Legal Aid in Dying

by Barbara Coombs Lee
May 15, 2013

Dr. Tom Preston, a Compassion & Choices leader in Seattle, chose these poignant words for the title of his new book. They are powerful words, gripping even on paper. Imagine them emerging from the lips of a patient, perhaps one whom the doctor has treated over decades, who is now dying of cancer. They strike right at the core of a physician’s identity, training and moral compass.

Preston knows well that each person, each healer and each caregiver responds to such a request from patient or loved one from the deepest parts of their own authentic being. He begins his book quoting Dumbledore, who in the last Harry Potter book pleaded with Snape to cut his dying short. “You alone know whether it will harm your soul to help an old man avoid pain and humiliation,” the wizard tells his reluctant friend. So it is with every doctor In America.

I recall hearing Dr. Peter Goodwin, Compassion & Choices’ leader and dear friend who died last March, describe how his “blood ran cold” the first time he heard these words. He responded to his patient he could not, but spent the remainder of his life regretting that answer.

Last month Dr. Eric Kress testified to the Montana legislature that when he refused the first patient who asked for his help in dying, the patient reacted in disgust and called him a coward. Thus began his own soulful rumination and his decision not to abandon subsequent patients who asked for his help. “What kind of man am I?” he asked himself. “What kind of doctor am I?”

Preston writes from his long and passionate interest in how doctors respond to this plea. By extension, he is also vitally interested in the historic and potential relationship between the field of Medicine and patients who yearn for choice and control in their dying. Today, it’s mostly a dysfunctional relationship. But it has not always been so, and this book may well help heal the dysfunction.

Preston is a fine writer, and a splendid historian. I greatly enjoy his reaches into ancient Greece and Medicine’s dawn as a profession. In one enlightening chapter he traces the transformation of medical oaths, “From Hippocrates to Lasagna,” to demonstrate how politics, religions and accidents of history influence the words and meanings that endure, even when at odds with ancient precepts or practices. Personally, I’ve always been fascinated to observe that sometime in the course of history the caduceus, symbol of Mercury, god of thieves and business, came to replace the staff of Asclepius, son of Apollo and the first mortal healer, as the symbol of Medicine. (That’s right, the patron god of financial gain stands as the profession’s symbol in modern times.)

Another of Preston’s great contributions is his concentration on “patient-centeredness” as the mark of excellent care. Preston acknowledges that his colleagues may pay lip service to the term, while actually delivering “physician-centered” service. Therefore he takes care to advocate a “meaningful” patient-centered approach. One of the speakers at this year’s TEDMED conference noted that even “patient-centered care” can mean that professionals circle the patient and impose a one-way dialogue.

Non-physician readers will find in Preston’s words the reassurance, courage and tools to approach their doctors with legitimate requests arising from their experience in health and in decline. Physician readers will find compassion and gentle guidance in adopting an open and responsive attitude toward the needs of their dying patients. Physicians across the nation are examining their position on intention and assistance in dying, and this book is bound to help.