Hastings Center Rep.: Confronting Physician-Assisted Suicide and Euthanasia: My Father's Death.

• Author: Wolf, Susan M.
• Position: Abstracts

The death of the author's father forced her to rethink all she had written over two decades opposing legalization of physician-assisted suicide and euthanasia. Years ago, when she started working on end-of-life care, her father challenged her views on advance directives by insisting that he would want "everything," even in a persistent vegetative state. There is no afterlife, he claimed. This is it, and he wanted every last bit of "it" on any terms.

Her father was diagnosed with a metastatic head and neck cancer in 2002. His predictable view was "spare no effort." A top head and neck surgeon worked through conflicting pathology reports to locate the primary tumor in the thyroid and excise the gland. Metastases would crop up from time to time, but radiation and then CyberKnife radiosurgery kept them in check. For five years he did well.

Things changed in 2007. One look at her father and the surgeon admitted him, ordering a gastrostomy tube to deliver nutrition. Now her father was in an excellent hospital, with the head and neck, pulmonology, and gastroenterology services working him up. With multiple services focusing on her father's condition, she hoped the picture would soon come clear. She waited for a single physician to put the pieces together. The medical picture was becoming worse. A surgical procedure revealed cancer in the liver. Pulmonology added pneumonia to the roster of lung ailments. Meanwhile, a dipping oxygen saturation number drove a trip to the intensive care unit. Attempted endoscopy revealed a tumor between the esophagus and trachea, narrowing the esophagus. But no physician was putting the whole picture together. What treatment and palliative options remained, if any? What pathways should he and the family be considering at that point?

Her father was becoming increasingly weak. Then one morning he said he wanted to stop. No more tube feeding. No one was prepared for this switch from a life-time of "spare no effort." He told me he feared he was now a terrible burden. She protested, knowing that she would willingly bear the "burden" of his illness. The doctor urged him not to stop, warning that he would suffer a painful death, that morphine would be required to control the discomfort, and that her father would lose consciousness before the day was out. Instead of assuring her father that health professionals know how to maintain comfort after withdrawal of tube feeding, her father was scared away from this option. Weeks...