>>Questioner: So you very briefly alluded to assisted suicide.
I was a hospice nurse for a couple years.
>>Dr. Atul Gawande: Were you?
>>Questioner: Yeah.
And overwhelmingly in my practice it was something that I had a couple family members and patients
always ask for.
Obviously I had to say no, but what are your personal feelings on active euthanasia, assisted
suicide, whatever you want to call it?
>> Dr. Atul Gawande: So I have complicated views on it.
On one level I would say the fact that there are people with unbearable suffering that
cannot be relieved means that we are heartless if we are unwilling to provide an option that
would let them end that suffering.
And I think that we’ve demonstrated in a couple of states, in Washington and Oregon
that it can be done safely.
I worry greatly, you know, my previous books were all about mistakes we make in medicine
and this would be the worst mistake, to prescribe people who had avoidable suffering to give
them suicide.
But less than one percent of the population in those states end up taking - seeking this
option.
Of those who get the therapy, as an option, less, only about half end up using it.
Just knowing that the option is there if the suffering becomes unbearable is really important
to people.
I don’t know if any of you have been following Brittany Maynard, who is the 29 year old who
says on November 1, because of her brain tumor, that she is going to take medication and take
her own life.
And what strikes me is that it’s a sign that our health system has failed her.
Because she cannot trust that people - medical personnel are going to recognize her priority
of not suffering and be willing to offer sufficient care and therapy to ensure that that doesn’t
happen.
You know, my father, when he came into a hospital with his -- towards the very end, with his
brain tumor, my mother, when he became unresponsive, my mother called an ambulance for him.
Not part of the plan, but these things happen.
And, but then when they got to the hospital, also made clear that she did not want cardiac
shock, put him on a ventilator, but with just IV fluids and reversing some of the narcotics
he was on, he woke up.
Turned out he had pneumonia, he was failing.
And, and then, he was in tremendous pain, of course, they reversed his pain medication.
So he woke up saying, “What the hell am I doing here?”
In his own hospital with his own colleagues, could not get them to give him enough pain
medication, because of their fear that he would not wake up.
And so he checked himself out of the hospital and we took him home.
And he made me promise I’d give him enough pain medication.
And he was fine.
It was a four-day process.
His pain was always under control.
but it took, it took a long course.
But he didn’t have to have that kind of suffering at the end.
And that’s where I think that my second more complicated view on this comes in, which
is that, the other cautionary tale to me is the experience in the Netherlands, where they
adopted assisted suicide.
And it was one of the first communities to do so, and it was one of the last communities
in Europe to have a hospice and palliative care movement.
Because it was easier to go for assisted death than go for assisted living.
And I think this is where the goal has to be very clear.
The goal is not a good death.
The goal is as good a life as possible all the way to the very end.
And I think when we understand that, you start seeing that someone like Peg, who actually
can achieve things along the way even though their life is narrowed.
So I think I would vote for the option of assisted suicide, but do it very nervous that
we – about making that our priority.
Our priority is assisting with living.