Euthanasia: Part 2

One of the key features of end of life care is knowing what is reversible and what is irreversible. And adjunctively, it is essential to know that this is an ever-moving, immovable target: that what is irreversible today may be reversible in the future, but that dying will likely always supersede at some point. It is unlikely that we are meant for immortality in human form, and in really coming to accept this idea, we understand that there is no such thing as time - decades could pass, or centuries; ultimately, we still need to die.

But this basic inevitability does not mean we should grossly misunderstand the process, render it black and white. Dying is not a superficial experience. Refining one’s knowledge about what is reversible and irreversible in every moment in time takes practice and humble open-mindedness. It is indeed possible to take what another unknowing clinician would deem irreversible, and push it out to make it “irreversible” in the near-term (days to weeks), and “irreversible” in the longer term (months to years). I have had those cases.

Two such cases occurred recently. Both cases were fulminant respiratory failures in the ICU setting. In both cases, the attending physicians had stated the patient could not go home, and would need to be decelerated inpatient. In taking over the care (hospice with GIP level of care) and building a cautious and tailored regimen for both patients, we were able to get both individuals home. The first patient, who had metastatic cancer, lived another two weeks, and was able to spend incredible quality time with family and friends. The other patient is still doing well, being managed with a carefully curated regimen.

This is what a dedicated understanding of mortality yields, the ability to give some shape to the trajectory of death. We certainly cannot stop the ultimate outcome, even in attempting to prolong it as much as possible. But we can shape the trajectory, and in doing so, with full recognition of what is going on, can offer patients and their families an alternative to heavy-handed inpatient euthanasia. We can take breathless patients who were told that they were destined to die in the hospital, and bring them comfortably home, to where most patients would like to be in taking their last breath.

This is why the idea of euthanasia can be problematic. It misses the mark in terms of medicating, aiming to depart from following the true trajectory of dying. In my estimation, most patients do not need any form of euthanizing; they only need an extremely dedicated and dynamic regimen which anticipates their next move along the trajectory of death. If the regimen is on point, and continues to be on point, and the clinician is vigilant and tailoring according to what is being declared, there will be no need for hitting a nail with a sledgehammer.