Terminal Cancer and Euthanasia

Leafing through an old keepsake catalogue from the Van Gogh Museum.  It was bookmarked at the "Raising of Lazarus" because, as remembered now, it reminded me of a Prof who could never quit. 

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Impending demise, or when the end is in sight.  This does not refer to all cases of far-advanced incurable cancer– just those unfortunates whose deaths are expected very soon.

After working all these years in this country, it still boggles the mind that many relatives AND doctors resist opiate therapy at that late stage. These well-meaning folk usually have an overriding fear of the suppression of breathing and consciousness.  Unfortunately, its the patient who pays the terrible costs of a terminal disease rampage.  Palliative care being within the spectrum of cancer treatment, its the patient who's prioritized, not the others around his deathbed.  So, unless the patient specifies otherwise…

Now remembering the first time that I gave a morphine drip laced with tranquilizers to alleviate the labored breathing of a lung cancer patient in Manila.  This was years ago, shortly after my return from training.  I discussed respirator support, advised the patient of its futility, and offered the alternative of symptom control through opiates at the price of its secondary effects.  He gestured his choices and, in no time, we had a signed living will.  He died the next day.  I then got a lot of flak from the relatives for my "overly frank talk", and from the doctors for "practising euthanasia".  At that point, I even had to go into the fine points about the differences between active and passive euthanasia, the principle of double effect, the uses of a living will, and the objectives of palliative care in the terminally ill. 

Luckily (for my peace of mind), soon after he was relieved of severe breathlessness and before he became comatose from lack of oxygen, the patient had actually spoken up to thank me.