Thursday, December 4, 2014

The Right to Say "No More"

We've all had that relative, friend, or spouse who has turned to us during a TV news broadcast or a Grey's Anatomy episode and said "If I ever get like that, shoot me."  I don't know if it is too precise to say "Put in the morphine drip and take off the governor" or too specific to say "Get me 10 pills of something with a a maximum dose of 5", but "shoot me" tends to be the phrase used to communicate when this mortal coil is no longer the preferred attire.

Despite a strong attempt in the early 1990's, Maryland has not adopted a "death with dignity" law that would allow a physician to prescribe medication that will allow terminal patients to have a death of their choosing.  The most choice you, and your family, have over end of life treatment can best be described in terms of whether you are maintained on life support or whether they "pull the plug".  While these deaths are often peaceful in their own way, they often come too late for the dignity and autonomy preferred of those of us still living healthy lives.  As depicted in The Descendants, "pulling the plug" can also mean allowing a patient to die from dehydration and starvation (the former often coming before the latter) as IV's and feeding tubes are discontinued.  And in doing so, we leave our remainders with nightmares.

That's only if you are fortunate enough to have a physician willing to implement living wills as written.  More commonly, the physician will transfer decision-making from the patient to the family.  All of the DNR orders in the world will not stop a physician from asking the family if they are ok with the decision.  No one should have to make the decision of whether their parent or loved one is to be "allowed to die", particularly if that person has already made a living will outlining their preferred manner of treatment.  Maryland only recently adopted a "Medical Orders for Life Sustaining Treatment" form, which is intended to remove family members from the process.  (Do your family a favor and take ten minutes to complete this form and give it to your doctor and your spouse/child).

We have a difficult time with death and for good reason.  What use is there talking about something so final and immutable?  But in this quiet deference, we give up a lot.  When your mind goes before your body, you stop eating.  When you stop eating, your skin begins to fail.  When your skin begins to fail, death begins before your life ends.  And I'm not describing extraordinary methods of life sustaining treatment.  I'm just talking about the fuzzy area at end of life where your brain no longer reminds you to re-position yourself in bed or swallow your food.  It is where medicine has outpaced common sense.

As with many other illegalities, in prohibiting death with dignity, we just make things messy.  People will still go out on their own terms, but it may only be after one or two unsuccessful attempts.  And instead of having their family in the room with them holding their hand, they'll be found three or four days after someone realizes they're not returning phone calls.  Is that a standard we want to promote in Maryland?

This is not a depressing subject.  The opportunity to own your death is powerful and life-affirming.  We may not cure every disease that kills us, but we can stop allowing those diseases the final say.

Have a great Thursday doing what you love!