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Hullabaloo


Saturday, April 07, 2012

 
The importance of death with dignity

by David Atkins

By most standards, I have been very fortunate in terms of the health of my family and friends. My parents and a majority of my grandparents are still alive, as are most of my immediate circle of relatives. Few friends close to me have passed on. Still, I have experienced the slow decline of a few, including an aunt from breast cancer. And every time I see the process of dying, I am amazed at the attitude people take toward the inevitable process of death in the United States.

What brings the subject to mind is fairly immediate. A friend and a couple of her family are staying over at my place for few days to visit a relative of theirs in hospice. The relative is in the final stages of ovarian cancer and has only a few days to live. Here is what happens in the final stages of this awful disease:

Ovarian cancer cells also spread to multiple places on the surface of the intestine, leading to the formation of adhesions. These surface adhesions, made up of fibrous scar tissue, bind together loops of the intestine. This impedes the normal muscle contractions of the intestines, which propel contents along, and movement slows. Adhesions also produce complete intestinal obstruction, meaning that food and fluid cannot pass.

Also causing intestinal obstruction, the ovarian cancer cells spread to the small or large intestine and grow. Multiple large growths of cancerous cells lead to blocking the intestines such that contents cannot pass.

Intestinal obstruction and decreased movement of the bowel content lead to distention and consequent severe abdominal pain. Further symptoms include anorexia, nausea, vomiting, weight loss, fatigue and constipation. In a 2004 publication of the Journal of Supportive Oncology, physicians from the Mayo Clinic report that this type of intestinal obstruction causes death in the majority of women who die of ovarian cancer.

The individual in question is going through exactly this, and has been released from the hospital to her home, with a supply of painkillers that will only serve to dull the increasing pain and discomfort that will fill her final days.

I do not know this woman's situation or her specific desires on this front, but I do know this: it is cruel and deeply inhumane to force a human being to waste away like this, experiencing convulsion after convulsion until the last one that mercifully ends her suffering. It is abominable. It is one of my greatest fears that one day it will be my turn to know that my end is inevitably at hand, and that due to a misguided religious taboo it will not be within my power to make a graceful, dignified and painless exit on my own terms, rather than those of a wracking disease.

This isn't a theoretical question for me. Many years ago I suffered from kidney stones too large to pass through my ureter. I had to undergo a procedure known as lithotripsy, which essentially involves blasting the stones into pieces with shockwaves, aided by a stent from the penis through the bladder and into the kidney. Unfortunately, the stent wasn't put in right, and it rubbed up against either my upper ureter or kidney wall, leaving me in bedridden excruciating pain for about 10 days, in addition to the pain of passing the series of blasted stones. I remember thinking constantly at the time that if this were the pain of the final stages of my life rather than of a temporary condition, I would not hesitate to request a morphine overdose after saying my final goodbyes. It was then that I began to read more and become passionate about this issue.

I understand if individuals have religious convictions that prevent them from making the same decision, or if they wish to experience this natural process in the same way as any other.

But it should be a human right to choose otherwise as well, and to take matters into their own hands with the help of a medical professional without the need to resort to messy, painful, or potentially ineffective alternatives. If my end is gradual and predictable, I hope to be able to make the same choice. And I hope that when and if that time comes, this country will have become enlightened enough to allow me to make that choice legally without risk to myself or others.

It's a question of dignity.


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