[Magdalen] RIP Sir Terry Pratchett

[James Oppenheimer-Crawford]

There seem to be very strong movements in both areas, for expansion of
hospice type care and the opportunity for death with dignity.

People want to have the final say over stuff.  Medical folks keep trying to
say they know best, and many times, obviously, they do, but in many cases,
it's not a question of what is best, but what is best, based on the
patient's priorities.  Human care-giving is the most difficult when we know
what the patient ought to want, and the patient is saying, "No, that's not
where my priorities are."

It wasn't really so long ago when the professionals would say, "We are the
experts, and this treatment is needed. If the patient doesn't want it, well
strap 'em to the bed and get on with it."

The right to refuse treatment has been steadily more recognized.  I noted
that many a social worker really earned their pay when they worked with the
patient, respecting their position, and gradually helping them work through
their concerns until they were finally able to genuinely see that the
recommended treatment was really the best course. and it was done with the
patient's concerns recognized, and their rights not arbitrarily dispensed
with.  When we were able to make that happen, I think we all went home a
bit more happy with what we were doing.

Getting to the point of having professionals accept the simple truth that
sometimes death is the best course is hard. We've always thought our jobs
were to enhance life, not take it away.  It wasn't too long ago that most
people, when they got sick, simply died relatively quickly.  Science has
given many the gift of a second chance at life, and none of us want to see
that go away; but there are now times, thanks to the miracles of modern
medicine, when horrific life is being prolonged, and we need to face the
need to end life. It is a truth that is hard for some to accept, but I
believe we're making real progress.

James W. Oppenheimer-Crawford
*“A life is like a garden. Perfect moments can be had, but not preserved,
except in memory. LLAP**”  -- *Leonard Nimoy

On Fri, Mar 13, 2015 at 9:29 AM, <sally.davies at gmail.com> wrote:

> Last year a colleague lent me Jennifer Worth's "In the Midst of Life" which
> was a beautiful read and a plangent call for more compassion and less
> technology. What stood out for me there was the application of palliative
> principles in a wide variety of medical conditions, not just the usual.
>
> It has opened my eyes to the amount of needless, expensive and painful
> medical interference, especially when patients are very frail and elderly
> to start with.
>
> Slippery slope arguments only help us with regard to policy and so forth,
> in individual cases we need options and that seems to be happening less and
> less.
>
> Port Elizabeth doesn't have an in-patient Hospice any more because they
> couldnt' raise enough donor funds to keep it going...there's still a
> community based service but two Sisters and one doctor can only do so much.
> Our hospital, Aurora, is taking in "palliative" patients but their
> "pathway" is undefined and unmanaged other than Lots Of Morphine which
> seems to be the solution to everything. That's not palliative care IMO,
> certainly not what I learned from the Hospice movement here and in the UK.
>
> I didn't appreciate that Death With Dignity is also committed in terms of
> effort and finance, to ensuring that everyone has access to high quality
> end of life care. Obviously the "assisted suicide" story gets all the Press
> attention but I remain convinced that in the great majority of cases,
> genuine high quality palliative care will offer a better alternative
> leaving less turmoil behind.
>
> Sally D
> On Fri, 13 Mar 2015 at 02:53 ME Michaud <michaudme at gmail.com> wrote:
>
> > I am glad that Vermont is an easy (and pretty) drive, should one of us
> > need to make the trip some day. Oregon and Washington (state) are
> > just too far. But maybe by then we won't have to leave the state at
> > all.
> > -M
> >
>