The Prairie Doc Perspective

Comfort not poison

By Richard P. Holm MD

I believe it is a moral duty to provide comfort for the suffering.

About twenty years ago my father was dying of metastatic colon cancer spread to bone. Dad was one of those unusual cases in which meds were simply inadequate for his unrelenting pain. Either he was totally unconscious, or awake and very uncomfortable. There seemed no helpful in-between, and too often pain meds brought wild and scary dreams, caused him to be combative, and frightened him and all us involved. I should add here, we do better now-a-days.

Mom called me one evening and warned that Dad was talking about driving into a bridge abutment. Then she handed him the phone and I pleaded with him not to do such a thing. “I will talk with your doctor and find a better pain reliever,” I said. “How can I get relief, and how will this end?” he replied. I explained in cases like his, people often develop pneumonia, and since he directed us not to use antibiotics, this might do it, “But don’t kill yourself.”

Indeed, in less than two days he developed pneumonia, his need for pain medicines lessened, and in less than two more days he escaped his cancer dying from pneumonia. The death certificate called it death by natural causes, but I suspect he voluntarily stopped coughing after our talk that night, which allowed for the blessing of a rapid case of pneumonia. Still, I would agree on the natural cause statement.

There are those who request that physicians should, by law, be allowed to prescribe death-inducing poisons for patients who are similarly suffering. These people could then fill the prescription, take the poison on their own time, and thereby choose to die on their own terms instead of having to wait for pneumonia. Although this is law in some states in the US, I struggle with that prescription for death.

In my opinion the issue turns around the word “intent.” It runs against my moral duty to give a poison intended to kill. On the other hand, I consider it also my moral duty to prescribe enough medicine intended to relieve suffering, even if it might hurry death.

I believe there is a huge difference between the intent to kill and the intent to comfort.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at OnCallTelevision.com. 

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