How easy it would be, when symptoms become difficult, to say “it is now time to move on to the last “medical procedure”. All problems solved!
Knowledge of symptom control has vastly improved over the last 24 years, thanks to medical research and the development of new drugs. At times patients in difficult situations have declared that they have “had enough”. However, with much effort on behalf of the palliative care teams, symptoms have been controlled and the patient has been able to continue living comfortably, accomplishing more of his/her goals and eventually dying a peaceful death in the presence of their loved ones.
I wonder, if euthanasia was a legal option, whether this scenario would give way to an easier option, and whether advances in symptom control would have come so far.
Gone are the days of having to tolerate all the side effects of morphine or put up with the pain, as there are now a wide range of drugs available. It is comparatively rare not to be able to find a medication that provides good pain control and is well tolerated.
Symptoms due to dehydration can be managed using subcutaneous or intravenous fluids as appropriate. However, in the terminal stages of the dying process, the body itself compensates for lack of fluids, and thirst and other symptoms of dehydration are not a problem.
In palliative care no attempt is made to disguise the fact that the patient is dying. However we do come across people who do not want to discuss this or admit that their disease is terminal. At all times we would endeavour to consider the person’s wishes, not focusing on death and dying unless asked, and helping them to make the most of their remaining time.