"Don't Block The Exit"-We Need to Learn to Allow Natural Death Before We Legalize Assisted Dying!

 


As we discuss Physician Assisted Dying, it may be helpful to step back a few years to when death was a normal and expected life outcome. It might help to ask ourselves:  What would it look like if we allowed people to die when the opportunity to die naturally presented itself?

Dying is a natural experience.  But we often prevent dying from happening when a person stands on deaths doorstep and the door opens.

To facilitate discussions about “what do you want if…..” consider the phrase – “Don’t block the exit”.

Dying is a natural experience.  But we have become so good at preventing death that we neglect to allow dying to occur when a person stands on deaths doorstep and the door opens.

Years ago a friend was dying.  She lay in ICU after being resuscitated. She struggled to breathe. She struggled to talk.  She was able to request no further attempts at CPR.

I knew how unhappy she had been living with very compromised health prior to this event, and imagined how frustrated she would be to survive this episode and return home even more incapacitated.

I wanted so badly to advocate for excellent symptom management to settle her breathing. I wanted to tell her that dying was an option, and that she could die comfortably.  I wanted her to know that if she stabilized and survived this crisis that it might be months or years before she would have another opportunity to die naturally. I wanted to make sure that she made decisions about her care with full understanding of what might lie ahead.  I wanted to say to the health care professionals “DON’T BLOCK HER EXIT“.

More recently I visited with an older family member to help him identify his goals of care. I wanted him to talk with his children  about the type of care and interventions he would want if he was to have another heart attack, a stroke, or other life threatening events.  I participated in a brainstorm session with him. During the conversation I provided some phrases and ideas that I hoped would help him clarify his preferences of what acute interventions he might choose if his condition declined and he was unable to voice his opinion.  I used the same phrase “Don’t block the exit”. He really liked that phrase.  He has quoted it dozens of times in the past months. “Don’t block my exit!”

Yesterday a colleague and I discussed our Advance Care Plans.  She said “If I have a stroke, and am unable to eat and unable to care for myself, I would like to be allowed to die.  I do not want rehabilitation, I do not want a feeding tube.” “Don’t block my exit.”

After my mother was diagnosed with a terminal cancer she said, “I am glad that they can not offer me any surgery!  I am 81 years old. I have had a good life. I have had my turn”. She was glad that there was no attempt to “block the exit!”

I remember a man in his late 70s.  His wife had recently died.  He said he would be happy to follow her in death. He fell, had a brain hemorrhage, called 911, was admitted to hospital and had brain surgery before his family was even aware of his admission. He was in the ICU for several weeks.  Technology, medications, feeding tubes all prolonged his life.

His children gathered, requested that life supports and any measures preventing death, be removed.  However his surgeon felt that because their father had been the one to phone 911 he had requested and given consent for acute measures to be followed. At that point it was more difficult to stop the acute interventions than it was to start them.

This man stabilized, he was discharged from hospital to long term care.  Interesting, the health care team and the system that prolonged his life are not there to visit him and provide the intensive care that they initially provided when they stabilized him and extended his life.  In his case, it may be many months or even years before another “EXIT” occurs.

As we debate legalities around Physician Assisted Dying, consider the benefits of allowing natural death, consider the benefits of “Not Blocking the Exit!”

“DON’T BLOCK the EXIT”

This blog was originally published on June 20, 2013 on the website Life & Death Matters.

 
 
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