By Ranjana Srivastava in the Journal of the American Medical Association (JAMA) (registration required): A first-person piece about a doctor’s encounter with a terminal cancer patient who asks for help in planning her death. The interaction is disturbing for the doctor precisely because she finds the patient’s request so reasonable.

I am stunned by her cold logic yet captivated by its lucidity. She is thinking aloud what has crossed the minds of anyone, physician or patient, who has witnessed the trail of emotional and physical destruction that a terminal illness often lays down.

… “Physician-assisted suicide is illegal here,” I restate more loudly than necessary. I need to hear myself say it because I also need to say what comes next: “I can see that you are fearful about your future.”

… “You understand my fear because you have seen lives become untenable. You know I am right.” Subtle accusation and stern conviction are finely mixed in the statement, so gently delivered yet hitting hard. I have often felt uncomfortable but never so insecure in the presence of a patient. I feel powerless, swimming hard against a mighty current but partially tempted to just succumb to it. I recoil at the horror of even contemplating euthanasia, mainly because it goes against the grain of everything I was taught as a physician. All I ever learned was that it was decried by the jury of one’s peers and punishable by law. But then, why can I not dismiss outright her request as absurd? Why do I find her argument compelling? How could I possibly see shades of my own reasoning in hers? I feel trapped between what the law dictates and my conscience suggests.

… What do we say to patients like her? Do we dismiss out of hand their call for assistance beyond that which we are capable of or willing to provide? Or do we subject ourselves to deep soul-searching at the expense of creating chaos within? Can we trust ourselves to weigh the nuances with the sagacity and deliberation that this irrevocable act demands? And then, if the conscience is torn between professional obligation and personal conviction, will the profession find it in its heart to counsel and comfort, or will it disown those who venture into the unknown?

My response to this patient’s request was visceral in its intensity. I would be concerned if it were anything but. However, what troubles me is that I did not find her argument unreasonable or worthy of dissuasion. Today, I can obscure my haplessness by quoting the law. But how much longer will my respite last?

This entry was posted on Tuesday, December 25th, 2007 at 4:27 pm and is filed under assisted suicide, cancer, chronic illness, euthanasia, first-person, medicine, personal stories. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.  Email This Post