My PJ colleague Walter Hudson published a compelling argument regarding physician-assisted suicide in response to the ongoing dialogue surrounding terminal cancer patient Brittany Maynard. His is a well-reasoned argument regarding the intersection of theology and politics, written in response to Matt Walsh’s Blaze piece titled “There is Nothing Brave About Suicide.” Both pieces are a reminder that, in the ongoing debate over whether or not Maynard has the right to schedule her own death, little has been said regarding the role the medical profession plays in the battle to “Die with Dignity.” Walsh argues:
None of us get to die on our own terms, because if we did then I’m sure our terms would be a perfect, happy, and healthy life, where pain and death never enter into the picture at all.
It’s a simplistic comment that ignores a very real medical fact: Death can come on your own terms. And that doesn’t have to mean suicide.
My mother was a nurse for 20 years. During that time she worked in a variety of settings, from hospitals, to private practice, to nursing homes. Much like Jennifer Worth, the nurse and author of the Call the Midwife series, my mother practiced at the end of Victorian bedside nursing and the dawn of Medicare. As a result, the abuses she witnessed in the name of insurance claims were grotesque. For instance, if a patient required one teaspoon of medication, an entire bottle would be poured into the sink and charged to that patient’s insurance company. This was just the tip of the iceberg of unethical practices that would become priority in the name of the almighty “billing schedule.”
If the future were knowable, would we want to know it? When I was young, a fortune teller who predicted several things in my life that subsequently came true predicted my age at death. At the time it seemed an eternity away, so I thought no more of it, but now it is not so very long away at all. If I were more disposed to believe the fortune teller’s prediction than I am, would I use my remaining years more productively or would I be paralyzed with fear?
In a recent edition of the New England Journal of Medicine a question was posed about a 45-year-old man in perfect health (insofar as health can ever be described as perfect) who asked for genetic testing about his susceptibility to cancer, given a fairly strong family history of it. Should he have his genome sequenced?
A geneticist answered that he should not: to have his entire genome sequenced would lead to a great deal of irrelevant and possibly misleading information. But if the family history were of cancers that themselves were of the partially inherited type – more factors than genetics are involved in the development of most cancers – then the man might well consider having the relevant part of his genome, namely that part with a known predisposing connection to the cancers from which his family had suffered, sequenced.
This is not a complete answer, however. Two obvious questions arise: is additional risk clinically as well as statistically significant, and if the risk is known can anything practicable and tolerable be done to reduce it? There is no point in avoiding a risk if to do so makes your life a misery in other respects. You can avoid the risk altogether of a road traffic accident or being mugged on the street by never leaving your house, but few people would recommend such drastic avoidance.
My home state of Colorado is a guinea pig for the pros and cons of marijuana legalization. Other states are observing closely to see if they should move down the path towards legalization.
There’s plenty of bad news to go around. Police in other states are pulling over Colorado drivers with no justification other than the green license plate. (We’re all stoners now, I guess.) A college student named Levy Thamba fell to his death from a high balcony during spring break after eating a marijuana cookie. And last week a Denver man who ate pot-infused candy became incoherent and paranoid and shot his wife to death.
Is there good news? Turns out there is. Colorado Springs is the source of the Charlotte’s Web strain of medical marijuana that has sent parents with gravely ill children flocking to the city for treatment.
The strain was developed by Joel Stanley and his brothers in their Colorado Springs medical marijuana facility. They’d read that marijuana strains that are high in a chemical called CBD can help to shrink tumors and prevent seizures. The chemical in marijuana that gets users high is called THC, and since it has an adverse affect on seizures the Stanley’s bred it out of the plant.
Their first patient, 5 year old Charlotte Figis, was so affected by a genetic seizure condition called Dravet’s Syndrome that she was not expected to live much longer. Today, she’s almost seizure free. The Stanley brothers named the strain after their first little patient, and it’s showing the world what medical uses marijuana can offer.
Today there are nearly a hundred families with gravely ill children who have relocated to Colorado Springs, purchasing a treatment for their children that would have landed them in prison just a few years ago. Medical marijuana is well known to help in the treatment of nausea in cancer and AIDs patients, but the strains now being investigated may uncover new lifesaving medicines such as Charlotte’s Web.
The recreational use of marijuana is proving to be the problem it was predicted to be, but while the stoners fill the headlines the researchers in medical marijuana are quietly making amazing advances in the treatment of illnesses. That’s some very good news indeed.
Image via CNN Health.
