Friday, July 25, 2008

Literature & Medicine: Physician-Assisted Suicide

More and more medical schools and health care worker training programs are beginning to include the humanities into their curricula; the terms "Literature & Medicine" or "Medical Humanities" grace many course catalogs (no matter the length or breadth of material covered).

A neat pairing of literature and life can be found in two recent oral history interviews (Goodwin and Toffler) and the novel The Idiot by Fyodor Dostoyevsky. The issue of physician assisted suicide is not a new one, and it is one which is unlikely to go away.

Compare some of Goodwin's comments on his first experiences as a physician:
Because the, you know, when, I notice the huge difference between death in hospitals and death in practice. And at that time, I was doing house calls. And I would do house calls on really ill patients who might have been into hospital, out of hospital. And I was dealing with two men, one dying of cancer of the prostate. The other, dying of complications from, he had a pulmonary disease and he also had prostate cancer. And looking after these patients in their homes with a supportive family environment, it was so different, you know, it was so heartwarming to be with those patients as both these men died. And then comparing that process with death in hospital, where the patient and family was all so often sort of shunted aside and tended to be sort of, not ignored, but sort of misled at times. “Oh, I don’t think things are quite so bad.” To sort of facing the idea that a patient was going to die was difficult for the medical profession. And that was part of my evolution.

The other part of my evolution was being approached by two men who wanted aid in dying. And the first time, it was just a shock. This couple came into my office. I had met them socially. They were new patients. And he just came right out with it. He said, “I’m dying. I’ve had this cancer for eight years. I’ve had all the treatment that’s possible. And I’m dying.” And he explained why he wanted to end the process, and it was overwhelming reason. But when he said, “I want you to help me to die,” Matt, literally I felt as though the blood had frozen in my veins. I just had this cold sensation all over.
with those of the fictional patient Ippolit, who is dying of consumption (Pevear and Volokhonsky translation):
I decided to die in Pavlovsk, at sunrise, and to do it in the park, so as not to trouble anyone in the dacha....

I recognize no judges over me and know that I am now beyond all judicial power. Not long ago I was amused by a certain supposition: what if I should suddenly take it into my head now to kill whomever I like, even a dozen people at once, or to do something most terrible, that is simply considered the most terrible thing in the world, what a quandary the court would find itself in before me, with my two- or three-week term and with torture and the rack abolished!...

But if I do not recognize any judgment over me, I know all the same that I will be judged, once I have become a deaf and speechless defendant. I do not want to go without leaving a word of reply--a free word, not a forced one--not to justify myself--oh, no! I have nothing to ask forgiveness for from anyone--but just because I myself want it so.

First of all, there is a strange thought here: who, in the name of what right, in the name of what motive, would now take it into his head to dispute my right to these two or three weeks of my term? What court has any business here? Who precisely needs that I should not only be sentenced, but should graciously keep to the term of my sentence? Can it really be that anyone needs that? For the sake of morality? If, in the bloom of health and strength, I were to make an attempt on my life, which 'could be useful to my neighbor,' and so on, then I could understand that morality might reproach me, out of old habit, for having dealt with my life arbitrarily, or whatever. But now, now, when the term of the sentence has been read out to me? What sort of morality needs, on top of your life, also your last gasp...

Literature can help bridge the gap between the physician's experience and that of the patient, helping each side to understand the position of the other.

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