Euthanasia, Pain Management, and Polls

by P J King, RN
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Results of a poll conducted by the American Medical Association (AMA) were released January 6, 1997. The survey was conducted nationwide by Global Strategy Group, New York City, and has a +/- 3.1% margin of error at the 95% confidence level, for those of you who understand all that.

In a nutshell, what the survey found was that people change their minds about assisted suicide when they have all the facts. Or, in other words: don't jump to conclusions when you read the latest poll informing you that 70% (or whatever) of all Americans want physician-assisted death. Those figures would drop drastically if those surveyed were informed first of their options.

This news doesn't surprise me. Two or three years ago I read in an IAETF Update that a team of surveyors inadvertently learned that people changed their minds when informed of the facts. (Since this is informal, I won't try to find the specific issue. Write me if you want to know.) The team's mission was to learn what it was that people most needed to know about assisted suicide and euthanasia, so that an effective video could be produced to meet that need. In the course of a 20-minute interview, a significant percentage of people changed their minds about the practice merely through being questioned! (The resulting video is called "Euthanasia: False Light" and is very effective.)

The AMA poll reveals that, five-to-one, Americans, when fully informed of available options, would choose comfort care and natural death over "death assistance."

The death peddlars paint gruesome pictures of people helplessly dying in agony. Who wouldn't be afraid of dying like that?

The truth is, however, that palliative care available for the dying right now makes such an end merely a piece of horror fiction for the vast majority. Palliative care, for those of you who might not know, is care with the goal of comfort, not cure, when cure is no longer possible.

The most visible organization devoted to palliative care is Hospice. I thought everyone knew about Hospice. Apparently not. Hospice philosophy begins with the premise that every person should be allowed, when his time comes, to die without the intrusion of unwanted and futile technology, in the presence of those who love him, in comfort and dignity, in his own home if he wishes. Furthermore, Hospice care forces nothing on him he does not want; he makes his own decisions and plans, and Hospice is there to see that they are carried out.

Although I work in a nursing home, not for Hospice, without exception the deaths I have seen have been comfortable, peaceful, and dignified. A few nights ago I had occasion to speak with a Hospice nurse with a lifetime of experience. I asked her if she had ever seen a person die in pain. Her answer? "Not even once."

This is the reality. But it's a reality that has been hidden from us in our culture in which death is all but denied. Grampa goes to the hospital. A few days later the children are told that Grampa has gone to heaven to be with Jesus and won't be coming back (or whatever unbelievers tell their children). The children may not even be allowed to attend the funeral. In any case, in the majority of instances people die in an institution, not at home. In the day when the opposite was true, children grew up with death. Death was part of life. Not welcome exactly, but not a stranger either.

Things have changed. Most of us are more or less insulated from dying. When we must think about it, we fear it. We fear pain, we fear loss of control. And so most people are suckers for those who would give us away "around" death.

These days we're haunted too by the prospect of "being hooked up to all those machines and tubes." Technology is no substitute for human contact when dying. Unfortunately, this fear is not without basis, as has been demonstrated by various studies. But forewarned is forearmed: it need not happen that way if our families and doctors understand fully our wishes to avoid such an end.

The AMA study revealed, among other things, that 43% of Americans did not know it is legal and medically permitted for a physician to provide pain medication which may unintentionally hasten death. (Note the word "intention." Your doctor's aim is to relieve your pain, not to kill you. And he is willing -- or should be -- to give you what you need to relieve that pain in your last hours, even at some risk of inadvertently hastening your last breath by a few minutes.)

Before having it explained to them, it was found that the terms "hospice care" and "palliative care" were not familiar to a full 35% of Americans. After these options were described to them, only 14% chose physician-assisted death as the way they would want to go should they become terminally ill.

People were also woefully uninformed about the true situation in The Netherlands, our only present model of euthanasia. When those surveyed were given the specifics, 76% were unwilling to support the rate of physician-assisted suicide and euthanasia (and unrequested euthanasia) deaths that actually occur there.

When all options were known, a plurality (40%) would elect hospice or palliative care, 33% would die naturally, without medical assistance. Only 14% would choose physician assistance in dying and another 14% were undecided. Quite an eye-opener, eh?

One hears much talk of patients' rights. Unless we're doctors, we don't stop to think of the physician's viewpoint. Nancy W. Dickey, M.D., AMA board chairman has this to say: "Are Americans willing to allow a slim minority of the population who might want physician-assisted suicide drive public policy for the rest of the nation -- the majority of whom do not want this option for themselves?... As a physician, my obligation to do what is in the best interests of all of my patients far outweighs any obligation put upon me by patients who feel more empowered by an ability to obtain death on demand."

SOURCE: "AMA Poll: Most Americans Would Not Choose...," COMTEX Newswire 1/7/97, provided by Peter C. Bennett, The Issachar Project, e-mail

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Posted 9 Sep 2000

Copyright 1997 by P J King
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