By Dr. Thomas LaGrelius
Today one of my long-standing seniors patients asked me if I did “P.A.D.” I looked confused, so he explained it stood for “Physician Assisted Death”.
His direct question caught me off guard. I was not prepared to answer.
My patient, now in his mid 90s, had worked full time at his demanding profession into his late 80s. Had health allowed, I believe he would have never retired. He remains very active now. He does have significant, but non life-threatening medical conditions that are management challenges for him and me.
Though clear-headed and quite independent, he thinks about end-of-life issues. He wants to deal with that, as he has every prior aspect of his fascinating life, on his own terms. He wants assurance that if he chooses to go at his own time, the medical profession will help him.
This is a question I always dealt with before by saying, “Such an act is illegal in California. I would lose my medical license, and worse.”
That is no longer true. Physician-assisted death is now legal in California. In 2017, the first full year the California Physician Assisted Death law was in effect, 374 Californians ended their lives by self administering a physician prescribed drug combination.
The idea actually makes me shudder.
The unwritten compact between physician and patient looks clear to me. The oath I took would seem to prohibit me from ending a life in this manner, regardless of what the legislature has done. It’s something most doctors assume is not their role, and most patients quite properly assume their doctor seeks only their good health.
On a distantly related subject, many physician agree that early pregnancy termination should be allowed, but some aren’t willing to perform the procedures. However, they are willing to refer to doctors who do, and on physician-assisted suicide, so am I, if I can find them. A year ago I was unable to find a resource for a terminally ill patient, who ultimately passed away in the comfort on hospice.
I do run hospice programs for my patients when needed, and I make sure the patients do not suffer, but that is not the point. Patients seeking physician-assisted suicide want to be clear and lucid when they decide to die on their own terms, still in relatively good shape. Hospice is offered much later and may not really provide this.
These issues have become more personal to me recently. My older sister died on Dec. 1 in Seattle. When I was little she was my “great protector” big sister, and her loss leaves a hole in our family and my heart. She was only seventy-eight, but aged much faster than others in the family. She had become weak and malnourished. For the most part she had refused medical care so nobody knew exactly what she died of. She belonged to an HMO and was on hospice, but a solid diagnosis was lacking. Hospice did keep her comfortable. She never asked for physician-assisted death and would have refused it.
All my life, disease and death have been the enemy. I cannot imagine actually assisting in a suicide. As with the pregnancy termination issue however, we must find referral resources for our patients when and if that is their choice. That may not be easy, but most physicians are determined to be with and support their patients emotionally throughout any process, whatever they choose.
On a more positive note, we would rather offer PAL. – Physician Assisted Life. Our primary role is to cure and control disease, prolong life-span and more importantly “health-span”, as well as to relieve suffering when possible. I look forward to the day when chronic, frustrating diseases like Parkinson’s and Alzheimer’s, and the aging process itself are defeated. I am convinced that day will come in the lifetimes of some of us, and I am slow to give in and give up. I have seen many cures suddenly come along for once incurable diseases, and we never know what research breakthrough is just around the corner.
For example, there has been great progress recently on anti-aging research, and the curve of further progress is exponentially rising. Medical researchers are working on behavior changes and cocktails of, so far, about seven drugs, called “senolytics” because they deal with destruction “lysis” and slow or halt some of the disease processes associated with age. These therapies could double human life and health-span, and this research is barely in its infancy. Some of these medications are in use for other purposes now, such as metformin for diabetes and rapamycin to prevent transplant rejection. For an expanded discussion of the subject, go to cbi.nlm.nih.gov
I am confident we will one day reverse the degenerative diseases of aging, and patients will ask for and receive P.A.L., rather than P.A.D. To some extent, we are already doing that. I find this incredibly exciting. However, end of life issues will always be with us, even if potential human life expectancy eventually doubles.
I wish all of you a happy, healthy 2019, and I look forward to the days when medical science, step by step, defeats the age old enemies of disease, aging and death. The future is unlimited.
Live long, be well,
Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance www.skyparkpfc.com. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital. Email questions and topic suggestions to email@example.com
Source: Orange County Register