Terminal Illness

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An interesting new field of ethical inquiry that the contemporary medical industry has opened to us:

If one is diagnosed with a terminal disease is he then justified in taking his own life to avoid the slow suffering that awaits him? Or is this a cheat on life; must we always take the good with the bad even when we have the knowledge to avoid the bad?

Is it immoral to embrace death?

Before the days of our advanced medical practices one would simply be forced to fight through the suffering of a disease, since he would not have the ability to know that the end is near, that the struggle for more life is futile. The hope that can come along with not knowing -- is it indispensable? Can hope overtake despair in the case of not knowing?

**Note: I'm not talking about Euthanasia or any such legal proceedings. I am talking about one taking his life by his own hands without doctors or family members or anyone else involved in the decision.

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@rhinogrey,

there are a lot of facets to this question and it is also an ethics question to me. issues that always arise are concerning the amount of intervention society will do.

but you seem to be specifically asking whether the person who makes this choice is justified in making the decision to continue to live or to commit suicide. i think both decisions would be justified, and either one can be moral depending on the individual's circumstances. i wont go into the obvious arguments but rather mention the thoughts that have come to my mind after having participated in the lives of people with terminal illnesses.

once a person really knows his days are numbered, he may change his attitude about a lot of things. he may develop new perspectives and find courage to try new things. since he knows his death is imminent, why be afraid of taking risks? this goes even for those who are unable to leave their beds-they can take psychological risks, such as opening up to others, or even confronting others. and if it is the type of person who has always taken risks and now is confined to bed, he can experiment with the experience of it and investigate that part of life which he had been fortunate enough to be able to avoid until now.

in an altruistic sense there are various effects that go out to those around a terminally ill person. being there and part of his suffering may help give someone else the courage to face the same situation later should it happen to him or someone he loves. it may cause someone close to him to develop a sense of sympathy which he might not otherwise have had the opportunity to do, it may even affect strangers profoundly.

and as for choosing to check out early, that can be considered moral in many ways, regardless of motive i think and looking at effects alone. for instance, medical care is expensive-why waste money and time of care-givers who could be attending on those who may recover? suppose the patient knows those closest to him well enough to be sure they would suffer intensely and possibly not bear up under the strain and doesnt want to be the cause of any more suffering on their part? suppose he knows that family members are at a crucial point in their lives, maybe a daughter is pregnant, maybe someone is planning a long hoped-for vacation trip, and that some situations would be adversely compounded and some things would be put on hold or may not ever materialize because of the need to focus on this person's care?

just a few ideas...memories...

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@salima,

A couple of things:

1) I don't believe in terminal illness. No such thing. People survive from all types of illness. A friend of mine was diagnosed with brain cancer and was told that she had a few months to live. That was 20 years ago.

2) As far as I am concerned, a person can do what they want with their lives. Heck, if the government can put someone else to death, why shouldn't a person be allowed to decide if she or he had enough of life. However, I certainly hope the decision is not made based upon some prognosis of a physician.

Rich

2 Replies

@rhinogrey,

i would hope that the mentality of a person knowing that their body will soon expire, theyd enjoy the heads up and make peace and soak up all possible enjoyment...

however the reality is somehow some people get scared... and sometimes they get drunk and think that they'll take a machine gun to the chest to choose the last breath instead of wait for it...

it is sad... but who are we to have the right to stop someone from making that choice... and who are we to judge them for having the mentality to make that choice... i would try to convince someone in such a position to change their viewpoint... but if it happened without warning what else can i do but try to empathize with the decision...

1 Reply

@sarathustrah,

rhinogrey;61799 wrote:

If one is diagnosed with a terminal disease is he then justified in taking his own life to avoid the slow suffering that awaits him? Or is this a cheat on life; must we always take the good with the bad even when we have the knowledge to avoid the bad?

I'm not sure there exists a hard, fast answer to this question. There are too many unknown variables, each case is to unique. In my mind I can imagine scenarios, all of which fit this description, in which suicide would be justified and unjustified.

richrf;69545 wrote:

1) I don't believe in terminal illness. No such thing. People survive from all types of illness. A friend of mine was diagnosed with brain cancer and was told that she had a few months to live. That was 20 years ago.

There is no illness which ends lives?

richrf;69545 wrote:

2) As far as I am concerned, a person can do what they want with their lives. Heck, if the government can put someone else to death, why shouldn't a person be allowed to decide if she or he had enough of life. However, I certainly hope the decision is not made based upon some prognosis of a physician.

