Physician-Assisted Suicide: Compassion, Not Crime

February 20, 2009 at 9:57 pm (2008, Articles)
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Physician-assisted suicide has always been a very controversial subject in society—the ancient Greeks brought the subject to forum, as euthanasia in Greece and in Rome was an everyday issue. It is even written in the Hippocratic Oath (written in the 4th century B.C.E.), “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” (“Hippocratic”). Today both euthanasia and physician-assisted suicide are still tough topics to tussle with, in our society and around the world.

Although the terms “physician-assisted suicide” and “euthanasia” have been used interchangeably, there is a distinct difference between the two. The name “physician-assisted suicide” may be self-explanatory: it is a patient dosing themselves on medicine prescribed by their attending physician while the doctor is not present in the patient’s room, and it is the patient’s decision whether to use the drugs or not, and when. (“Physician”) Euthanasia, on the other hand, is more aggressive; the doctor actually administers the drug to the patient which subsequently causes their death. In this paper I am going to address physician-assisted suicide specifically.

I am arguing for PAS on four bases: first, that refusal to allow it is a violation of the inherent right to self-determination of the terminally ill; second, that it can save patients and family, as well as health care providers, money; third, that physician-assisted suicide could save patients and families the trauma that comes with the uncertainty of natural and slow death; and fourth, that PAS is actually much more humane than allowing a suffering patient to die naturally.

Patients should have the choice of physician-assisted suicide, because it is a manifestation of their right to self-determination as it is interpreted from the Constitution. The Supreme Court ruled in Planned Parenthood v Casey (Leo) that “choices central to personal dignity and autonomy are central to the liberty protected by the 14th Amendment. At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe and of the mystery of human life.” This translates simply to the idea that one should have the final say about what happens to one’s body, outside of the realm of directly harming others.

Physician-assisted suicide can save patients, their families, and health care providers significant amounts of money. One Hospice Care professional cited a hospice care cost at roughly $6,000 per two months per patient (“Hospice”). Much or most of this is funded through Medicare or Medicaid, although both of these services are costly to these patients on top of their already high hospital care bills. Much of the money going toward hospice could be more advantageously propagated to medical research, children’s hospitals, and other medical programs that have unstable funding but serve functions crucial to the health of our society as well as other countries that rely on our medical breakthroughs. Outside of the realm of hospice care, “[a]ccording to recent Medicare data, for a beneficiary who dies of cancer after receiving conventional care, $30,397 (in 1995 dollars) is spent on medical care in the last year of life” (Emanuel and Battin). This includes medications that cost upwards of $4,000 a month, which may or may not be covered by Medicare (James).

The self-dosing of PAS could save patients and their families the pain and heartbreak that comes with prolonged dying and the uncertainty that accompanies it. It allows patients to decide when to end their own suffering, which gives family and friends ample time to say what they need to say to their suffering loved one.

Lastly, physician-assisted suicide is more humane due to the drugs prescribed and taken than letting terminally ill patients suffer until death. In the Netherlands they use high doses of barbiturates for PAS; this type of drug affects the central nervous system, and causes sleepiness. Barbiturates are a central nervous system depressant (CNS), used to calm patients before surgery and can be used to control seizures, sleep problems, and nervousness, although other drugs have begun to replace barbiturates in these last two areas (“Barbiturates: Purpose”). A barbiturate overdose can be likened to dying in one’s sleep; anxiety levels decrease and heart rate and respiration reduce (“Barbiturates Drug Information”), which is much more peaceful than the months leading up to death from the patient’s terminal illness.

One might argue that physician-assisted suicide is, at its basest, still simply suicide, and that if we as a country allow for the terminally ill to commit suicide, who is to say that we won’t extend this right to those who are depressed? Are we not denying this right of self-determination to them if we refuse physician-assisted suicide to them? I do agree that this could become an issue if PAS was legalized, but whereas such conditions as depression can be treated through medication, terminal illness can only be micromanaged, not cured, nor can the subsequent death be prevented once a patient is in such poor condition that a doctor will classify them as terminally ill. One might also argue that suicide in either form does directly affect the patient’s loved ones, but in the end, the one who suffers the most during the dying process is the patient who is dying.

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Living With Lactose Intolerance

February 19, 2009 at 1:04 am (2009, Articles)
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I have congenital lactose intolerance. When I was a baby, I nearly died from the cow’s milk formula I was on until I was switched to goat’s milk. When I got older, my lactose intolerance became less noticeable, although those years of oatmeal and pizza made for a lot of sick time. Once I hit about fourteen or fifteen, my lactose intolerance came back with a vengeance. Since then, it’s been a battle between my digestive tract, my medicine, and my overwhelming desire for the foods I absolutely cannot have anymore. I’m nineteen years old now, and I’d like to think of myself as somewhat of an expert at avoiding and compensating for dairy. I am only one of approximately 30 to 50 million people in the United States who suffer from lactose intolerance. (FBCH, 1999) This paper is mostly written for those who have lactose intolerance, to discuss ways in which to cope with this deficiency, but I hope that it may also help educate those who don’t know what lactose intolerance is, or maybe know someone who lives with it.

You may wonder, What exactly is lactose intolerance? It is the inability to digest lactose, a type of sugar found in milk, through a deficiency of lactase, the enzyme generated in your digestive tract that helps you digest the lactose. Lactose intolerance is not the same as a cow’s milk allergy. Also referred to as lactase deficiency, the condition can be divided into four types: primary, secondary, developmental, and congenital.

