Wednesday, November 19, 2014

On Death with Dignity

We take the will to live as a positive attribute, and naturally so; it is, of course in our genes.  Whatever subset of our species took a lackadaisical view toward the prospect of death was screened out long ago. We look with admiration on those who battle against terminal illness --  “She’s a real fighter” -- and look down on those who take their own lives. Fighting for your life is the genetic prime directive.   


Thus the recent death of Brittany Maynard spurred a flurry of news articles and posts on the Death with Dignity movement. There will be a lot more to come on this topic, and the movement will gather steam because whatever is in the crosshairs of the baby boomers weighs down on society as a whole. Soon the baby boomers will come to the last stage of their demographic wave, a wave that has progressed and altered society as it has moved through their life cycle, from crowding elementary schools into split session, to overcrowding colleges, to buying houses to retiring. The last area they can affect is the mode of dying, so this will become a topic we will increasingly hear about over the next few decades.  And ultimately some form of Death with Dignity will become standard in the US.  


I have weighed in on another medical issues in one of my past posts, making the controversial suggestion that people be compensated for some of the savings incurred if they select a cheaper but less efficacious course of treatment. Here I am going to barrel ahead with another one: a short vignette where I place the alternative to Death with Dignity in a disturbing but I hope illuminating context, that of a torturer and victim.  The victim is the one struggling with a painful, debilitating terminal illness.  The torturer is in part nature, in part the social norms that insist death proceed along its natural course, and in part the medical community that might be taking the Hippocratic Oath too literally. (And that, unfortunately, has a conflict of interest in keeping a dying patient in their revenue stream):


A particularly invidious development in techniques for torture, more common than many realize -- or are willing to admit -- starts with inducing periods of searing pain while a physician stands at the ready to assure the victim does not succumb to the torture and die prematurely, and indeed that he remains as alert as possible.  I mention dying prematurely because the spectre of death is another standard component of this brand of torture.  At the start, the victim is advised that no matter what transpires, the process will end in death.  Indeed, there is a program for increasing the stages of torture until death occurs. This program is determined before the torture has begun. The victim is given only a rough estimate of when termination will occur; the randomization is added so the victim remains in a state of uncertainty; this to add a psychological element to the torture.


The torture has been “improved” over time to match the physical pain with other aspects of psychological terror.  Probes are skillfully inserted into the victim’s brain, and slowly but steadily the victim’s motor skills are degraded.  Depending on the approach, this can occur by sequentially inducing paralysis -- first by subtle tremor, then seizures, and eventually ending in full paralysis, starting with the extremities, but then moving to the bowels and finally the lungs.  (This is a more clinically desirable replacement for the old school method of dismembering the extremities one at a time; the effect is functionally the same, but can be controlled to progress in a more psychologically devastating manner). More recently, thanks to better mapping of the brain, the degradation of motor skills has been accompanied by degradation of mental abilities, ranging from memory and speech to broader cognitive function. (Which, of course, cannot be allowed to progress too far too quickly, lest it inhibit the victim's awareness).


A common practice is to force the victim’s family members to observe the torture at every step, and even to encourage them to try to comfort the victim, but of course this is done with little effect as the torturer progresses the pain and dysfunction toward its inevitable end. Essentially this leads the victim to be tortured a second time at each stage, because he is left to observe his family’s helplessness in seeing what is transpiring, adding another clever wrinkle to this carefully developed strategy.


There comes a point where the victim and his loved ones plead with the torturer to bring it to its inevitable end, to speed up the clock that is set to bring the drama to its close.  But this falls on deaf ears; that would defeat the whole point.  There is no early exit from the meticulously planned progression.


And yet another wrinkle is being considered, though still under research and subject to the approval by the ethics board under which the torture establishment operates. In the room, which, despite its clinical appearance and ongoing medical support, we literally can term a torture chamber, is a switch that a loved one can pull to speed up the termination. But this is effectuated at the peril of incarceration. So now the drama is confounded: the victim has to absorb the torture to protect his loved one, the loved one is torn to save the victim while sacrificing herself.  

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