I agree, but I think the question is an ethical question. Sure, the individual should have the right to decide, but what should the individual's decision actually be?

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@Didymos Thomas,

I have had friends and family who where terminally ill and their courage and determination has humbled me.They never appeared to contemplate suicide and yearned for life not death.I would not have wanted them to suffer for my benefit and if they had chosen an earlier death i would not have condemned them, life appeared very precious to them and them to me.Treat the pain and if the pain is unbearable the cure may cause the death, that in my opinion is the moral thing to do.

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@richrf,

richrf;69545 wrote:

I don't believe in terminal illness. No such thing. People survive from all types of illness.

The illnesses are not terminal in those who survive. But we know that 95% of patients with lung cancer are dead within 5 years of diagnosis, and if someone presents with widespread metastatic disease their odds of survival beyond a year are nearly zilch. So what would you have us do? Give people false hopes? Or tell them that we should work on comfort, that they should have family around them, and that they should try and get affairs in order? I think it would be barbaric to make a patient think that the rare miraculous recovery should somehow be regarded as the rule and not the exception. It's fine for people to have hope, but they also need to know what is likely.

1 Reply

@Didymos Thomas,

Didymos Thomas;69561 wrote:

There is no illness which ends lives?

People die from all kinds of causes. However, I don't think anyone can predict. A person dies when that person dies. The (prognosis) prediction may itself may be more harmful than the disease.

Rich

2 Replies

@richrf,

richrf;69597 wrote:

People die from all kinds of causes. However, I don't think anyone can predict.

Sometimes we can. I can name you some circumstances in which there really is no doubt, and even a short term recovery is almost certain to be followed by continual relapses and deterioration.

I don't regard "cure" as my job. I think of my job as finding ways to make people's lives better. Sometimes that means doing my damnedest to cure a bad disease. But sometimes that means knowing that any more fighting is just torture, and the remainder of someone's life will be better if I attend to comfort.

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@Aedes,

Aedes;69790 wrote:

Sometimes we can. I can name you some circumstances in which there really is no doubt, and even a short term recovery is almost certain to be followed by continual relapses and deterioration.

I don't regard "cure" as my job. I think of my job as finding ways to make people's lives better. Sometimes that means doing my damnedest to cure a bad disease. But sometimes that means knowing that any more fighting is just torture, and the remainder of someone's life will be better if I attend to comfort.

Hi,

I can tell you that the physicians who predicted the death of my friend with a brain tumor had no doubt. I can also tell you that the physician who told my past client that he would be on powerful blood pressure pills for the rest of his life, had no doubt. And the two elderly people that I teach Tai Chi to were told that they would have arthritis for life. And I can also tell you without a doubt, that all of these physicians are wrong so far - and its been 20 years for the brain cancer patient, and in the other situations the problems are gone. So ...., just because a medical doctor does not know how to cure, it doesn't mean there aren't ways to do it. It has to be learned and practiced like anything else.

BTW, the Chinese doctors that I know to try to cure. Many times successful and many times not. There are so many variables to life.

Rich

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@Aedes,

Aedes;69577 wrote:

The illnesses are not terminal in those who survive. But we know that 95% of patients with lung cancer are dead within 5 years of diagnosis, and if someone presents with widespread metastatic disease their odds of survival beyond a year are nearly zilch. So what would you have us do? Give people false hopes?

Other things being equal, feeling hope is always better for one's condition than feeling no hope.

But if a doctor feels there's no possible way that his patient can be cured, he is not able to induce the kind of hope in his patient that makes the difference - sometimes the difference between life and death.

A doctor has much more power than he thinks, when his patient believes in him. He can in many cases literally cure his patient with his words, if he knows how. The problem is that most doctors do not know how.

Albert Schweitzer was one of the few doctors who knew how:

"There is no difference between myself and a native witch doctor. We are both doing our best to convince our patient he or she can survive the worst the world can throw. If we can do that our patient will live. If we can not, our patient will die." - Dr. Albert Schweitzer

Rado

1 Reply

@rado,

rado;72039 wrote:

He can in many cases literally cure his patient with his words, if he knows how.

Yes, words are powerful. And we can always offer someone a fight without promising them a victory.

But no words are going to take the tumor out of someone's brain. And seeing as people look to physicians for a realistic appraisal of their longevity when faced with a grave illness, it is our responsibility to give our best estimate with the stipulation that we seldom know for sure.

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@Aedes,

Aedes;72081 wrote:

Yes, words are powerful. And we can always offer someone a fight without promising them a victory.