Primary lactose intolerance, also called adult-type hypolactasia is caused by the body simply losing the ability to digest milk. (Reilly, 2004) Your body produces less and less lactase as you become older, because milk becomes less of a primary source of nutrition. An illness or injury to the small intestine can result in secondary lactose intolerance. Secondary lactose intolerant may be temporary or permanent, depending upon the severity of the illness or injury. Congenital conditions are ones that you are born with. This is the least common type of lactose intolerance, affecting about 1 in 1,000 births. (Reilly, 2004)

Developmental lactose intolerance occurs in premature infants, and usually becomes better as the gastrointestinal tract matures. (Leeds & Sanders, 2008) People with congenital lactose intolerance, like myself, have lived with the symptoms all their lives. (MayoClinic, 2009)

Lactose intolerance may be detected through medical tests. Right now there are four types of test in use. In one test, the patient drinks water containing 200 ml of lactose, then they and the doctor wait for symptoms to occur; in another, the patient simply cuts dairy out of their diet for a number of days, then reports back to his or her physician to discuss the difference in the patient’s stomach pain and stools. (Aziz, 2008) Another, the most sensitive test at about 90% sensitive, is the lactose hydrogen breath test. The last test for lactose intolerance is an invasive one; it is a biopsy “performed on duodenal [...] specimens” that “measures lactase activity directly.” (Leeds & Sanders, 2008)

As stated previously, lactose intolerance is not the same as a cow’s milk allergy.* Symptoms of lactose intolerance range from stomachache, cramps or pain, and gas to vomiting and the most common symptom, diarrhea, depending on the severity of an individual’s intolerance. (WebMD, 2007)

If you’re lactose intolerant, you probably know how hard it is to find foods that are non-dairy these days. What you may not know is that milk has two components: whey and curd. Both of these components contain lactose, and are found in many foods. (Cavette, 2009) Whey, which makes milk watery, is used in processed foods, and can be found in the ingredients lists of many foods you’ll find in boxes. (Food Lovers Companion) This makes up most of our daily indirect dairy intake. Curd in milk coagulates when the milk goes sour or is treated with enzymes, and is primarily used to make cheese. (RhymeZone)

For the purpose of this article, there are two types of dairy products: basic, “no-brainer” dairy foods, and sneaky dairy products. The basic dairy foods are: milk, cheese, yogurt, butter, sour cream, cream cheese, ice cream, and pizza. Obviously, anything containing any of these is also a dairy product. Sneakier dairy products include some medications, processed foods, dried fruit, margarines, breads, breakfast cereals, and pre-prepared meals. Lactose is also used itself in commercial foods for texture, flavor, and “adhesive qualities.” (Wikipedia) Some of the sneakier products now have the bold warning on the nutrition labels that the product contains milk, but it’s always a good idea to look through the list of ingredients. Remember that the ingredient that’s in the most quantity in a food item is listed first on the list, and if you have a good feel for how tolerant you actually are of lactose, you can gauge about high up on the ingredient lists certain milk products can be before they make you sick.

An inherent difficulty with lactose intolerance is replacing the nutrients in our diet that we no more get from milk, or that we don’t get enough of from a restricted dairy diet. Milk contains nine nutrients vital to our health: calcium, potassium, phosphorus, protein, riboflavin, niacin, and vitamins A, D, and B12. (National Dairy Council, 2006) Calcium is necessary for bone health, and is key in preventing osteoporosis. It is recommended that people in the age groups of 11-24, 19-50, and 51 and up get between 1,000 and 1,500 mg of calcium every day. (NIH, 2006) The calcium in milk can be obtained through products such as calcium-fortified soy drinks, dark green vegetables, fortified oatmeal, tofu, rainbow trout, pink salmon, and clams. (ARS, 2008)

Potassium is necessary for muscular and regular growth, as well as electric and cellular functions. (Tsai, 2008) Some of the foods from which you can obtain potassium are: bananas, most fish and red meats, tomato products, lentils, kidney beans, apricots, and orange juice. (ARS, 2008) Phosphorus can be obtained through a diet rich in calcium and proteins. Its function in the body mainly concerns strong bones and teeth. Protein is found in most bodily fluids, as well as in muscle, skin, glands, and organs. There are complete and incomplete proteins; complete include eggs, meats, fish, and soybeans; incomplete proteins include rice, beans, wheat, and corn. (McGee, 2007) Riboflavin and niacin are both B-vitamins. They, along with B12, can be found in nuts, eggs, poultry, legumes, green leafy vegetables, shellfish and lean meats. Vitamins A and D can be found in eggs, meat, liver, certain fish and fish oils, and oysters and margarine. (Dietary Guidelines for Americans, 2005)

Now, if you’re like me and absolutely cannot give up certain dairy foods, there are treatments available. At Walmart, for example, they sell Equate Dairy Digestive Supplement pills in a bottle and in a sheet (the bottle is a much better deal). These are to be taken at every meal, or for every half hour you’re eating. (Equate is a Walmart brand found in their pharmacy; other pharmacies have their own brands if they carry lactase supplements at all.) There are also Lactaid Fast Act caplets, which work about the same. There are also certain brands of once-a-day lactase pills, that I recommend if you aren’t severely lactose intolerant. I read somewhere that you should take an antidiarrheal, such as Imodium A-D, to help reduce the effect of a dairy product on your system. Also, at Walmart I have found Lactaid milk, which is regular milk (2%, skim, and whole, I believe) with the medicine already in it, as well as a type of vanilla bean ice cream that’s the same way.

Whether you can just take a pill once a day and eat what you want, or you have to cut dairy foods out of your diet altogether, lactose intolerance doesn’t have to ruin your life. You don’t have to spend hours in the bathroom or feeling sick, nor do you have to go without all the health benefits that milk has to offer.

*Milk allergy manifests in the same way as most food allergies, with hives, nausea, and head- and stomachache. (Williams, 2006) If you believe you might have a cow’s milk allergy, you should avoid consuming dairy and see your health care provider.

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