter human cognition. For some (the opiods are the classic example), that’s how they actually provide pain relief. They alter a patient’s perception. When used to treat recoverable injury (including surgery) we accept these effects as a passing inconvenience on our road to recovery.

But what about the intractable pain of some terminal illnesses? The doses of these centrally acting medications that are required often impair cognition even when combined with NSAID's and other medications. Is the pharmacological loss of self in the face of pain any less important than structural losses such as severe head injury or coma?

What do you think?

5 comments:

Saint Brian the Godless said...

If one is forced to be medicated for the rest of one's life and the medication produces a loss of self, then I could see the desire to put an end to it.
Of course our society is still too immature to see the validity in the idea of being able to decide when you die. They want to preserve life at all costs like it's a religious belief. Which it mostly is, let's face it.

Of course I'm a fine one to speak, since to me a loss of self is a great evening.

Harvey said...

Pliny:
Like you, I have had to deal with patients who are facing an inevitable end to life. In my practice, which is mostly Head and Neck malignancy, the impending end cannot come too soon for some of these patients, afflicted as they are with intractable pain, significant disfigurement, interference with speech and eating, and, in so many ways, isolation from whatever remaining life they may have because of all of these issues. We are often better able to manage their pain than these other devastating problems that rob them of their dignity and "personhood". Small wonder that many of us who have the privilege of trying to cure their physical ailments are much more devastated by our inability to help them escape from what is no longer a meaningful or emotionally tenable existance. I don't know if your recent post is intended to reopen the end of life/ assisted suicide discussions, but this is my read on it.

Harry C Pharisee said...

Well of course it isn't.

Being mentally ill, I find a corollary with the 'new' self which emerges for terminally ill patients coping with growing sickness and medication.

If a rational person is faced with prolonging a sub par physical existence by having to significantly diminish mental health, they should have the right to a peaceful death.

Harry C Pharisee said...

"Of course I'm a fine one to speak, since to me a loss of self is a great evening."

Picture a bad acid trip and you'll get a sense of the fear involved.

GearHedEd said...

@ Harvey:

All of us are "facing an inevitable end to life".

Most just haven't come to grips with that yet.