Even non-hypochondriacs such as I sometimes worry fleetingly about their health when, having reached a certain age, some of their friends and acquaintances fall foul of a disease, namely (in this case) cancer of the prostate. But my anxiety does not last long and so far I have managed successfully to resist all attempts by my medical colleagues to measure my prostate specific antigen (PSA). I want to have as little to do with doctors as possible, other than socially of course, and there is nothing quite like a high PSA level to provoke doctors’ interference in a man’s life.
Would this interference, though, prolong my life if I allowed it to take place? A recent paper in the New England Journal of Medicine starts optimistically and ends pessimistically. It draws attention to the fact that mortality from prostate cancer has fallen drastically and attributes this to improvement both in early diagnosis of the cancer by means of screening and of treatment once diagnosed.
The body of the paper, however, is less sanguine. First 18,880 elderly men were divided into those who were given finasteride, a drug that was hoped would prevent cancer, and those given placebo. Some years later it was discovered that finasteride did indeed reduce the numbers of patients who developed cancer, in fact by nearly a third.
So far so good: but this is not the end of the story. Unfortunately, prostate cancer is a very variable disease such that, while some men die of it, many more men die with it than of it. And while finasteride seems to have prevented many low-grade cancers, those that would not have killed the men in any case, it seems also to have increased both the number and proportion of the more serious kind.
Human kind cannot bear very much reality, wrote T. S. Eliot, and a recent paper in the New England Journal of Medicine bears him out. The authors of the paper asked 1193 patients who had opted for chemotherapy for their metastatic cancer of the colon or lung how likely it was that the chemotherapy would cure them. The correct answer, of course, was that it was very unlikely (in the current state of the art); but 69 percent of patients with lung cancer and 81 percent with cancer of the colon had a much higher hope of cure than was reasonable in their circumstances.
The authors found that those patients with the least accurate estimate of the chances of cure (that is to say who were the most falsely optimistic) rated their doctors the highest for their communication skills. In other words it is possible that doctors who give an optimistic message are those that patients think have told them the most, in the best and clearest way; but it is also possible that optimistic patients view their doctors in a benevolent light. What doctors tell patients, and what patients hear their doctors tell them, may be very different as every doctor is, or ought to be, aware.
The paper raises the question of what constitutes truly informed consent. How many patients know or truly appreciate that, as the authors put it, “chemotherapy is not curative, and the survival benefit seen in clinical trials is usually measured in weeks or months”? For there to be informed consent, is it necessary for the doctor merely to have given the relevant information, or is it necessary for the patient to have inwardly digested it, to believe it? Is the onus entirely on the doctor, or does the patient have some responsibility? Is a doctor automatically to blame if a patient has not understood and absorbed his message? At any rate, the authors say that “this misunderstanding could represent an obstacle to optimal end-of-life planning and care.”
When I think about the strange twists and turns life takes, I’m reminded of the strange story of my great uncle Julius Lowenbein. Although fully true, his story could have been written by O. Henry. Listen and hear it.
Gyula (Julius) Lowenbein was born on March 11, 1869, in a small Austro-Hungarian village now located on the western end of Slovakia just across the border from the Czech Republic. At the age of 20, he went into the clothing business with partners in another town but either the business didn’t do well, the partners quarreled, or he had an itch to leave. So in 1894 they wound up the business and he immigrated to New York, with a second-class ticket bought with his share from the sale.
I have a picture of the family, about 20 people, taken at some resort just before he left. He is a young handsome man with light brown hair and a serious but slightly mischievous expression. In New York, where he would soon greet his arriving sister (my great-grandmother), Julius went right back to his trade of selling clothes. By 1900 he was a boarder at a building at 1074 Lexington Avenue. He was engaged to a woman named Sophie. His future looked bright.
Then disaster struck. He didn’t feel well and the doctor diagnosed his problem as tuberculosis, a dreaded disease in those days that one could not be expected to survive long. What could he do? There were new sanitarium opening up in the beautiful little town of Asheville, North Carolina, where the air was pure and clean. Perhaps he could be saved by going there.
Real Life Superhero Christian Bale Treats 4-Year-Old Cancer Patient and Family to DisneyLand Vacation
A 4-year-old Boardman boy with terminal cancer and his family were flown to California this week to meet Batman.
Jayden Barber, who was diagnosed with terminal bone cancer, and his family spent Wednesday with superstar actor Christian Bale, according to a Facebook page post by the family.
“Finally can share!!! Christian sent us to LA and we had lunch at Disney club 33 on wed!! He and his family were so awesome and down to earth!!!,” said a post on Lighting the Batsignal for Jayden page.
The family also posted pictures of Bale posing with the family on the site.
Jayden’s favorite character is Batman, and on Aug. 23 the Caped Crusader visited Jayden at the Boardman football stadium. That day was declared Jayden Barber Day in Youngstown.
Last week, Barber’s family said Jayden was in remission.
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