Hippocratic Oath – Marilyn R. Gardner

As a nurse I’ve cared for hundreds of people who are going into surgery, women who are in labor, people who have cancer, people who are dying. It has been both a privilege and a burden. It brings me face to face with my mortality, my frailty, and my need to figure out what this thing called ‘Life’ is all about.

I have sat with people waiting for their last breath, only to realize there would be none. I have been beside women as they gave birth to still-born babies, weeping with them as tears streamed down their cheeks. Tears that fell on the heads of babies who did not feel them or know the pain of their mamas.

I have cleaned up vomit, suctioned mucus, emptied bedpans,

So there is one thing I can tell you with certainty: There is no dignity in being sick. There is no dignity in bed pans. There is no dignity in throwing up. There is no dignity in fainting or seizures; in high fevers or runny noses, in chemotherapy or intravenous antibiotics. There is no dignity in getting the dreaded diagnosis “You have cancer…”. None. There is absolutely no dignity in labor as you’re hanging out all over the place just waiting for that little muffin’s head to crown.

And Psalm 23 is not kidding about the “Valley of the shadow of death” for there is little dignity in dying.

And yet the Massachusetts ballot is presenting me with a question come November 6 – a question where I have the choice to vote ‘yes’ or ‘no’. It is called the Massachusetts Death With Dignity Act, but it is really a vote up or down for Physician Assisted Suicide.

I get it. We hate pain – for ourselves and for others. “Needless pain!” we cry out! Why should we have to suffer? Why should those we love have to suffer? We’re going to die anyway! Why not be able to control the process?

So why do I, who ooze compassion when I see a hurt bird, let alone human, plan to vote no on this bill that would supposedly “alleviate” suffering?

There are several reasons.

1. While diagnosis is a fact, prognosis is an opinion. Most of us know people who have lived far longer than the prescribed prognosis given for a particular disease state. This is because many things go into living. It’s not about a doctor’s evidence, what has happened before, or what typically happens – it’s about the individual, it’s about will, it’s about faith, it’s about God.

2. Amazing strides have been made in pain relief and end of life care. No longer does end of life care need to be a time of intense suffering. Current research and practice gives great hope to patients and families who are dealing with end of life issues. Palliative care focuses on relief of pain, easing of symptoms, and improving quality of life. This area needs to be strengthened, not weakened by diminishing its importance through allowing patients to request medication that will end their lives.

3. There is no requirement in the language of the law that any family members be notified. This is unconscionable to me! That a patient can take the medication alone, with no one else present, and no record of having taken it is unbelievably bad practice. The potential scenarios this presents have law suits written all over them.

4. Death is not, and never will be, dignified. To paint the issue with language like this is disingenuous at best. Just because you are the one who holds the medicine that can end it all doesn’t mean it will be dignified. The very nature of death is that of losing control, taking a last breath, mouth gaping open, losing control of bodily functions, fighting to live only to die. I am all for easing some of the pain and discomfort of death but let me repeat: It is not, and will never, be dignified. It’s death.

The only dignity given in death is given by others to the one dying, it cannot be given to oneself.

5. Organizations that I respect are against it. The Mass Medical Society, Massachusetts Hospice and Palliative Care Federation, the American Medical Directors Association, and the Massachusetts Academy of Family Physicians are all against it. Why? Because it’s poorly written, because there is already a strong end of life care program in the state that aims to alleviate suffering, because patients are not required to see a psychiatrist or psychologist to check mental health status before being prescribed a lethal dose of medication to end their lives, and because they recognize that physicians should be in the business of providing “compassionate, high-quality care during every stage of life.”

6. I believe the act diminishes and violates the Hippocratic Oath at the deepest level. In the classical version of the oath the statement “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” are words sworn by most physicians on graduating from medical school. The entire oath speaks to the need to practice medicine ethically and compassionately.

