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Thoughts on Living and Dying

http://www.healthzone.ca/health/newsfeatures/article/729852–man-thought-in-coma-for-23-years-was-conscious

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The above article appears in the Toronto Star today. It is about a car crash victim, Rom Houben, who was thought to be in a vegetative state for 23 years, when in fact he was conscious the entire time. I can’t imagine the horror of being trapped in one’s own mind, unable to communicate.

The article raises a lot of important questions about the fallibility of the medical profession and the depth of suffering that can occur when doctors get it wrong, but I was even more interested in one of the comments written by a reader.

borisb said: “It’s scary to think of the implications such cases have for euthanasia (which is a person killing another person, as opposed to assisted suicide which is a person killing themselves under supervision). The same people advocating the abolition of death penalties should be equally vigilant about euthanasia – for all the same reasons.”

I have always been an advocate of assisted suicide.  I believe that people should be able to make their own determinations about whether they have an acceptable quality of life, and if not, they should be able to choose to die with dignity on their own terms.  However, it’s an incredibly serious and difficult decision to make, both for the person who wishes to die and for those who are asked to assist.  Here are some of the questions that come up for me:

-What if the person is suffering from depression or other mental health issues when they say they want to die?  How can we know for sure?  If depression is a factor, should some effort be made to treat it before moving ahead with an assisted suicide?

-What support and preparation can be offered to those people who are helping their loved one to die?  Even if someone felt that it was absolutely the right thing to do, I can’t imagine the psychological/emotional repercussions that would come with participating in the death of a friend/lover/family member.  Since assisted suicide is illegal in this country, who would one go to to ask for advice, emotional support or after-care?  It seems like it would be an isolating experience.

-What if someone has been improperly diagnosed with a fatal illness?  Doctors aren’t perfect, as this article poignantly illustrates.  I remember reading a story about a woman who was diagnosed with Multiple Sclerosis, as she displayed all of the symptoms.  Her suffering was so intense that she asked her daughter to help her end her life.  Her daughter complied, but when an autopsy was done after her death it came out that she didn’t have MS, and was a physically health person.  She had a somatoform disorder, a psychological condition in which one is so convinced they have an illness that they begin to manifest the organic symptoms.  I’m not saying this is common, but it is certainly disturbing. I can’t imagine the toll it took on this woman’s daughter, whose only desire had been to help her mother.

Euthanasia seems fraught with even more pitfalls.  In this case, often family members are making decisions for their loved one,who due to illness is unable to communicate or advocate on his/her own behalf.  Not only that, they are forced to make this choice at a time when they are suffering from extreme grief and stress.

-How do we know if someone’s suffering outweighs their desire to live, if they are unable to tell us?

-If one of the many dangers of the death penalty is the risk of killing an innocent person, then certainly the greatest risk of euthanasia is killing a person who doesn’t want to die.  What safeguards can be put in place to ensure this doesn’t happen?  Is it enough to have someone write a document outlining what they want to happen to them should they become seriously ill?  Can we be sure that someone’s wishes in healthier times will stay the same when they are close to death?

I have no answers, only questions.  I would love to hear other people’s thoughts on this.

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