But no words are going to take the tumor out of someone's brain.

If the patient believe your words enough they do, that's for certain. The problem is that it may take so long to make the patient believe you that he will die before he does. Everyone is different in that respect.

That's the crux of the matter - anything can with absolute certainty be healed if you can convince the patient enough that he will be well, but with some it may take 500 years to convince them, while with others only 5 seconds. And that is why we see some that are healed miraculously by these methods, while others are not affected at all.

Rado

1 Reply

@Aedes,

Aedes;72081 wrote:

Yes, words are powerful. And we can always offer someone a fight without promising them a victory.

But no words are going to take the tumor out of someone's brain. And seeing as people look to physicians for a realistic appraisal of their longevity when faced with a grave illness, it is our responsibility to give our best estimate with the stipulation that we seldom know for sure.

An example of an article on spontaneous remission.

The Body Can Beat Terminal Cancer ? Sometimes | Cancer | DISCOVER Magazine

Have you ever tried to research the power of words? If so, can I see the research or similar research? If not, can you tell me how you arrive at your conclusions. Thanks.

Rich

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@rado,

rado;72089 wrote:

If the patient believe your words enough they do, that's for certain.

What is the basis upon which you can say this with any certainty at all? If just getting people to believe they will be well were enough, then we would try to convince everyone of that. But then again, people would never come to doctors if we fed them a line to provoke unfounded hope.

No one is healed miraculously. There are some illnesses in which the odds of survival are very small but not zero. What's miraculous about that? I've got a patient right now who 14 years ago survived metastatic small cell lung carcinoma, which has a roughly 99% 5-year mortality rate. But 99% isn't 100% -- he got radiation therapy, chemo, and he made it. No miracles involved.

---------- Post added at 11:22 AM ---------- Previous post was at 11:19 AM ----------

richrf;72099 wrote:

An example of an article on spontaneous remission.

That's well known -- especially with stage 4S neuroblastoma in babies. But cancer is not one disease -- it's a kind of disease, but there are hundreds of different unrelated kinds all with different biology, all with different immunogenic properties, all with different degrees of invasiveness. It's metaphysical hoo-ha to say that it's words and not the basic biology of the thing that determines how it does. In fact, seeing as stage 4S neuroblastoma is perhaps the best known example of a spontaneously remitting tumor, and yet this phenomenon occurs mainly in young infants (whereas stage 4 neuroblastoma in older children is usually fatal), one can't really speak of the impact of words on a pre-verbal infant.

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@richrf,

richrf;69597 wrote:

The (prognosis) prediction may itself may be more harmful than the disease.

Rich

Scientifically it's called the nocebo effect, and it's actually quite well documented but not very well known:

The Nocebo Effect: Placebo's Evil Twin (washingtonpost.com)

nocebo and nocebo effect - The Skeptic's Dictionary - Skepdic.com

Rado

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@Aedes,

Aedes;72109 wrote:

No one is healed miraculously.

I probably didn't make myself clear. What I am asking is: What is the basis upon which you can say this with any certainty at all?

For me, spontaneous remission (which I have observed and was confirmed by medical tests), is not necessarily a miracle with the sense of a religious connotation, but it is simply the body healing itself, as it does all the time. Admittedly, some states of illness are much more difficult than others for the body to heal (it does not happen over night), and gradations exist in healing.

So with this said:

What is the basis upon which you can say this with any certainty at all?

Rich

---------- Post added at 10:39 AM ---------- Previous post was at 10:36 AM ----------

rado;72113 wrote:

Scientifically it's called the nocebo effect, and it's actually quite well documented but not very well known:

The Nocebo Effect: Placebo's Evil Twin (washingtonpost.com)

nocebo and nocebo effect - The Skeptic's Dictionary - Skepdic.com

Rado

Hi,

Thank you for the references.

Rich

1 Reply

@Aedes,

Aedes;72109 wrote:

What is the basis upon which you can say this with any certainty at all?

Personal experience.

Aedes;72109 wrote:

If just getting people to believe they will be well were enough, then we would try to convince everyone of that.

But you haven't tried it, obviously. So how can you know it doesn't work?

That said, it won't have much effect unless you believe in it yourself, or at least stay open to the possibility that it works.

I do understand your position as a doctor however - if you promise people they well be well and they get worse or die anyway they or their family will blame you.

