Patients win right to choose
After more than a decade of controversy and delay, an edict designed to reduce suffering in the terminally ill finally came into force last week. Under the "right to die" clause of the National Health Act, patients can now make clear their decision in advance of treatment not to receive further medication to extend their lives or to be resuscitated. A living will setting out the boundaries of treatment would be signed before witnesses and close relatives. First, though, a doctor would have to advise a patient of his or her health condition so an informed decision could be made.
This long overdue act of mercy will allow compassion and the patient's wishes to become the guiding principles of care. Up until now, a number of physicians have not allowed nature to take its course. Instead they have prolonged life without sufficient regard to its quality or the distress caused to the patient and loved ones and done so because the law required them to. By legitimising the "living will" the Public Health Ministry has provided an acceptable alternative and, with modern methods of pain management, no patient need suffer unduly.
Sadly, it does happen. There have been cases where patients diagnosed as suffering from a terminal illness have been denied adequate amounts of medication to ease their suffering. Hospitals have cited two reasons for this. First is the fear that the patient could become addicted to strong pain-relieving medications such as morphine: hardly the paramount consideration in someone diagnosed as having a terminal condition. Secondly, such strong pain-relieving medicines could, in some cases, actually hasten death, thereby placing doctors at risk of being held in technical violation of the law and recognised medical ethics.
Now, by invoking the right to die, a patient can be spared what might otherwise turn into a prolonged, financially devastating and undignified ordeal with an initial lapse into coma and then to a persistent vegetative state. Such deaths can often take a long time because of the sophistication of modern medical technology. A living will would even allow patients to die in peace in their own homes, if they felt their time had come and if that was their wish.
Much of the controversy has swirled around the mistaken belief that legal provision for a living will could pave the way for mercy-killing, assisted suicide or euthanasia. Another fear has been that vulnerable and sick people could be coerced, pressured and exploited into agreeing to end their lives for the "crime" of being old and poor, ill, disabled, or overly-dependent on family and friends. This has been countered by requiring the patient to be suffering from a terminal illness before they can invoke the "right to die".
By putting the patient's wishes first and requiring authorisation, medical staff are also protected. What happens, though, if the patient is comatose or not sufficiently alert to make their wishes known? Also open to question is the exact point at which a person is considered dead, even when he or she can be kept alive almost indefinitely on a machine. What makes the issue so complex is the sophistication of modern intensive care units where technology increasingly blurs the boundaries between life and death.
Palliative care as exemplified by hospice movements here and in Britain and the United States perform a vital public service. They allow terminally-ill patients to die with dignity and the minimum of distress. But there is a shortage here, both of beds and of funding. Given our ageing population, we cannot afford to neglect such a humane source of end of life care.
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