Writing When Cancer Hits Home (http://www.amazon.com/When-Cancer-Hits-Home-Empowered/dp/0615391117) was a labor of love. After 15 years treating patients with cancer and having experienced my father’s and both of my wife’s parents’ cancer journeys, I felt compelled to write to help other future patients and families. I started thecancermd.com blog to provide timely information on cancer-related topics that couldn’t be included in the book. However, “blogging” has never been my passion, so I’m “closing the book” on thecancermd.com. Over the past couple of years, it’s been a pleasure and a privilege to have helped many patients and families through my writing.
For this final blog post, I thought it appropriate to address the concept of cancer death with dignity. The topic is also timely, in light of a prominent discussion put forth in the prestigious New England Journal of Medicine on the controversial topic of physician-assisted suicide: http://www.nejm.org/doi/full/10.1056/NEJMclde1302615?query=TOC#t=cldeOpt2
The taboo and fear of death in America looms large. Unlike in many other societies, American culture has largely failed thus far to embrace or even accept death as the natural culminating event of life. However, having been at the bedsides of many patients and several close family members as they were dying, I know that the process can be meaningful and sometimes even beautiful.
When faced with the inevitable, we all would wish for “death with dignity,” though what that means may vary for each of us. Most would agree that being at home, alleviated of physical pain and emotional anxiety, surrounded by family and/or close friends, represents an ideal situation. From a medical standpoint, there is no reason for the dying to suffer with uncontrolled pain or anxiety. Patients and caregivers must be assured of this fact, shedding the common misconception that intense suffering is inherent to the process. Enlightened physicians comfortable with palliative care as well as skilled and dedicated hospice nurses and volunteers are available in most communities to teach, assist, and comfort patients and families in this regard. For various reasons, some highly preventable and others not, death at home may not be possible. Hospice care centers are available in many communities and are filled with the same type of experienced, caring people as noted above for home hospice care. Some family members are so pleasantly surprised with the dying process of their loved ones under hospice care that they become volunteers to help others.
The primary doctrine of medical care that young physicians learn in medical school is primum non nocere, or “first, do no harm.” While I hear the arguments in favor of physician-assisted suicide, I feel strongly that the potential harm of euthanasia outweighs the perceived benefit, both to the individual and to society. Physicians who help patients take their own lives harm them, particularly when a decision is made in the shadow of fear and anxiety, without full understanding of the potential for a natural “good death,” as described above. Moreover, euthanasia harms society, damaging the safety and sanctity of the physician-patient relationship.
One of the most challenging and rewarding times of my life was caring for my dad in his home as he was dying of stomach cancer. He was comfortable and peaceful. I was extremely grateful to be able to give back a fraction of the love and care that he had shown me throughout my life. This experience, a cancer death with dignity, should be the rule rather than the exception. Even in death, “an empowered patient and family are the best weapon against cancer.”
- Patrick Maguire MD
PS – For those interested in reviewing any prior blog topics, please review ASAP, since the website will no longer be hosted after this month.