The Dying Patient

The Daily Telegraph, a UK paper has this health article posted on their website.  The title is Hospitals "letting patients die to save money".  It should not surprise me since euthanasia seems to be a desirable option now-a-days for people in more developed countries who does not want to suffer from a debilitating or terminal illness.  But still, news like this continue to surprise me simply because I believe in the sanctity of life and no one, absolutely no one has a right to take it away. 

The article talks about "The Liverpool Care Pathway, so called because it was developed at the Royal Liverpool Hospital in the 1990s, aims to ensure that patients who are close to death can die without being subjected to unnecessary interference by staff. In addition to the withdrawal of fluid and medication, patients can be placed on sedation until they die".  Supporters of  this say it is the kindest way of letting dying patients slip away.  But there are some UK doctors who suspect that this is not the only reason, but also the fact that prolonged care for dying patients stretches hospital budgets, and so when these patients die earlier, money can be saved.  When money and not comfort becomes the motivating factor, then the process becomes unethical and immoral.

Although I would agree that dying patients or those who are terminally ill and who would no longer benefit from any kind of treatment should not be subjected to further medical interventions, I would draw the line from removing supportive care like food and fluids. When our patients or their families sign a DNR (do not resuscitate), it does not mean that they are asking us to stop giving them comfort, care and attention. This care includes giving them food and water when they want it. Withholding these will not make them comfortable, rather add more distress.  We are still their doctors and nurses till the end. 

"God only knows"

When I was a medical clerk, at times when we had difficult cases, we would jokingly say that the diagnosis was GOK or "God only knows". Today I say that to families of dying patients when I am asked by them how much time their loved ones have...only God knows.  One of the things I remember from some of our consultants was their predilection of giving a time frame as to when a patient may die.  They would tell us that this or that patient has 3 or 6 months to live and we, students would knowingly nod our heads. But more often than not, they were wrong.  My grandmother was diagnosed with stage 4 Breast CA in November 1988 and was "given" 3-6 months more to live. She called all her family to place everything in order.  Almost two years later, she was still alive, in spite of not having undergone any treatment for her cancer, and so realizing she was not going to die anytime soon, she decided to move back to the province together with her handicapped daughter (my aunt), building a small house besides us.  During the last 2 weeks of her life, my grandmother continued to eat when she wanted to and she agreed to a feeding tube when she became too weak to swallow. She was asleep most of the time but during moments when she was awake, she was coherent and would even joke about me losing weight by the time she dies. She had vivid dreams of my grandfather (who passed away in 1964) and would sometimes impatiently ask God to take her already.  After spending four of the happiest months in her life (that is what she told me), she passed away peacefully in October 1990.

If there was one important thing I learned from all these, it is that no human can predict death and that we should never be afraid of it. But when the time comes, God will be there to take us home with Him.