Hospice, Not Hemlock: The Medical and Moral Rebuke to Doctor-Assisted Suicide

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The medical and moral rebuke to doctor-assisted suicide

In the deepening debate over assisted suicide, almost everyone agrees on

a few troubling facts: Most people with terminal illnesses die in the sterile settings of hospitals or nursing homes, often in prolonged, uncontrolled pain; physicians typically fail to manage their patients' symptoms, adding mightily to their suffering; the wishes of patients are ignored as they are subjected to intrusive, often futile, medical interventions; and aggressive end-of-life care often bankrupts families that are already in crisis.

Too many people in America are dying a bad death.

The solution, some tell us, is physician-assisted suicide. Oregon has legalized the practice for the terminally ill. Michigan's Jack Kevorkian continues to help willing patients end their own lives. The prestigious New England Journal of Medicine has come out in favor of doctor-assisted death. Says Faye Girsh, the director of the Hemlock Society: "The only way to achieve a quick and painless and certain death is through medications that only a physician has access to."

This, we are told, is death with dignity. What we do not often hear is that there is another way to die--under the care of a specialized discipline of medicine that manages the pain of deadly diseases, keeps patients comfortable yet awake and alert, and surrounds the dying with emotional and spiritual support. Every year, roughly 450,000 people die in this way. They die in hospice.

"The vast majority of terminally ill patients can have freedom from pain and clarity of mind," says Martha Twaddle, a leading hospice physician and medical director at the hospice division of the Palliative CareCenter of the North Shore, in Evanston, Illinois. "Hospice care helps liberate patients from the afflictions of their symptoms so that they can truly live until they die."

The hospice concept rejects decisions to hasten death, but also extreme medical efforts to prolong life for the terminally ill. Rather, it aggressively treats the symptoms of disease--pain, fatigue, disorientation, depression--to ease the emotional suffering of those near death. It applies "palliative medicine," a team-based philosophy of caregiving that unites the medical know-how of doctors and nurses with the practical and emotional support of social workers, volunteer aides, and spiritual counselors. Because the goal of hospice is comfort, not cure, patients are usually treated at home, where most say they would prefer to die.

"Most people nowadays see two options: A mechanized, depersonalized, and painful death in a hospital or a swift death that rejects medical institutions and technology," says Nicholas Christakis, an assistant professor of medicine and sociology at the University of Chicago. "It is a false choice. Hospice offers a way out of this dilemma."

Hospice or Hemlock?

If so, there remains a gauntlet of cultural roadblocks. Hospice is rarely mentioned in medical school curricula. Says Dale Smith, a former head of the American Academy of Hospice and Palliative Medicine, "Talk to any physician and he'll tell you he never got any training in ways to deal with patients at the end of life."

The result: Most terminally ill patients either never hear about the hospice option or enter a program on the brink of death. Though a recent Gallup Poll shows that nine out of 10 Americans would choose to die at home once they are diagnosed with a terminal disease, most spend their final days in hospitals or nursing homes.

And, too often, that's not a very good place to die. A four-year research project funded by the Robert Wood Johnson Foundation looked at more than 9,000 seriously ill patients in five major teaching hospitals. Considered one of the most important studies on medical care for the dying, it found that doctors routinely subject patients to futile treatment, ignore their specific instructions for care, and allow them to die in needless pain. …