Wednesday, October 15, 2008

Excellent Blog Post on Savage Editorial and I-1000

Jay, a primary care physician who writes at Two Women Blogging does an excellent review of the Dan Savage editorial on Washington State's I-1000 Death With Dignity initiative I posted on previously. She covers many issues very well and I will highlight a few of my favorite parts here:

I was also shaken by Savage's article, mostly because his mother had lousy care. I don't see any mention that hospice or palliative care was offered to her at any point, although she clearly knew she had a fatal illness and was deteriorating.
I really like this primary care doctor!
Savage equates physician-assisted suicide with "end-of-life-pain-management". No. No. No. The medications used for suicide are not pain medications; they are sedatives. We can achieve adequate pain control for more than 90% of people at the end of their lives (see, I told you I've been studying).
She would make a good palliative care doc it seems! And from reading her past posts she is studying for the palliative medicine boards! Woo-hoo!
If Savage was trying to say that assisted suicide can be merciful, I would agree, but I think he is speaking from the common - and mistaken - assumption that good pain control will shorten life, and is only offered as a means to death. Most people with pain and shortness of breath can benefit from treatment with narcotics.
I'll giver her a pass on the 'opioids not narcotics' pet peeve because she makes some great points!

She brings up an interesting take from Prof. Susan Wolf who thinks women will disproportionately choose physician assisted suicide:
And might this tendency be compounded by a cultural lineage exalting female suicide, a tradition going back, Wolf suggested, borrowing from the work of the French classicist Nicole Loraux, to Greek tragedy, where suicide is carried out almost exclusively by women?
That is an interesting point, I never would have thought of if it wasn't for the internet and blogs. Ain't technology amazing at creating new relations and connecting ideas and people?

And she finishes the post with a reference from the classic NEJM article by Quill from 1991. If any of you have not read his piece on Diane, go to your medical library now. Or read it online at a non-NEJM approved site. It is a seminal piece of writing for all of medicine regardless of how you feel about his actions.

I hope she blogs more on palliative medicine issues.
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