Lastly, it is because I operate from a God-centered worldview. I see all of life through this lens. And so I believe that all of Life is sacred – whether it be in the abortion clinic, the battlefield, the workplace, the slum, the homeless shelter, the hospital room, or the hospice. Life, all of it, is sacred. And in believing that Life is sacred, I believe that only One can give or take life. Only One has and knows the big picture.

Only One can offer death with dignity and so, clear-eyed and clear-headed, I’ll vote No.

“Take away my capacity for pain and you rob me of the possibilty for joy.” Ross W. Marrs

“The role of family physicians is to provide compassionate, high quality health care to all patients, in each stage of life. End-of-life care is no different. Given the tremendous strides made in palliative care delivery services, patients with terminal illnesses often live active and fruitful lives for months, if not years….“Given the seriousness posed by the ballot question, and especially given our daily experience as family physicians caring for patients, we urge Massachusetts residents to vote NO to Question 2 on November 6.” Massachusetts Academy of Family Physicians

“We’ll continue to educate voters that Question 2 is poorly written, confusing, and flawed. This is why concerned doctors, nurses, hospice workers, religious leaders and citizens have banned together to defeat Question 2. Visit our website to see the full list of organizations opposed to physician assisted suicide”. Coalition against Physician Assisted Suicide

Death with real dignity (bostonherald.com)

Since Friday evening, I have tried to figure out what bothers me (besides the obvious sting from the slap in the face of humanity that the cry “Let him die” brings) about the now infamous interaction between Ron Paul, Wolf Blitzer and audience members at the CNN – Tea Party Express Republican Debate. As a full disclaimer it is important to note that I am a nurse. Nurses care not about who has insurance, their administrators are the ones who care. Nurses want to give the best treatment and care possible for the problem that presents itself, regardless of ability to pay. In analyzing the dialogue from that perspective, I feel the most disturbing part of the interaction is based on the familiar words “First do no harm“.

Ron Paul graduated from Duke University School of Medicine. He then went on to serve as a surgeon in the air force during the Vietnam War. Ron Paul had to have seen young people die senselessly and tragically. As a physician schooled in western medicine, Ron Paul would also know the words “First do no harm.” The phrase is erroneously thought to be part of the Hippocratic Oath, an oath from an ancient Greek medical text. This oath was often recited on graduating from medical school, as a reminder or commitment of sorts for the doctor as they entered a new phase of their education – that of learning to care for patients. A phrase in the Hippocratic Oath says “I will keep them from harm and injustice” and although the oath is no longer a part of medical education, the phrase “First do no harm!”is widely known and widely used. Rooted in Latin, it forms the basis of medical ethics. Basically a physician is called to do good, and if he can’t do good, then at least don’t harm. It serves as a reminder that the possible harm of any intervention must always be considered before going through with the intervention.

This is where Ron Paul’s response to Wolf Blitzer bothered me. In the case that was presented, not intervening is the intervention, and not intervening causes harm. Not intervening causes a young man to die. The callous cry or jeer “Let Him Die” should have been met with a strong response from Paul, a physician, with the words “First, do no harm”. The initial silence was an indictment, not only on him as a politician, but also as a physician and as a human being. His next words, that the hypothetical patient “should do whatever he wants to do” are equally indicting. Last time I checked, people who were being cared for in the intensive care unit of a hospital, didn’t necessarily have the ability to make decisions.

I understand the problem with the sky-rocketing costs in medicine. As a state government employee, I understand frustration with government waste and daily see the effects of inefficiency. What I don’t understand is his willingness to let jeers of “Let him die” from the audience win the moment. Let’s be clear, no one really remembers what he said after the loud jeers of “Let him die”. Even if he had something substantive to say, it was lost in the moment. As a politician, he has come a long way from his days in medical school and in this debate seemed to rewrite this well-known Latin phrase to say “First make sure that the patient has done all they can to help themselves. Only then will they be deemed worthy of treatment”.