Faith healers do promise that people will get healed - and that's part of the process, a psychological "trick" if you like, because they know it's important that the patient believes in his own healing. That's why they're so often being accused of fraud - there will always be some, usually the majority, who do not get healed, and then people say "you promised those people would get healed but they didn't". But the faith healers know that if they do not promise that everyone will (or can) be healed, most likely no one will be healed at all.

Aedes;72109 wrote:

No one is healed miraculously. There are some illnesses in which the odds of survival are very small but not zero. What's miraculous about that?

But what is determining the odds? Why do some survive "miraculously" despite all odds and prognosis? If science knew that, it would also have the cure.

(a "miracle" is per definition an extraordinary event for which you yet not have a natural or logical explanation)

Aedes;72109 wrote:

It's metaphysical hoo-ha to say that it's words and not the basic biology of the thing that determines how it does.

The biology is strongly affected by the mind, even in science there's lots of evidence for that. It just hasn't drawn the logical conclusion from that evidence yet.

Aedes;72109 wrote:

In fact, seeing as stage 4S neuroblastoma is perhaps the best known example of a spontaneously remitting tumor, and yet this phenomenon occurs mainly in young infants (whereas stage 4 neuroblastoma in older children is usually fatal), one can't really speak of the impact of words on a pre-verbal infant.

Maybe that's why they recover so easily? They do not understand that they're suffering from a "deadly" or "dangerous" disease, like the older ones do, so their minds do not worry about anything, which is the ideal condition for a healing to take place.

Rado

0 Replies

@richrf,

richrf;72114 wrote:

For me, spontaneous remission (which I have observed and was confirmed by medical tests), is not necessarily a miracle with the sense of a religious connotation, but it is simply the body healing itself, as it does all the time.

I agree.

richrf wrote:

Admittedly, some states of illness are much more difficult than others for the body to heal (it does not happen over night), and gradations exist in healing.

I agree. And since "states of illness" are generally categorized and named by their clinical / pathophysiologic / pathologic / epidemiologic features; and the "gradations in healing" are well known based on experience and observation with such "states of illness" as we define them; we are thus able to formulate rational, evidence-based, recommendations and assessments that don't treat every patient as if they're all the same.

richrf wrote:

What is the basis upon which you can say this with any certainty at all?

Experience and consensus. Didn't you say that you can label the language I speak based on the consensus that my idiom would be called by most English? We have consensus, based on vast experience (and not just dreamy musings), as to how to discriminate one disease state from another, and we have ample justification to prognosticate based on this.

rado;72132 wrote:

But you haven't tried it, obviously. So how can you know it doesn't work?

I try it every single day of my life, already several times at work today.

rado;72132 wrote:

I do understand your position as a doctor however - if you promise people they well be well and they get worse or die anyway they or their family will blame you.

I'm not worried about that. I want the right thing for them. If someone is dying of an illness, and they are suffering greatly from it, then I want to offer them peace and comfort. If they are dying but have a little bit of time, I want them to be able to prioritize spending quality time with their family. And if someone has a chance of survival and has quality years in front of them, then I want them to have every opportunity to survive. I just want to make the quality of their lives better, and someone with paneatic cancer who has brain, spine, and liver metastases requires a different conversation than someone with an asthma attack.

rado;72132 wrote:

Maybe that's why they recover so easily? They do not understand that they're suffering from a "deadly" or "dangerous" disease, like the older ones do, so their minds do not worry about anything, which is the ideal condition for a healing to take place.

Then why are these same infants more likely to die of leukemia, lymphoma, influenza, or malaria than older children? Do you have a rationalization for that too?

2 Replies

@Aedes,

Aedes;72150 wrote:

Experience and consensus.

Are you, as a physician, satisfied with saying something with certainty based upon your own experience and some consensus that is reached by a group of your peers? You realize, I am sure, that there have been numerous times in the past and it continues till this day, that the consensus that the medical community here in the U.S. (which is much different from the consensus in other countries), has reached conclusions that has drastically over time.

Even within your own profession there is disagreement. I can give you very specific examples when 30 years ago and even more currently, the medical profession ridiculed (and I do mean ridiculed), the idea of reversing heart disease, yet Dr. Ornish ultimately showed that it was possible via diet and other health practices alone. Similarly, I have had many students of mine reverse and greatly diminish arthritis without any medication. Something that they were told by their physicians with great certainty was impossible. Similarly, I had a student, in his 40s, who was told that he would be for certain on blood pressure medication for life, and was off of it within eight months.

So, with all of this evidence to the contrary and without any kind of research at all to back up your statement (not that I put much validity on research, but that is your gold standard not mind), how do you reach certainty in this case?

Rich

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