COPD, Euthanasia by Omission

One of the common causes of death in Canada today is C.O.P.D. (emphysema), and although the life expectancy for people with heart disease has been on a dramatic rise, the same cannot be said for people with C.O.P.D. One of the reasons has been that although medical advances have been shown to be a great benefit to cardiac patients, the same cannot be said for medical advances for patients with C.O.P.D. Medications for this group of patients show good symptom relief but really no prolonging of life. Surgical interventions, in select patients, have been helpful, but the numbers helped are a small percentage of the total group. Good nutrition and exercise can have a positive effect, IF the patient quits smoking! In fact, the only thing that consistently and significantly extends the C.O.P.D. patient’s life is the cessation of smoking. This follows, of course, because by far the most common cause of COPD is smoking.
As a society, we will be seeing the impact of this group of people in the years to come, not just from a cost and care perspective, but from a “life expectancy” perspective. Already we are seeing the prominence of smoking in the 40’s/50’s/60’s/70’s and 80’s translated into C.O.P.D. and consequently, pulmonary failure and death. The impact of this group on our health care system of the future may well be much greater than anticipated.
Death occurs because of organ or multiple organ failure. We can prevent death (extend life) by:
1) Preventing deterioration of organs, e.g. reducing cholesterol to prevent heart disease.
2) Assisting organs in their function, e.g. angioplasties on coronary arteries to assist the heart to function.
3) Taking over the function of the organ by some means e.g. organ transplants, dialysis for renal failure, etc.
People die from pulmonary failure when their lungs deteriorate to such a degree that they do not have the capability or the strength to exchange air quickly enough to provide their body with oxygen and to get rid of the accumulating CO2. Lung transplants are done but in an environment of scarcity of donor organs, age basically disqualifies the COPD group. Is there some way that modern technologies can assist the lungs and the patient in gas exchanges? Well, as a matter of fact there is; but it is rarely talked about in a positive way. It is Mechanically Assisted breathing. I had the opportunity to look after someone who was on mechanically assisted breathing and it extended his life by three years. Was it ideal, no, but was the patient quite functional, definitely.
Most people see this situation as being continuously hooked up to a machine, lying in bed all the time. In fact, I think the situation is often “put down” by care givers when they ask the patient “ do you want to be hooked up to a machine all the time and have the machine breath for you?” Actually since the problem is patient fatigue, the machine only has to help you breath and you can have short periods to talk, do your bathroom functions, etc, but it is quite tiring. The machines are quite compact and can be used in your home, the range of movement determined by the length of the electrical cord.
Minimizing effort in other areas is a good idea(walking, moving, etc creates greater oxygen demand) so as time goes on this does become more of a problem. Good nutrition is important to keep up your strength. You can enjoy your children and grand children’s visits and you can correspond through E-Mail and have active internet dialog. You could continue to run your business if you were so inclined. We live in a technical age where entertainment is brought into the home and our homes can be run through your computer. So why are people not choosing this option instead of dying. They certainly would be better off than many people who have strokes and still choose to carry on with their lives. Perhaps in the one to three years that their life is extended a new drug will be discovered that facilitates the transport of gasses though their lungs! The vast majority of these patients simply say they wish to not be “put on a machine,” possibly with little knowledge other than preconceived ideas from television. possibly augmented by frowns and resistance by caregivers. Many of them die in the emergency departments, our hospitals, our long term care facilities, our palliative care units, or in their homes. I’ve often wandered what the information presentation was like to these people and their loved ones. Is cost once again coming into the equation? Are we as health care information providers practicing euthanasia by omission?