Taking control over one’s death; why don’t we do that? Lee, fifty-five year old African-American male, heavy smoker for forty years, heavy drinker for twenty years, but now sober for ten years, is dying from metastatic lung cancer. He is in agonizing pain; he has good insurance. The pain doctors, or so they call themselves, are hesitant to give him opiates because he has a substance abuse history. “No way,” I say to the family. “That can’t be true,” I repeat in total disbelief. Yet, it is true. “Well, then get him a new pain doctor” I say, with a demanding tone, realizing that for inpatient pain management, there may not be a lot of choices. Eventually, Lee says “put me down” with such clarity that he realizes that living must be worse than dying, at least as far as he is concerned. Veterinarians heed the call of the animal, when the dog or cat or bird is nearing the end of his days. Physicians on the other hand, tend to be insensitive in this domain. Although palliative care is a growing field, most dying patients do not receive services which help a faster, more peaceful exit. Mental health providers, by and large, have also remained silent. Why don’t psychiatrists, psychologists, and social workers speak out, about how for the sake of the person, for the sake of humanity, let’s help this patient die? Our silence is deafening. It is time to change health care policy for end of life care. Shortening life, in the face of a terminal illness with chronic pain, is both humane and cost-effective. We have to stop pretending that both issues are not important.
Shirah Vollmer MD 