Pain Management

People who are actually in pain are more likely to reject the notion of physician-assisted suicide and euthanasia than those who anticipate or fear pain. <
  • There is a hospice saying about treating chronic pain: 'The right drug, by the right route, by the clock.'
  • 95% - 98% of patients can achieve a degree of comfort they are happy with.
  • The WHO recommends that governments devote specific attention to cancer pain relief and palliative care before considering laws allowing euthanasia.
  • Many doctors still need adequate training in pain control.
  • Research is discovering new and better methods of pain relief.
"Putting an end to unbearable suffering" has been one of the most frequent reasons used by euthanasia advocates in their push for legal change.

Where public surveys and polls show strong support for assisted suicide and/or voluntary euthanasia, it is almost always due to fear.

Fear of pain
Fear
of cancer and other debilitating diseases; fear of becoming a burden to one's family; fear of surviving without really living; and, perhaps most of all, fear of severe, uncontrolled pain.

Before changing existing laws it is important that there should be a careful examination of what is being done to address these fears, especially that of pain.

Researchers studying American cancer patients discovered that those who were actually in pain were more likely to reject the notion of physician-assisted suicide and euthanasia than those who anticipate or fear pain. Researchers concluded that patients who are actually confronting the problem are more interested in getting rid of their pain than in dying.

One of the leading figures in the pro-euthanasia movement in the Netherlands, Dr Pieter Admiraal, has said, "There are many good reasons for euthanasia, but pain control is not one of them." 2

Dr Admiraal is an anaesthiologist, therefore he knows, perhaps better than most, the many, effective pain-management medicines available. He wrote:
"In fact, for most patients "cancer pain" means real physical pain combined with fear, sorrow, depression, and exhaustion. This kind of "pain" is an alarm signal indicating shortcomings in interhuman contact and misunderstandings of the patient's situation. One can treat this "pain" with good terminal care based on warm human contact." 3
Dr Admiraal does not endorse euthanasia for pain, only for a "diminished quality of life."

Dr John Bolifant, then a New Zealand GP and Medical Officer at Wellington's Mary Potter Hospice, said at a conference in 1992, in regard to chronic pain:
"First we have to take a careful history to determine the nature of the pain which the patient presents. Then we apply a series of tests and diagnosis to get the best results. There is a hospice saying about treating chronic pain: 'The right drug, by the right route, by the clock.' In New Zealand we use morphine. It is freely and widely available and there is a wide range of doses. It has a very high level of safety, you don't kill patients with morphine."
Dr Bolifant acknowledged that although not everyone can be helped, 95% - 98% can achieve a degree of comfort they are happy with. For those others he says,
"Some of them and some of the families will agree that they should be allowed to sleep and we would use flunitrazepam infusions to try and induce that when everything else seems to have failed, to allow them to have a degree of comfort and dignity and relaxation." 4
Untreated pain
Brian Johnstone, author of Death as a Salesman - What's Wrong with Assisted Suicide says "The request to die is usually a sign that there is underlying pain that is not being treated."5

Dr Kathleen Foley, Chief of Pain Services at Memorial Sloan-Kettering Cancer Center in New York said:
"We frequently see patients referred to our Pain Clinic who request physician-assisted suicide because of uncontrolled pain. We commonly see such ideation and requests dissolve with adequate control of pain and other symptoms, using combinations of pharmacologic, neurosurgical, anestetic, or psychological approaches." 6
Dame Cicely Saunders, founder of the modern Hospice movement, put it this way:
"When someone asks for euthanasia or turns to suicide, I believe in almost every case someone, or society as a whole, has failed that person. To suggest that such an act should be legalised is to offer a negative and dangerous answer to problems which should be solved by better means." 7
WHO recommends waiting
In 1990, a World Health Organization (WHO) Expert Committee found that the greatest improvements in quality of life for cancer patients and their families would result from implementation of existing knowledge about pain and symptom management.

The committee concluded that "...with the development of modern methods of palliative care, legalization of euthanasia is unnecessary. Now that a practical alternative to death in pain exists, there should be concentrated efforts to implement programs of palliative care, rather than yielding to pressure for legal euthanasia" (WHO, 1990).

The WHO Expert Committee recommended that governments, including that of the United States, devote specific attention to cancer pain relief and palliative care before considering laws allowing euthanasia. 8

Education in pain management
It has been determined that not enough health professionals, patients, families, and government policymakers understand that the proper use of existing drugs and neurosurgical, anesthetic, and psychological approaches can relieve pain and make life worth living.

As Brian Johnston points out, "Many doctors still need adequate training in pain control. If the doctor isn't treating the pain, don't kill the patient - get another doctor." 9

In 2003, Otago University in New Zealand appointed a Wellington-based specialist, Dr Rod MacLeod, to New Zealand's first-ever Chair in Palliative Care at the University of Otago's Dunedin School of Medicine.10 He has this to say:
"I'm responsible for teaching young medical students how to care for people with terminal illness. My goal is to ensure these future doctors receive enough training to properly care for people who are dying. I will remind them of their ethical and moral obligations.

It makes sense for New Zealand to put less emphasis on doctor-assisted suicide and more emphasis on ensuring that people who suffer receive help from well-trained doctors. 

Euthanasia is not a debate as black and white as it might appear. Before we engage in further national dialogue, perhaps we should search our souls and ask if there's a more honest way to end the pain." 11
Research
Combining the most potent neurotoxin known to man and a protein from the Mediterranean coral tree could deliver a long-lasting treatment for the chronic pain that afflicts millions of people, including cancer patients.

The neurotoxin, whose effects can last for months, works by blocking the release of the neuro- transmitters that relay the "contract now" message from nerves to muscles. The neurotoxin in question is botulinum toxin, perhaps better known as Botox. Read more

References:
  1. Lancet, 6/29/96:1805-1810
  2. Dr Pieter Admiraal, speech before the Biennial Conference of the Right to Die Societies, Maastricht, Holland, 1990
  3. Free Inquiry 9 [1989], No.1.
  4. Palliative Care
  5. Brian P Johnston Death as a Salesman - What's Wrong with Assisted Suicide Ch.3
  6. K.M. Foley, "The Relationship of Pain and Symptom Management to Patient Request for Physician-Assisted Suicide," Journal of Pain and Symptom Management 6 (July 1991)
  7. Cicely Saunders, "Caring to the End," Nursing Mirror 4, 1980
  8. World Health Organization. (1990). Cancer pain relief and palliative care: Report of a WHO Expert Committee [Technical Report Series 804]
  9. Brian P Johnston Death as a Salesman - What's Wrong with Assisted Suicide Ch.3 
  10. Press release 29 May 2003, End of Life Care Given New Focus at Otago Medical School
  11. Hospice New Zealand, Media Story Access to hospice care answer to stormy euthanasia debate