Patients Often Suffer Under Twisted Medical Ethics

Death by starvation might be the most excruciating kind of death imaginable.

In search of nourishment, the body begins to metabolize itself. The kidneys stop working, which causes toxins to accumulate in other organs. The ultimate cause of death is often respiratory failure, a particularly agonizing kind of death after weeks of a particularly agonizing kind of suffering.

It’s tragic that geo-politico circumstances allow thousands of people to starve to death in the developing world every day. It’s unconscionable that we’d sit and watch someone die of starvation right here in our midst.

As you might guess, this column is about Terry Schiavo (search), but it isn’t about the merits or demerits of keeping her alive. It’s too bad that a decision that should have been made by her family is now being fought out in the courts, the media, and – most unfortunately – Congress.

But let’s put the political posturing aside for a moment. What’s most troubling about this case is the way we’re letting Terry Schiavo die. There’s no need for her to starve to death (there’s a heart-wrenching irony here, too — complications from an eating disorder put Schiavo in her current condition. Starving here seems particularly ill-conceived).

For the sake of argument, let’s assume that Terry Schiavo had a living will (search), and that it explicitly said she’d have no desire to be kept alive in the condition she’s in today. In theory, her doctors could put a solution in her IV drip that would end her life peacefully, painlessly and quickly. In theory, doctors could do that for any terminal patient who’d rather die than battle on. But in our twisted conception of medical ethics, that wouldn’t be acceptable.

"First, do no harm" makes passive, undignified, and sometimes painful death by starvation, dehydration, or asphyxiation the norm. It makes measures that could bring a quicker, more peaceful death a crime.

What in the world is wrong with us? We treat convicted murderers better than this. Most states now understand that state-sanctioned killing ought to be merciful, brief and painless. Most use lethal injection. But we can’t extend that same consideration to the most helpless and vulnerable among us. That, apparently, would be unethical.

It’s insane to think a terminally ill patient might be better off on Death Row than in a hospital or hospice. Our medical and pharmacological Calvinism (search) isn’t limited to the right to die, either. It runs rampant in end-of-life care.

Look at the epidemic of untreated pain. Sick people with little hope for recovery not only aren’t permitted to end their lives on their own terms, many times they’re forced to endure their last days in pain most of us can’t imagine, despite the fact that in most cases it’s treatable. Stigmas against drugs like morphine cause millions of patients needless suffering.

One 2004 study of medical literature published in the Annals of Health Law found widespread undertreatment of pain "among the terminally ill, cancer patients, nursing home residents, the elderly, chronic pain patients, as well as in emergency rooms, post-operative units, and intensive care units."

Another study of children who died of cancer in Boston-area hospitals found that nearly 90 percent of them had "substantial suffering in the last month" of their lives.

In a 1997 Time article on the underuse of morphine, one doctor told the heartbreaking tale of a father who refused to allow his son to be treated with the drug, even though the boy was in terrible pain, and near death from cancer. The father said he didn’t want his son to be a drug addict.

"In his grief over the imminent loss of his son," reporter Christine Gorman wrote, "the father failed to see the absurdity of worrying about long-term addiction in a child who is dying in pain."

Perhaps no case illustrates the absurdities of letting morality trump medicine than that of Peter McWilliams (search). In 1996, McWilliams wrote a wonderful book arguing for the legalization of consensual crimes called Ain’t Nobody’s Business If You Do.

McWilliams also suffered from AIDS and lymphoma. After California legalized medicinal marijuana in 1996, he found that smoking the drug forestalled nausea long enough for him to eat the food he needed to keep his medication down. By this time, McWilliams’ book had become very popular, and he became a popular advocate for legalizing victimless crimes. In 1997, federal agents raided his home, and arrested him for possession and distribution of marijuana. At his trial, McWilliams wasn’t allowed to tell the jury that marijuana enabled him to take his medication, nor was he allowed to use in his defense the fact that medicinal use of the drug was legal in California.

While out on bail and awaiting sentencing (and not permitted to smoke marijuana), McWilliams could no longer digest his medication. His nausea returned, and his condition deteriorated. One night while taking a bath, he choked on his own vomit, and died.

People who are hurting ought to be able to get the medication that makes them feel better. It’s better to enable someone to die peacefully than to starve them to death. Cops shouldn’t be making medical decisions. All sound pretty reasonable, don’t they?

Yet none are so cut-and-dry. The reasonable, self-evident supposition that we own our own lives and bodies, and so should be able to consent to our own course of treatment, has become entrenched in a sludge of professional ethics, social mores and political grandstanding.

It’s time we stopped mingling our morals and our medicine.