Five Medical Methods of Managing Dying
by
James Leonard Park
If we will die under medical care,
our deaths will be
managed
using some combination of the following
five medical
methods of managing dying.
If our deaths
are not thoughtfully managed,
we might be 'treated-to-death'.
Perhaps 20% of deaths under medical care
occur while maximum
medical treatments
are still being applied.
Dying in the
intensive care unit (ICU)
would be the most obvious example
of
being 'treated-to-death'.
The doctors and nurses do not give
up
until we die despite their best efforts.
However, if we die from chronic illnesses,
our doctors will
recommend some combination
of these medical methods of managing
dying:
(1) comfort care only,
(2) beginning terminal
sedation,
(3) ending curative treatments and withdrawing life-supports,
(4) giving up water, &
(5)
receiving gentle poison.
Using gentle
poison is a medical option
only in some locations at present,
but new right-to-die laws in many states and countries
have
extended this quickest method of dying
to more locations where
modern medicine is practiced.
(1) Comfort
care only
includes using drugs to control any suffering
we might be experiencing at the end of our lives.
The
specific medical problems
that are bringing our lives to an end
will shape which drugs should be used.
And our doctors are
authorized
to increase these drugs already in use
to whatever
level provides the relief we desire.
When
we are clearly dying,
there is no further reason to worry about
'drug addiction' or 'drug dependence'.
And usually we will
not worry about the possibility
that the palliative-care drugs
themselves
might shorten the process of dying.
(2)
Beginning
terminal sedation
is a step beyond comfort care.
If our suffering is so intense
that it cannot be
controlled by any pain-meds,
then our doctors might manage our
dying
by recommending that we be kept
unconscious
for the rest of the process of dying.
We should say our good-byes
before terminal sedation begins,
because we will never again
have any interaction with other
people.
Terminal sedation will guarantee
that we will 'die in
our sleep'.
The drugs used to keep us permanently asleep
might
be adjusted from time to time
if ever there is any sign of
suffering.
Terminal sedation as a medical
method of managing dying
might also shorten the process of dying,
but in most cases, this is not a problem.
Everyone knows that
death is coming.
And this method assures everyone
that the
dying patient will never suffer anything.
(3) Ending
curative treatments
means giving up all of the medical
methods
that have already been tried to save us from death.
Medical science has already done its best.
And our doctors
explain that these methods
could not save us from death.
There will be no more surgeries,
no more chemotherapy,
no
more drugs to fight off the disease.
When
curative treatments are ended,
we might be moved to a different
medical setting,
perhaps into some sort of hospice care.
Supportive and comfort-care replace
all of the acute medical
treatments
that have now failed to save us from death.
(3) Disconnecting
life-supports
will probably also take place
whenever
curative treatments are ended.
All of the 'tubes and machines'
that were being used to keep us alive
can now be switched off
and disconnected.
This medical method of
managing our dying
will also include deciding not
to use
some
forms of life-support that might
have been tried.
For example,
if we are dying from lung cancer,
what is the point of using a
respirator at the end?
Such ways of helping us to breathe
will
ease the distress of not getting enough oxygen,
but no
breathing-assistance will cure the cancer.
When disconnecting (or declining) life-supports
our doctors can
recommend
methods of reducing the likely distress.
And they
can tell us how long we can expect to live
without the mechanical
assistance.
(4) Giving
up water
is usually also recommended
when all
other forms of life-support are being abandoned.
When nutrition
and hydration were being provided by tubes,
this medical method
of managing dying
will be noted as part of disconnecting
life-supports.
Perhaps we have already stopped ingesting anything
because we are dying from a medical
problem
that prevents us from benefiting from more food and water.
Or our doctors might recommend giving up water
if there is no further benefit.
And when all fluids are abandoned,
the duration of
natural dying can be predicted
to be just a few days,
depending
on how much water we have stored in our bodies.
Even if we are not actively dying from one specific disease,
we
might still decide that our meaningful lives are over
and that
this method of managing our dying process
would be better than
continuing all supportive care
until we die from natural causes.
(5) Receiving
gentle poison
will make the process of dying even shorter.
This
medical method of managing dying
has only been authorized in a
few places in the world.
But if the other medical methods of
managing dying
have been found unsatisfactory for any reasons,
then the doctors can recommend a gentle poison
that will
bring a quick and painless death.
In the
Netherlands, this medical method of choosing death
usually takes
the form of a lethal injection given by the doctor.
But Dutch
doctors can also prescribe death pills,
which are taken by the
patient himself or herself.
In Canada, dying patients are also selecting lethal injection
as their preferred medical assistance in dying (MAiD).
In
choosing any of these five
medical methods of managing dying,
the
most careful safeguards
should be fulfilled for each decision.
We know that any of these methods
(or any combination of
them)
will inevitably lead to our deaths.
Thus before we select the best methods of dying,
we should settle
any uncertainty about the wisdom
of dying
at this time
rather than dying
at some later time.
Is our medical condition clearly terminal?
Have we exhausted all possible medical care?
Are we ready
for death to come?
Are others at the bedside ready for us to die?
If and when we are ready to die,
we
can end the medical battle to save us from death
and surrender to
the inevitable.
What combination of these
five medical methods
of managing dying
would be best for us
and for the people
around us as we die?
Created
January 20, 2016; Revised 1-21-2016; 2-9-2016; 5-1-2016;
5-5-2016; 6-7-2016;
5-5-2017; r 6-14-2017; 8-25-2017; 3-29-2018; 7-5-2018;
This opinion article includes the following links
to detailed
explanations of each
medical
method of managing dying
(MMMD).
Here they are again:
MMMD1:
Comfort Care Only:
Easing the Passage into Death
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-INCRE.html
MMMD2:
Terminal Sedation:
Dying in Your Sleep---Guaranteed
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-TERMS.html
MMMD3:
Pulling the Plug:
A Paradigm for Life-Ending Decisions
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-PLUG.html
MMMD4:
VDD:
Why Giving Up Water is Better than
other Means of Voluntary Death
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-VD-H2.html
MMMD4:
Voluntary
Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-VDD-SG.html
MMMD5:
Gentle Poison:
The Demand for Quick Death
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-GEN-P.html
These Medical Methods of Managing Dying (MMMD)
are also discussed
in the context of a hospice service
that embraces all legal,
doctor-approved methods of dying:
Methods of
Managing Dying
in a Right-to-Die Hospice
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/METHODS.html
The safeguards for making end-of-life medical decisions
were
merely mentioned at the end of this article.
But here is a book
of over 600 pages that
explores each of 26 safeguards for
life-ending decisions:
How to Die:
Safeguards for Life-Ending Decisions
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/HTD.html
Historical note about
the numbers:
Originally this essay was called "Six Medical Methods of Managing
Dying".
What is now number 3:
—ending curative treatments and
withdrawing life-supports—
was originally listed as two separate methods.
But it is more common in medical ethics
to list these methods together, under such expressions as:
"ending life-sustaining medical treatments".
Thus, even tho these methods get separate paragraphs above,
they are numbered as one medical method of managing dying.
Here is a chapter about giving up medical treatments and life-supports:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-PLUG.html
DEATH-CERTIFICATES
SHOULD INCLUDE METHODS OF DYING
As
modern medical care acknowledges more clearly than ever before
that
we are using these medical methods of managing dying,
certificates
of death might be expanded to include a new line for
life-ending
decisions
or medical
methods of managing
dying:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/DC-LED.html