Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.
This is not yet another philosophical discourse arguing against physician-assisted suicide. This piece is about life with dignity-even amidst its raw and ravaging agonies.
“Death with dignity” is such a catchphrase right now in the media. But for those of us who suffer in our dark thoughts every day, we are living ‘life with dignity.’ Each day we live and make it through is a success. -Anonymous1
No, this is not yet another philosophical discourse arguing against physician-assisted suicide. Along with my colleagues Drs Mark Komrad, Annette (Anne) Hanson, and Cynthia Geppert, I have covered that territory elsewhere.2-5 This article is about life with dignity-even amidst its raw and ravaging agonies. Mainly, this piece is about an Englishwoman, Hilary Lister, who recently died at the age of 46, after a long voyage of pain, endurance, and courage.
As related by Daniel Slotnik in The New York Times6
Ms. Lister was relegated to her couch for years by a degenerative disease that rendered her immobile from the neck down and left her in near-constant pain. At one point the agony and tedium became too much to bear, and she resolved to end her life. ‘I had been a very active person as a child,’ she told The Sunday Telegraph of London in 2008. ‘I did sport. I played the clarinet. I went to Oxford University and studied biochemistry, and yet at that point I not only couldn’t do anything, but I was also in terrible pain . . . I just couldn’t see the point in continuing, really.’ Then a friend persuaded Ms. Lister to come sailing, and she found a reason to live.
Over the years, Ms Lister became an adept sailor who could navigate sailboats using mechanisms similar to those that control electric wheelchairs, “. . . sipping on and puffing into straws connected to electronic mechanisms that controlled the vessels.”6 Most remarkably, in 2005, Ms Lister became the first quadriplegic person to sail alone across the English Channel and later to circumnavigate Britain entirely on her own. Throughout her many years of sailing, she endured almost unimaginable physical challenges:
Her body struggled with thermoregulation . . . She was unable to go to the bathroom on a boat, which meant she could spend hours without relief. And she still experienced pain, which she said ranged from the sensation of sandpaper rasping her joints to that of knives piercing her.6
There were times when she was unable to breathe and required resuscitation by her support crew! And yet Ms Lister did what the English so famously and traditionally do: she carried on. Moreover, she described how sailing renewed her sense of pleasure in life, saying, “It was as if I was free.”6
Hilary Lister died in hospital with her husband Clifford at her side.
Of course, Ms Lister is not alone in finding life worth living, even when its “slings and arrows” become nearly unbearable and ultimately unavoidable. In a recent piece in The Washington Post,7 Dr Isaac Chan, a medical oncology fellow at Johns Hopkins, describes a terminally ill 68-year-old man with metastatic renal cancer who had been through five different types of chemotherapies and was now in the final stages of his illness. He was experiencing worsening diarrhea, sores in his mouth, and almost constant pain.
Dr Chan recommended-wisely, I believe-palliative treatment. But the patient wanted to continue with chemotherapy, and Dr Chan, quite ambivalently, agreed to provide it. He wrote:
[The patient] continued to plead that I not give up on him, and I continued treating him until one day he had bleeding in his head. He ended up in the intensive-care unit where he passed away. In the weeks prior, he had thanked me for the extra time he had to spend with family.
As physicians, we may not have chosen the course Dr Chan did; nor would all patients choose to continue battling their terminal illness after all realistic hope of cure or remission is gone. And, to be clear: any mentally competent person can refuse treatments that are unlikely to be of benefit (or are simply not desired) during one’s final days. Perhaps that is the wiser course for most-but not all-patients. And yet I believe Dr Chan exemplifies the best of Hippocratic medicine: listening carefully to the dying patient; offering one’s best medical advice; and then providing diligent care throughout the final days of the patient’s life. Most important, Dr Chan’s account vividly illuminates the concept of “life with dignity”-the conviction that patients and physicians together may bear even the most harrowing circumstances at the end of life.
Dr Chan’s case and Hilary Lister’s life provide us with counter-narratives to the all too prevalent notion that death with dignity is synonymous with assisting patients in ending their lives. Dignity comes in many forms, and for some patients, it means seeing the dying process through to its end, come what may. As the poet Dylan Thomas8 famously expressed it:
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.7
Sulmasy LS, Mueller PS, for the Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. October 17, 2017. http://annals.org/aim/fullarticle/2654458/ethics-legalization-physician-assisted-suicide-american-college-physicians-position-paper. Accessed September 14, 2018.
Borchard TJ. Is Physician-Assisted Suicide Right for Severe Psychiatric Disorders? PsychCentral. https://psychcentral.com/blog/is-physician-assisted-suicide-right-for-severe-psychiatric-disorders/. Accessed September 14, 2018.
Pies RW. Suicide and Communal Values: Ethical Implications for Psychiatrists. Medscape Psychiatry. 2014. http://www.upstate.edu/psych/pdf/szasz/pies-suicide-communal-values.pdf. Accessed September 14, 2018.
This article was originally posted on 9/11/18 and has since been updated.
1. Pies RW. Assisting Suicide is Not Assisting Nature. PsychCentral. https://pro.psychcentral.com/assisting-suicide-is-not-assisting-nature/. Accessed September 14, 2018.
2. Pies RW, Hanson AH. Twelve myths about physician assisted suicide and medical aid in dying. MD Magazine. July 7, 2018. https://www.mdmag.com/medical-news/twelve-myths-concerning-medical-aid-in-dying-or-physicianassisted-suicide. Accessed September 11,2018.
3. Geppert CMA, Pies RW. Two misleading myths regarding “medical aid in dying.” Psychiatric Times. August 1, 2018. http://www.psychiatrictimes.com/two-misleading-myths-regarding-medical-aid-dying. Accessed September 11, 2018.
4. Komrad MS. A psychiatrist visits Belgium: the epicenter of psychiatric euthanasia. Psychiatric Times. June 21, 2018. http://www.psychiatrictimes.com/couch-crisis/psychiatrist-visits-belgium-epicenter-psychiatric-euthanasia. Accessed September 11, 2018.
5. Pies RW. When is self-killing not suicide? Psychiatric News. July 19, 2018. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2018.7b29. Accessed September 11, 2018.
6. Slotnik DE. Hilary Lister, a quadriplegic who sailed solo, dies at 46. New York Times. August 22, 2018. https://www.nytimes.com/2018/08/22/obituaries/hilary-lister-dead.html. Accessed September 11, 2018.
7. Chan I. My patients are dying. But it’s their right to keep going. The Washington Post. August 24, 2018. https://www.washingtonpost.com/opinions/my-patients-are-dying-but-its-their-right-to-keep-fighting/2018/08/24/487c71ba-809a-11e8-b660-4d0f9f0351f1_story.html?utm_term=.423ce262bd0b. Accessed September 11, 2018.
8. Thomas D. Do not go gentle into that good night. https://www.poets.org/poetsorg/poem/do-not-go-gentle-good-night. Accessed September 11, 2018.