There are plenty of doctors to see if you’re looking for a cure. Michael Preodor is one to see if you’re not.
On a warm and sunny spring morning in Chicago, Preodor is taking care of dying patients. It is not easy or happy work, but as medical director of Horizon Hospice at St. Joseph’s Hospital, he has the satisfaction of knowing he is providing something his patients need and want–and that most such patients don’t get.
That something is a comfortable and dignified end to their lives, which Horizon’s doctors, nurses and volunteers try to achieve by treating pain, assuring all needed care and assistance, and letting patients live out their final days at home if they possibly can. Today, Preodor and a Horizon nurse are on their way to visit a 42-year-old man with AIDS and a 62-year-old man with cancer of the larynx, both of whom are still living at home, surrounded by their families.
The hospice’s mission is a departure from standard medical care, which puts far more resources into overcoming disease than helping patients whose illnesses can’t be overcome. It is also a reproach to a fashionable new idea: giving doctors the freedom to help suffering terminal patients commit suicide–or even kill patients who can’t do it themselves.
Pain is a huge but invisible public-health problem. It is particularly prevalent among terminal cancer victims, 80 percent of whom encounter serious pain before they die.
The good news is that this pain can always be controlled, usually without significant side effects. Morphine and its sister drugs are extremely effective in making these people comfortable, and if treatment is begun early, they can be administered so as to leave the patient awake and fully alert–not sedated or confused.
Says Preodor, “I had an AIDS patient who needed 1000 mg. of morphine every hour”–about 300 times the dose typically required for patients after painful gall-bladder surgery. “He was doing better with crossword puzzles than the nurses.” In some 90 percent of his cases, patients can stay at home.
The bad news is that most people facing the end don’t get the help they need. Studies suggest that despite medical advances in this area, only 20 percent to 50 percent of terminal cancer patients receive adequate pain treatment. Most are underdosed by doctors who fail to take such discomfort seriously enough or mistakenly fear the consequences of the most effective drugs. So at least a quarter of a million cancer victims have to endure serious and unnecessary pain in their passage from this world.
Patients with this burden are prone to depression, making them susceptible to the lure of suicide. Medical professionals involved in hospices fear that legalizing physician-assisted suicide will distract attention from the need for better palliative care by providing a cheap shortcut. Supporters of assisted suicide, in fact, often argue that it spares patients from what amounts to physical torture. Their option, however, would shorten the lives of those who would rather die quickly than endure unremitting agony but who could be spared either fate.
Preodor says he has never had a patient commit suicide, though some talk about it. “Most are receptive to staying alive once they know they’ll be taken care of,” he says. What hospice personnel have learned, he says, is that “if we control the pain, we can allow patients what they need to go through with their families, friends and churches.”
Allowing access to assisted suicide without first assuring the availability of good palliative care is addressing the problem backward. The tools for treating terminal-cancer pain have been available for decades, yet doctors have made no apparent progress in using them.
They assume that patients will become addicted to morphine, which turns out not to be a danger. They fear that morphine will hasten death, which it doesn’t when given properly. They worry about scrutiny from the government if they write too many morphine prescriptions, a concern that may be justified.
And they generally place too little emphasis on helping patients who cannot be saved. Preodor says that 95 percent of articles published in medical journals on cancer care deal with possible new cures, not methods to minimize the suffering of terminal patients. Likewise with AIDS. Research dollars are allocated in roughly the same proportions. “It’s a societal thing,” he says. “We value conquering disease.”
Yes, we do, and when we can’t stop disease, we are tempted to pre-empt it by using artificial means to hasten death. Good palliative care offers an alternative: not prolonging life pointlessly, but making the most of the time each dying person has left. Better to kill pain than to kill patients.
