August 20, 2009

Right to Refuse

We've been talking a lot about death and life this week - I know, the first week of medical school and we literally just dive right into the deep stuff - but it's made me think a lot about what the right to die means, and what it means for me.

So in this country, we have not a right to die, but a right to refuse life-saving treatment. There have been several court cases guarenteeing consenting adults' right to refuse life saving treatment. In two states, Washington and Oregan, it is legal for physicians to prescribe a lethal dose of a medication to terminally ill patients, but those patients have to take the medication orally themselves.

As part of this class, we had to fill out our own advanced directives or "living wills". At first I was a bit petrified to do this and even though I'm in medical school, I'm not so interested in thinking about death, especially my own. But this class made me realize that that fear - of mortality of our patients and especially our own - can result in physicians avoiding taking care of patients completely when they are close to dying or not telling patients the whole truth about the progression of their illness. I feel that becoming comfortable with the concept of good deaths and bad deaths is something that is very important for physicians-in-training - and knowing how to make sure the decisions of the patient are being secured is the first step. Additionally, giving a patient all the information s/he wants about her/his own health care is something I feel really strongly about - there are very few reasons other people should know things about your body that you are not allowed to know.

I ended up filling out my advanced directive and talking about it with my family and friends - I realized that if someone I love does have to make really hard decisions about how to care for me if I am incapacitated, I want them to know that they are making the decisions I would want them to make. There's enough that's hard about losing someone you love, guilt about making them comfortable should not be part of it.

For more info on advanced directive terminology and to learn how to write your own:
The American Academy of Family Physicians info sheet

A Great Wall Street Journal Health Blog Article on AD:

For more info on palliative care (which is different from hospice care) see a recent New York Times Article on Palliative Care

“I would like a doctor who is not only a talented physician, but a bit of a metaphysician, too. Someone who can treat body and soul…I want a metaphysical [person] to keep me company. To get to my body, my doctor has to get to my character. He has to go through my soul”
– Anatole Broyard in Intoxicated by My Illness

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