19 Nov, 08 | by BMJ Group
Debbie Purdy, a 45 year old woman with progressive multiple sclerosis, failed in her bid last month to be able to end her life when her excruciating symptoms become unbearable for her. When the time comes, she wants her husband to accompany her to Dignitas, a Swiss clinic, which will prescribe a lethal dose of barbiturates, thus sparing her a life of suffering that she finds not worth living. Mercy killing is forbidden in Britain and most European countries, but not in Switzerland. Debbie Purdy wants to leave behind something meaningful; she does not want her legacy to be her husband ending up in prison. So she asked the Director of Public Prosecutions to define just what her husband could do for her on the final journey to Switzerland, without later being prosecuted.
Had she gained permission to get assistance from her husband on her way to Switzerland, her case may have been politically manipulated to influence the discussion of what constitutes a life worth living. Legitimising suicide is the end point that courts want to refute. Failure to react to her plea, however, highlights how modern medicine sometimes disregards one of its pillars: the relief of human suffering. Alleviating the strain that diseases put on patients is what doctors do on a daily basis. But alleviating painful conditions when the term “end of life” enters the picture changes the agenda altogether.
A visit to my nearby supermarket with several thousand brilliantly coloured vegetables on display gave me a sudden insight. Immediately ahead of me in the queue at the till, a teenage boy, whom I personally know – reached for a quadrangular box, in turn handing a few coins. No questions were asked and the chiming coins exchanged. The boy, his newly purchased cigarettes, and any opportunity for health-directed preventive behaviour on the part of the cashier, at once disappeared. I was left contemplating that legally wrong, morally disastrous and insalubrious incident—surely the mere tip of an iceberg?
At first glance, Debbie Purdy and the teenager illegally buying cigarettes are worlds apart. The 17-year-old seems to be in rude health, his body fast maturing into a man’s, whereas for 10 years or so Debbie has been confronting some of MS’s most malicious symptoms, her paralysis challenging even the most basic activities. The cigarettes would not impair the teen’s life any more than they would yours and mine when we passively inhale chemicals getting around in our cities—at least not in the short run.
In contrast, Debbie intends to request that lethal barbiturates be administered to her, a decision that will seal her fate.
However, the two cases have many parallels. In both, a person, a “bystander,” assists another to ruin or completely extinguish his or her health. The boy (and possibly many of his peers) is led into an addictive habit, the number one preventable cause of death worldwide, destroying his vital organs and probably shortening his life span as well as the quality of his life.
What would strike you as more wrong: someone’s insistent request for the humane cessation of a disease’s torment, or actively helping to expose someone to cigarettes, alcohol, sunbeds, etc? Society has, by and large, chosen the first option as the unacceptable public – and medical – demeanor that demands continuous and tight regulation. But why is there turmoil when end-of-life arguments are discussed, and silence when people are unnecessarily provided with health-eroding products?
The conventional life-death division that is common in medicine is not the only paradigm we should bear in mind when treating patients. Health-disease-death may be more appropriate in certain medical circumstances. Rather than invest the lion’s share of our resources and energy in the final moments of a person’s life, serious attention should be directed at the supported erosion of a person’s health at much earlier stages. The fundamentals of medicine postulate that it is illegal to “aid, abet, counsel or procure the suicide of another,” in the words of the 1961 UK Suicide Act. Where does that leave tobacco companies and their activities?
Relieving human suffering is pointed out as a priority for doctors. Why does the elimination of sources of future suffering matter less? Such interventions have substantial potential. Individuals’ quality of life as well as their number of disease-free years will be positively affected.
Deciding which patients might benefit from being assisted to die will forever be a problem for ethicists and medical practitioners. Human suffering is an immeasurable entity, hard to define for both its objective and variable nature of assessment. The gradual advancements seen in the field of palliative medicine make the typical end-of-life scenario all the more complicated. Nevertheless, the obvious ramifications to health that result directly from knowingly supplying a “pro-disease pill” must be dealt with more drastically. It must be made crystal clear that contributing to the erosion of one’s health is not an invisible, repercussion-free action, but one that has consequences that are both preventable and initially reversible. No one should be able to buy the tools of their own destruction in a supermarket.
Ohad Oren is a fourth year medical student at Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel.