By Dr Patrick Kee /
The topic of death and dying is taboo to many of us. Some feel it is bad luck to talk about dying. Others are just very fearful about the subject of death. We prefer to focus our attention on the gifts of longevity and healing. Medical advances in the treatment of diseases have blinded us to the reality that death is our common and final destiny. No matter how young or old, how rich or poor, we will all die one day — sooner or later! [1]
There is also much confusion between euthanasia, physician assisted suicide and the advance medical directive. Terms like active and passive euthanasia further confuse the difference between euthanasia and end of life care that is based on common sense and compassion.
The objective of the advance medical directive is NOT euthanasia but to ensure that doctors will not carry out FUTILE medical interventions against the wishes of the patients who are at the end of life as well as to protect doctors from families who insist on futile treatments.
Euthanasia or physician assisted suicide is the ACTIVE termination of a life in a patient who is NOT at the end of life on the pretext of ending suffering. It is in fact an act of assisted suicide which is no different from the suicide of a person suffering from depression. However, discontinuation of futile medical treatment is NOT passive euthanasia — it is common sense and compassionate end of life care.
Ars Moriendi – The Art Of Dying
To live well, we need to learn to face death and to see death as a part of life. We need to “befriend” death so that our deaths will bear the fruit of love, joy and peace in the lives of those we leave behind. But this is a far cry from choosing death as a way out of our suffering and problems in life through euthanasia or suicide which saddles loved ones left behind with the burden of guilt, anger and resentment.
Caring for the elderly and the dying have taught me many lessons about death and dying. So often, it is in our dying that we find true life. To find meaning in suffering and to face the reality of death we need to change our mindsets towards suffering and life. We have lost the art of dying in our modern society. We do not know how to prepare for death. Many have been seduced by the proponents of euthanasia that a quick and easy death is a good death. The psychosociospiritual dimensions of dying are often neglected. Dying is ultimately a spiritual event — a movement from the dusk of the physical process of dying through the dark night of death to the dawn of a new life in the spiritual realm. [2]
The real question before our death, according to Henri Nouwen, is not, “How much can I still accomplish, or how much influence can I still exert?” but “How can I live so that I can continue to be fruitful when I am no longer here among my family and friends?” [3]
We are all born to die but human beings, unlike the other animals, have a sense of eternity in their hearts. Deep within us we know that there is something beyond the grave. We are spiritual beings and not mere robots programmed by a bag of genes. If we want to die well, we need to live every day as if it is our last day — one day we will be right and we will be ready. More importantly, when we live each day as our last, we will find each day worth living as we do something special for ourselves and for others. When we do so each day and every day, we will add life to our days instead trying to add years to our lives.
Euthanasia – A Symptom Not A Solution
Euthanasia is more of a symptom, a cry for help, rather than the solution to suffering. From my experience in caring for the dying, it is important to understand the three different messages we hear from those who are asking for euthanasia:
- Let me die
- I want to die
- Kill me
Let me die:
The elderly sick often request that they be allowed to die. Such requests are not requests for euthanasia but a healthy acceptance of death and a communication to their loved ones that they are on the last mile of their life. Their decisions against any active medical interventions that cause distress should be respected and acceded to. Surely common sense should dictate that the dying should not be subjected to unnecessary and futile interventions such as NG tube feeding, IV drips, ventilators, etc.
An old lady with cancer expressed her wish for an early death. I told her that she was in fact dying and that her time would not be long. She thanked me for giving what many assume is “bad news” but which was good news to her! Her primary concern was that she would be a burden to the family. She asked if I could give her an injection to end her life. However she did not have much physical pain. I assured her that we would not do anything to prolong her dying but we would do all we could to help her live each day as well as she could without pain. She was comforted by this assurance and by the fact that her days were numbered.
I want to die:
Another group of patients may tell us that they want to die. Again, such requests are not really requests for euthanasia but expressions of the suffering that they are going through. What they need urgently is the relief of their physical and emotional suffering rather than assisted suicide. With all the modern drugs and our modern technology, physical pain and even physical disability need not be a reason for suicide.
A man suffering from metastatic cancer of the prostate was physically well when he was told that there is no more treatment available for his cancer. He struggled with this “death sentence” but found support in a hospice day care centre. Unfortunately, he developed a urinary obstruction a couple of months later and had to use an indwelling urinary catheter and he had to stop going to the centre.
The cancer spread and caused an intestinal obstruction and he had to have a colostomy a few months later. In spite of all the above complications, he was able to live an independent life at home. He was understandably demoralized and depressed by his condition but we encouraged him to live one day at a time.
One morning as he was walking to his favourite hawker stall he was knocked down by a car and suffered a fracture of his right hip. But he was able to walk after his hip operation and died at home after another 3 months.
It was not an easy time for him and his family and he expressed a wish to die a couple of times. If euthanasia had been permitted by law, he could have found someone to assist him in ending his life. But choosing euthanasia would have deprived him and his family the last few months of his life which gave them an opportunity to resolve issues and the opportunity to share their love with one another.
Kill Me:
Only a few patients make the request, “Please kill me.” They are often depressed and are afraid of becoming a “living dead” without any control of the decision making with regard to their medical treatment. Such requests are born out of fear, ignorance and a sense of hopelessness. They are no different from the suicide attempts of those who are physically well but depressed and have lost all hope for their lives.
There was a middle aged man with cancer who made a strong request for euthanasia. He was single and had caring brothers who were struggling to come to terms with his impending death. Their concern and attempts to get him to eat and to get well were very stressful to the patient. I could not accede to the patient’s request for euthanasia. I explained to him that he needed to give his brothers time to prepare for his death.
At the same time, I advised the brothers to face the truth of the patient’s terminal condition and to respect his wish not to have tube feeding, etc. I shared with them the fact that those who are in their last days of life will often just stop eating and drinking. This is the natural and comfortable way of dying. We relieved his pain and he passed away peacefully at home a few weeks later with the family at peace as well.
The evil of euthanasia is that it is a symptom of a materialistic society that measures life only in terms of wealth and health. Such a society is one that is without hope and spiritually poor for it deprives the people from showing compassion and love as they care for the dying.
The primary problem is not whether we should legalise euthanasia but how we can provide better end of life care and to humanise the practice of medicine.
Suffering is a call for compassion and not a license to kill. We always have the choice to choose life or to choose death. However it would be wrong to insist that doctors must assist their patients who choose suicide as a way out of their suffering. It is also foolhardy to confuse the doctor’s role as a healer with that of an executioner. A healer is not just one who cures but one who creates a healing space for the patient in the midst of suffering and pain.
Hospice Care
The alternative to euthanasia is hospice care. Hospice care is not a place for the dying but a philosophy of care that focuses on the total care of the whole person. The hospice movement was founded on the belief that we need to do all we can to help the dying to live as well as they can up to the time of death. It seeks to humanize the process of dying which is becoming dehumanized by modern medicine. [4]
The answer to suffering is not to end life but to see it as a challenge to love and to care more. Dying has become medicalised to the extent that it is practically impossible to die naturally once a patient is admitted to hospital. Modern medicine often prolongs the dying process at the expense of the quality of life. It is foolish to put our faith in doctors only to cure our diseases instead of seeing them as our fellow and fallible human beings who can use their medical skills to relieve our physical suffering and disabilities so that we can live our final days with meaning, dignity and grace.
Euthanasia is not the best way to die well — the simplest and easiest way for the terminally ill to die naturally is to provide hospice home support for them and their families so that they can remain at home and not be admitted to hospital. Do we really need laws for the dying to die a natural death or just common sense? Competent and compassionate end of life care at home will help the dying and their families have a meaningful closure. There are five important tasks to be fulfilled at the end of life — to express love, to forgive, to seek forgiveness, to express gratitude and to say goodbye,
When one is at the end of life, the most important thing to do is to stop all treatment that does not relieve suffering so that the process of dying is not unnecessarily prolonged. For example, when the body is shutting down at the end of life, not eating or drinking is normal and does not cause suffering. At this stage, artificial feeding is futile and may in fact cause more suffering.
Competent and compassionate end of life care will help us to learn the art of dying. To say no to euthanasia is not just because it is wrong but because the most loving thing is to help another to choose life rather than death and to affirm that our lives matter right up to the time we die. For even though we die, we live on in the hearts of those we love. And so we need to pass on hope, faith and love not only through our lives but in our deaths.
__________________________
References:
[1] Kee, Patrick: Living Well In The Autumn Of Life, page 126
[2] Ibid, page 128
[3] Ibid, page 129
[4] Ibid, page 137-139
————–
Dr. Patrick Kee has been actively involved in the hospice ministry since 1990 and was the founder of the Methodist Hospice Fellowship. He gave up his general practice in 2004 to care for the elderly and the terminally ill. In 2007, he started a private company, TLC Home Medical Services Pte Ltd to provide hospice home care. Currently, he is also providing his services to HCA Hospice Care on two days a week.
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Firstly, I must say it is rather disingenuous to cite your own book as reference to back up normative, prescriptive statements on death as a phenomenon.
I.e. I claim this, I quote it from an external reference, who happens to be myself.
I have no beef with a Methodist doc espousing his opposition to euthanasia but this whole feature seems to rest on his belief that “Dying is ultimately a spiritual event — a movement from the dusk of the physical process of dying through the dark night of death to the dawn of a new life in the spiritual realm.“
Unfortunately not everyone is a spiritual being, not everyone shares the same faith as the author, who has further gone on to castigate that euthanasia is evil, empty of spiritual hope.
All this based on his own religious convictions and premise which unfortunately does not appeal to the non-religious or non-spiritual.
@Spiegal
Self citation is commonplace in articles. That’s how one builds new work on one’s past work. But there’s a problem with the position of the citation that comes right after the statement everyone utters, “No matter how young or old, how rich or poor, we will all die one day — sooner or later!” — gives the impression he should be credited for it. Furthermore, all the citations are at the end of a paragraph instead of sentence. I guess he might as well do away with them altogether.
@devil,
Self-citation is common, yes. But in this case, he is introducing superfluous or flawed references. Which leads me to suspect that the real intent is less about providing an external source for readers to verify, than to a) sell his book, or b) present a facade of scholarly authority.
Citation (1) – you’ve already noted the problems with that statement. Nothing particularly original, don’t think Dr Kee can claim anything in that paragraph as his own work.
Citation (2) – there could have been original input. If he had done original philosophical work in his book to argue that “Dying is ultimately a spiritual event” and “a movement from the dusk of the physical process of dying through the dark night of death to the dawn of a new life in the spiritual realm”, then this is an acceptable reference.
Nonetheless, the previous statements in the same paragraph are vague, filled with weasel words and are designed to be imprecise – not exactly a very empirical piece of work.
Lacking his book, which I can’t find any mention of online as well, I cannot judge if he had done any empirical research into attitudes towards death. Perhaps he has. Then he would have benefited from inserting that information here.
Citation (3) – a quote from Henri Nouwen. Emphatically not an original work of Dr Kee’s own. He should be citing an original source as far as possible, failing that a secondary source which is fine. Presumably, he got this quote from somewhere else, as opposed to hearing it for himself first hand. What is that source? Now if we wanted to check it, we would have to check his book, and see if he cited a source. Perhaps he wanted to push some copies of his book?
Citation (4) – the statements and claims in this paragraph are clearly not original work from Dr Kee – they are positive and normative statements which many others would make. If he wanted to cite them, cite the original source.
Sorry, i don’t think this is a well written piece. Again, what this seems to me is yet another case of the other people (well and healthy) deciding what is best for the terminally ill and not the terminally ill folks themselves.
Also, what’s with the use of Latin phrase : “Ars Moriendi” ? I always think that people who throw in latin phrases (and then citing it in english) is just showing off.
@Spiegel
I am just saying that self-citing is not necessarily bad in general. I agree with you the citations in this case are bad and this gives the impression that there is an intent to advertise. I think the in-text citations should be removed. Then again, this is hardly an academic article. Perhaps we expect too much.
@devil,
No, I don’t think we are not expecting too much.
Using references is supposed to help the reader, not to confuse or mislead. He chose to use references, but used them in a bad way. A writer can’t have his cake and eat it – use citations and hide behind the notion that it isn’t an academic article, especially when he uses them badly.
The use of footnotes – a distinctly scholarly device – has been criticised in academic circles (in history for example, see the David Irving trial) as a shield for academic dishonesty or sloppiness, as it lends an air of scholarly authority, which is derived from the idea that the author has done much background original work and is offering the footnotes as a measure of transparency.
The only safeguard against this is that readers examine references and footnotes. That was how many an academic scandal first broke – when someone decided to check the references, to see if the source material says what the author claims it says, or if it even exists at all.
Dr Kee’s use of footnotes only adds to the air of credibility he had built in his bio, which is inserted at the front of the piece (as if to say, before you even read this, be sure to know that I know what I am talking about).
“Dying is ultimately a spiritual event — a movement from the dusk of the physical process of dying through the dark night of death to the dawn of a new life in the spiritual realm”
“We are all born to die but human beings, unlike the other animals, have a sense of eternity in their hearts. Deep within us we know that there is something beyond the grave. We are spiritual beings and not mere robots programmed by a bag of genes”
____________________________________________
Can the author prove any of these assertions? Seems like someone’s personal religious beliefs are asserted as universal fact and used to justify public policy.
Why should the sovereignty of a person over his own life by determined by the religious morals/beliefs of someone else?
It is so very obvious why the author has such narrow minded view of the subject. It is so very obvious what influenced the author’s way of thinking, although he used his profession as a form of credibility while spewing bias points of view.//Ya sure, I feel it, so it’s right. I am coming from a emotionally and spiritual point of view, wrapped in what appears to be on true compassionate grounds, so don’t fault me and it is so frustrating that you don’t understand. And if you disagree, I feel you are emotionally and spiritually empty, and you are wrong because I feel much more than I assume you are able to feel. And because you do not believe what I believe, you have less clue than me what I am talking about. Never mind if people who are in similar field, have done countless studies and research on this same very subject disagree with me. I trumped them because even if you recognize I come from plenty of assumptions, I come from an angle of love. And I would like you to feel this pure feeling of mine, then perhaps you can see the light as I have, perhaps you can see why I understand the ‘art of dying’ better than those who disagree with me.//What a load of …….
@Spiegel
I think the impact of misleading here is not so great unlike in an academic journal. This is an alternative news website, everything must be taken with salt and spices. Same goes for those opinion articles in the mainstream press where they state the author’s background, even if they do not cite there.
Apart from the questionable citations, I find the middle part on “Euthanasia – A Symptom Not A Solution”, a reasonably interesting view.
The distinction between “active” and “passive” methods of dying is arbitrary. Starving yourself to death (which the writer amazingly recommends as “the natural and comfortable way of dying”) is no different from jumping off a building. Both are conscious decisions that you know would surely lead to death. It is irrational to think that one is more morally acceptable than the other.
Also, the writer fails to adequately respect the interests and wishes of the suffering patient, and instead seems more concerned with giving the patient’s loved ones a chance to show their compassion for the dying. This is a total misplacement of priorities. The patient should not be forced to continue an agonising existence just to make his family members happy.
Dying is an intimate and personal decision that a patient should be allowed to make for himself, rather than be held hostage to the wishes or religious beliefs of other people.
@xargonax,
Actually I would argue the opposite, because in an academic journal, peer-review is a prerequisite to publication, and then there is another layer of checks in the form of an audience generally well-versed in the processes and methods of citation and referencing.
Readers of an academic journal are also far more likely to check on the contents of the citations – especially by fellow researchers working on the same subject, who would like to verify the sources or data, or replicate the tests to see if they get the same results themselves.
It’s not just on news sites that people should be wary and take things with a pinch of salt. Even in academia, academics are liable to review each others work, and in some cases, they do catch gross misconduct in falsifying or deliberately misinterpreting sources or data.
On a news blog/news site, where some readers would be laypersons that may not be as familiar with citations and aware of the importance of checking references, the references are more likely to be taken at face value.
In most mainstream press commentary, the bio comes last, after the article – not before.
@Spiegel
Sorry, posted under wrong nickname as xargonax earlier.
@Spiegel
Precisely because blog/news site are not as trustworthy that people accord them a less credible status compared to an academic work that goes through a more rigourous review process before publication.
I think we differ on how discerning a lay person is. I tend to believe that if they are reading these online sites, they are more careful of what they absorb. Furthermore, the comments from the audience so far do not seem to be from people taking the article at face value. I doubt the dubious citations will escape them that easily.
As for the positioning of the bio, I tend to look at the bio before reading an article even in mainstream press. Sometimes it gives me a clue which part of the article may be biased.
@devil,
Perhaps so, but it is still a good idea to call out bad referencing where ever it appears.
My attitude is – if the writer has taken the trouble to cite and use footnotes, he or she must take responsibility for it; i.e. ensuring that they are done properly, that the information is indeed attributable to the source they provide, that they do not misrepresent the information they are citing, etc.
@joe & chiper,
With regards to the religious perspective this article apparently bases its arguments from, it is suggested in the title itself.
Ars moriendi (Latin for the art of dying) is a 15th century text discussing the issue of dying from a Christian perspective, offering normative advice on the matter.
http://en.wikipedia.org/wiki/Ars_moriendi
I am aware what Ars Moriendi mean……
just felt that people who spew such Lation phrases are just exhibiting scholastic snobbery when a simple English phrase would suffice…
guess it’s just a personal peeve i have when i hear Lation phrases spewed unnecessarily…
@joe,
Maybe he is using it as shorthand to tell readers where he is coming from – a literary device. Which in this case would appear a fair reflection of the content of the article.
@spiegel..
yeah, perhaps. probably a prejudice on my part.. but still i agree with your points about the article..
You know, sometimes when you read something and you know something is not right, but somehow i was just adequate in my english to articulate or explain what i feel is not right..
that was what i felt when i read the article.
I meant “NOT adequate in my english” … not adequate.
Sorry, type too fast
Any academic worth his published salt will present a argument to appeal to as wide an audience as possible. As a christian, he could have made his affiliations known from the start and then argue his points based on a rational and logical viewpoint instead of peppering his whole feature with faith based declarations that turn off non-christians or the non-religious readers. Basically he is preaching to the converted which in turn makes his whole effort pointless.
What is even more surprising for a published academis is his use of personal examples to bolster his arguments. there is no citations of external research for the claims he raised, just his own personal assumptions of what he knows (thinks) is best for his case studies, what he knows (thinks) the solution for them. This is highly presumptuous and arrogant!
I have no doubt the author is a caring medical professional but as one, he should listen more to what his patients are really saying and he should study more published research on the issue before making these personal claims as proof why euthanasia is ‘evil’
Lets play the morality card by a religious dogma and creed to rubbish euthanasia; provide us more with a scientific and rational explanation why euthanasia is truly bad, and not just for the soul.
SPIEGEL Interview with Dr. Michael de Ridder
‘What Is So Bad About Dying?’
http://www.spiegel.de/international/zeitgeist/0,1518,685426,00.html
Oops!
“Lets NOT play the morality card by a religious dogma and creed to rubbish euthanasia; provide us more with a scientific and rational explanation why euthanasia is truly bad, and not just for the soul.”
@Spiegel
I’m aware that he is arguing from a religious perspective. Latin aside, that would probably be quite clear from his credentials.
What I do take issue with is the way he presents his religious beliefs as objective fact. i.e. “EVERYONE knows that there is an afterlife in a spiritual realm, therefore euthanasia is immoral and evil!”.
That smacks of religious arrogance and intellectual dishonesty. It would have been more credible for him to say something like “According to my personal religious opinion, there is an afterlife in the spiritual realm”.
@Deutschland,
Interesting interview. Thanks for posting it.
Just as Patrick Kee would want the freedom to live out his conviction, he ought to respect others’ freedom to live out their different conviction.
A thinly disguised evangelising article.
Wonder if the “good doctor” proselytizes in his humanitarian work :)
Can any “good Christian” not feel sinful not to proselytize as they are commanded to spread the good news from the good book?
I have seen too Christians taking ’”emotional” advantage of dying people desperately clinging onto any last straw of a guaranteed “good” afterlife to be wary of any Christian nurses or doctors, who will inevitably whip out the bibles once the patients are comfy and in a guillible moment!
Hey..I thought this article was inspiring & it made a lot of sense to me. To each his own, don’t be too hard on Dr Kee :)