BRANFORD – The physician-assisted suicide in Oregon of Brittany Maynard, 29, caught much media attention and reignited discussion of end-of-life issues. Legislation has been proposed in Connecticut that would make it legal for a doctor to prescribe medication to end a person’s life.
Dr. Joseph F. Andrews Jr., chief medical officer of The Connecticut Hospice Inc. since 2007, has spoken at a number of forums recently about a life-affirming alternative called palliative care. He is chairman of the Connecticut Palliative Physicians Group.
He is one of several health care professionals who provide expert testimony on the website DontJump.org, which was launched Feb. 20 by the Connecticut Catholic Conference the public advocacy and policy arm of the state’s Catholic bishops.
CT: Today we have technology, advanced medicine and the resources of palliative care to manage end-of-life care. Can you talk about that?
Dr. Andrews: Palliative care means that you manage people’s symptoms. The cardinal symptoms that we look for are shortness of breath, nausea, vomiting, anxiety, terror, confusion and, of course, all the forms of pain. Our area of expertise is really patient-centered; it focuses on relieving symptoms whether the patient is short of breath from lung cancer, COPD, unmanageable asthma, or pulmonary fibrosis; the shortness of breath is there and the fear is there. So our particular targets are to relieve those things that make life better while life lasts. It’s all about living better as long as your powers to survive are there. (He later said that palliative care is appropriate any time one has a serious, life-threatening illness that can’t be cured.)
Hospice care is a subdivision of palliative care, which really concerns itself with those who are within six months of the end of their life and may need even more intensive, more aggressive symptom relief to maintain comfort and dignity. Notice I haven’t said anything about killing anybody. It’s not what we do. It’s often thought that when you go to hospice, they’re going to give you morphine and Ativan; and you’re going to be dead in two days. That’s not what we’re about. Many times, patients come to us who are already very advanced in their illness and are close to their death from the biological process that made them sick. But our job would never be to end their lives with drugs. In fact, the evidence is that properly done palliative care will actually prolong your life.
Referring to a 2010 study published in the New England Journal of Medicine that showed that palliative care prolonged life, he said: The ones [patients] that were seen by oncology and palliative care reported less anxiety, better pain control, more realistic goals in their lives … and they lived longer, which took everybody by surprise. The palliative interventions actually made people feel better, have less anxiety, made them eat a little bit more and were very frank in their relationships.
Better communication between and among family members is one of the big things we really push for. We look at our patients and their families as the target of our care, as the unit of care. So already it’s not just an individual thing. It’s patient-based; but it’s also that the patient is part of a society, part of a cohort of friends, family, church members, co-workers, whatever.
CT: What’s the reason for those findings?
Dr. Andrews: I think it’s because their inner sense of order and satisfaction and peacefulness kept them around longer and they were more comfortable – not working as hard to breathe, not having agonizing back pain that would keep them in bed. It’s about life, it’s not about death. Death isn’t something we push on people to reduce their suffering.
I was talking to a couple of my colleagues who are opposed to PAS (physician-assisted suicide); but they said the things that tempt them most to be in favor of it are neurologic diseases where the patient becomes locked in and can’t speak, can’t communicate and can’t make their wishes known; and are totally helpless, like Lou Gehrig’s Disease or Huntington’s Disease, where you have dementia with progressive loss of bodily functions and control, and you’re constantly in ceaseless motion.
CT: Your thoughts on that?
Dr. Andrews: My thoughts on that are that you can control a lot of the suffering, it’s not a perfect world and you have to give medicines where they’re appropriate to relieve the patient. Your intention is to do no harm, but to do good; and to relieve the suffering caused by the illness.
CT: What do you say to people who think palliative care hastens early death?
Dr. Andrews: I think a lot of that comes from patients’ anxiety. Many patients are afraid that they will be left without their symptoms managed, that they will be a burden to their families, that they will suffer unduly around the time when death is inevitable. I’ve been doing this for seven years, and medicine since 1974; and the number of times people have asked me about assisted suicide … is probably fewer than 10.
The underlying part is if you reassure them that you’re going to be able to handle their needs and not abandon them, and take good care of them as they begin to move toward their death, that satisfies them. My own patients … I tell them we have a wonderful facility in Branford with 51 beds, 24/7, three shifts. You will never be alone. We really try to have a sitter, a volunteer or a staff member to sit by the bedside if they’re actually beginning to go. So don’t worry about being lonely, that’s not going to happen. And don’t worry about being in pain because we can deal with your pain and you will not die aware of it.
CT: Assisted suicide is a hor-rible way to think about death. What is another way for people to consider this issue?
Dr. Andrews: When I was a kid, we had something called the Communion of Saints. We have ancestors, who came before us; we have our lives right now and we have posterity to come after us. We are part of a long pilgrimage. Death is part of life.
Our culture has become so narcissistic and so self-obsessed in so many ways that death has become almost an affront, an insult, something we don’t deserve, and which for someone of my vintage makes very little sense. … It’s a philosophic spirit which leads to assisted suicide; it’s a total statement that we can control everything about our own life and destiny, and that’s it. There’s nothing but us.