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No avoiding death and taxes for Washington State voters
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Ben Franklin, one of our first American statesmen, said that there's nothing certain in this world other than death and taxes. Washington State voters will look squarely at both this election.
While paying taxes is part of your day-to-day life, chances are good that your experience with death is limited. Sure, you may have lost a beloved pet. Still most adults have never seen a dead human body, and surprising numbers of people have never attended a funeral. The fact that we all die seems to be our dirty little secret we keep hidden away. Who knows--maybe you'll be the first person to escape the clutches of death.
Initiative 1000 that will appear on the November ballot would allow terminally ill patients to legally obtain lethal doses of prescription drugs for ending their own lives. Only one other state in the nation--our neighbor Oregon--has a similar law.
The physician in me wonders if this is a band aid measure responding to a symptom when the better choice is treating the underlying cause.
I believe that there are five factors driving this legislation.
The primary reason that voters would vote yes to Initiative 1000 is a response to the fear that they will spend their dying days with uncontrolled pain and suffering. You may have even witnessed a loved one going through an anguished death.
Uncontrolled pain at the end of life is a real and legitimate concern. The inadequate treatment of pain in patients with both terminal and chronic disease is well described. Current studies suggest that up to 70% of cancer patients have pain that could be controlled with more aggressive treatment.
How and why could this be? Factors from both sides of the doctor-patient relationship contribute to this tragic reality.
Patients have been taught to fear narcotics; it's part of the war on drugs. A colleague from England tells me that heroin may be more effective than morphine in the treatment of angina--the pain from the oxygen-starved heart. The very word heroin elicits strong emotional responses and creates dark images of the underbelly of society.
I've had patients who know that they are in their final weeks of life express concern that they will become addicted to the pain medication. Logic suggests that this is not a rational, well-considered response. However, the response to pain and pain medication is based in emotion rather than logic.
Health care professionals who administer pain medication know that narcotics are not without risk. A high dose of narcotics can shut down the center of the brain that controls breathing. Every nurse and doctor fears that the medication that will end the pain will also end life. In an effort to first do no harm, pain is undertreated rather than risking lethal consequences of overtreatment or even adequate treatment.
So, in a twist of irony, the fear of over treating pain and causing a patient's death--choosing pain over death-- leads to legislation that allows patients to choose death over pain.
We all share the same vision. We all want patients to have a peaceful comfortable end of life. I would much rather achieve this vision by making a commitment to more effective pain management than by legislating the way doctors and patients work together.
The medical community is making steps towards a more enlightened approach to pain management. In many medical centers, the patient's pain score is the fifth vital sign joining temperature, blood pressure, heart rate and respiratory rate. As they say, if you want to change it, measure it.
How about if patients were coached to tell their doctors about inadequately-controlled pain rather than assuming the pain cannot be treated and suffering in silence?
While the fear of uncontrolled pain at the end of life is the most compelling reason that voters will say yes to this initiative, stay tuned for four other.
Vicki Rackner MD is described as the "Suze Orman of Health." She's a surgeon who left the operating room to help patients and their family caregivers manage their health through her company Medical Bridges . Dr. Rackner helps both individuals and businesses stretch their health care dollars through better doctor-patient collaboration. To get your free special report The Biggest Skeleton in Your Doctor's Closet, write DrRackner@MedicalBridges.com or call 425 451-3777.
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