Today while on call I went to see a patient who, in her ICU bed, reached for my hand immediately. She looked very uncomfortable and, upon being asked, said she has no friends or family visiting her. Her nurse chimed in: “Her husband visits.”
“Oh, your husband is here. That must be a comfort.” Normally I would not have said the second sentence, but the patient was having a lot of difficulty speaking, so I was trying to save her some trouble. She had the energy to roll her eyes, though, which she now did.
“It is not a comfort to have your husband here?”
She shook her head no. We continued to visit, and I offered prayers, and then she suddenly asked, “What about euthanasia?”
“You’re interested in the End of Life Options Act?”
“Is it legal?”
“Yes, it is. Would you like me to tell your doctors that you’d like to discuss it?” She nodded yes.
Later in the visit, after saying how much pain she is in, she asked if God would be angry at her if she took her own life. Normally I would ask for her own views, but again, due to the laboriousness of her speech, I decided just to offer my opinion. I said that I think God loves her, and does not want her to suffer, and could never be angry at her. “What do you think?” I added.
“I think God doesn’t want me to suffer,” she said. “It would be good if you could pray.”
I already had prayed, so this suggested that maybe the patient was having some confusion. When I left, I asked her nurse who I should let know about her request. She said I should tell the transplant team, and they could tell the patient’s medical team. So I paged the on-call transplant person and he called right back and I told him that the patient is interested in discussing the End of Life Options Act, and he thanked me heartily.
Later I ran into one of the palliative care doctors, also on call this weekend, and he said that it wasn’t necessarily wrong that I had done that (which pretty much told me it was wrong that I had done that), but that his approach is to find out more: why is the patient interested in this? Maybe she has a problem that can be solved. Maybe it is a matter of managing symptoms. He gently said there is the possibility that the transplant team will overreact, and then of course I felt terrible that in seeking to help this person, I may have cost her an organ. Though the doctor went on to say that it’s kind of moot, because if the person is so ill that she is never going to leave the hospital, she can’t exercise that right, anyway, because the hospital doesn’t allow it to be done on the premises. He also said that when we tell others, it’s important to provide context. The patient told me she is in pain, but I didn’t mention that to the transplant team guy.
I hope they don’t just cross the patient’s name off their list after a 20-second conversation. I hope there is plenty of discussion with the patient and time for the truth to emerge and best choices to be made.