Oncology (General Cancer)/question
QUESTION: I just read about a woman who wants to end her life because she's terminally ill with cancer she is fighting this in her home state so her doctor will be able to give her the medication to do this. she painted the most horrible picture of suffering and then dying. she said her lung cancer has spread throughout her body, and since it's in her liver her stomach will swell and she'll be in pain. It's in her bones and she claims there is nothing to help with pain that she will endure. It's in her brain too, I can't believe in the 21st century people have to suffer in this way. the scenario she has told the public is incredible It's inexplicable to me. in the 1800s people didn't suffer in this way. they were kept sedated. I would think medical science has some sort of medication that could keep her unconscious, until she goes, or some sort of medical induced coma. or at least some sort of pain management..I would like to hear from an expert on this, instead of a whole lot of talk from non experts. I have a group of friends who are aging now and they are terrified of dying in this way. since they've read her story. would like to hear what you have to say re; this. thank you
ANSWER: During my career I've specialized in symptom management and had other cancer specialists refer their patients to me when "standard" things didn't work. I can honestly say that during this time I've hod six patients whom I could not make comfortable using the many things that are available --drugs, injections, even surgery sometimes. In the case of these six patients, we did end up sedating them -- they were all quite terminal, and didn't survive more than two or three weeks.
As a physcian, I have a lot of reservations about "physician assisted suicide" and medical science properly applied can almost always make the end stages comfortable. There are board certified pain specialists (a branch of anesthesiology and neurology) and very sophisticated hospice programs. No one should have to die in pain. It's a good idea for people (even when they are healthy) to make out a living will, to find out who the local pain specialists are, and to prepare themselves for this scenario, even though most won't need it.
Physician assisted suicide if available simply becomes a cop-out, and since this will take care of anybody with pain, people will have no incentive to develop better approaches to managing pain. It's similar to the situation with Down's syndrome. There was a thriving research effort to improve the lives of these individuals. One of them recently graduated from college here. Progress was being made on early detection and genetic modification in utero. But now, with amniocentesis more than 85% of babies with downs syndrome are being aborted, meaning that a) the other 15% are without resources; and b) the spin-off from research has died down to a trickle; and c) the mind-set is taking over that you have a right to a designer baby, and if it isn't the sex or eye color or whatever that you want, abort it. So that's how I feel.
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QUESTION: I felt I should write back, to say I agree with you. I too think assisted suicide is probably as you say a cop out. I found it very hard to believe that people will suffer until they died of a terminal illness. Not in this day and age, doesn't seem possible to me. There has to be some sort of medically induced type coma to help people who are in pain, and let them sleep so to speak until it's over for them. As I mentioned there are several older people I know who were actually frightened that this will happen to them and their lives will end in pain terrible pain. In 2015????.the article stated that this woman said that her stomach would swell and she would be in terrible pain as well as the bone cancer which she claimed nothing can be done for the pain. hard to believe. The only thing I thought was strange is when you mentioned specialists refer their patients to you. the ones who are terminal. They couldn't help them??? thanks again I hope that it's true that people will not suffer in the way she described. I appreciate your input.
As an oncologist I specialized in the area called "supportive care", which includes pain management. In addition to getting occasional referrals from other oncologists, I would get referrals from surgeons and internists. It wasn't because they couldn't deal with the pain problem, but more often because they didn't want to take the time. Managing pain is time-intensive, since we don't have a lab test that can tell us whether we are on the right track -- only the word of the patient. As for bone pain, it is probably easier to manage than some other kinds of pain. In addition to radiation therapy there are bone-seeking radioisotopes that can be given in the vein and deliver radiation right to the bone lesion. So there are a lot of things that can be done. Hope this helps.