Where I Stand -- Mike O'Callaghan: Pain management is the answer, not phy sician assisted suicide

MIKE O'CALLAGHAN is executive editor of the Las Vegas Sun.

THE RECENT REPORT about pain in nursing homes being ignored or undertreated had to cause extreme heartache for millions of Americans. The study of 13,625 cancer patients aged 65 years and older was published in the June 17 issue of The Journal of the American Medical Association. The impact of this report on families with loved ones in nursing homes should be great and they should take immediate action to protect their friends and relatives from unnecessary suffering. Encourage them to report pain and then follow this up by checking with the doctors and nurses to make certain the pain has been relieved. Too many patients believe that pain is something they must expect and suffer from cancer and so they remain silent.

The report done by the SAGE Group tells us that "No physiologic changes in pain perception in the elderly have been demonstrated. In fact, the elderly may experience more pain than younger people, although they may be less likely to complain of it. However, the assessment of pain in elderly individuals with cancer may pose significant and specific challenges. Residents may be reluctant to report pain, often viewing it to be an expected concomitant of aging." Very simply there's a lot of unnecessary pain being suffered by the elderly in nursing homes.

The JAMA editorial in the same issue of the magazine stresses the lack of clinical training for pain management among members of the medical professions. When all is said and done, "The best pain management requires an informed patient who is willing to report pain and to voice complaints if pain is not controlled. Patients are reluctant to report pain for a variety of reasons, including fear the reporting of pain will take physician time away from the treatment of their cancer. Language and status differences compound this reluctance. Unfortunately, it is the rule rather than the exception that patients must volunteer that they are in pain before health professionals take notice. Unrecognized pain is untreated pain."

Another most interesting observation in the magazine's editorial concludes that "Treatment of pain should be a top priority in cancer care. However, excellence in pain control and symptom management has not been adopted as a 'mission' of cancer practitioners, probably for several reasons. First, patients do not die of pain, although some evidence suggests that untreated pain begets worse pain."

This leads us into the fear of protracted suffering and using assisted suicide as a way out of it. The magazine editors write, "Undertreatment of pain is a persistent clinical problem. A leading indicator of inadequate pain management is the poor control of cancer pain, a condition for which every effort should be made to assure patient comfort. Cancer pain is feared by patients, their families, and the general public and this fear has helped to fuel the debate concerning assisted suicide."

The study also points to the relationship of this unnecessary pain and depression. "The relationship between depression and pain may suggest that elderly patients with depression are more sensitive to pain caused by the coexisting physical condition, as others have concluded."

This all boils down to destroying the key illogical argument supporting physician-assisted suicides. It doesn't make good sense to surrender to pain and depression by suicide of any method. Demanding and receiving the care available to overcome these problems and continuing life is a much better solution.

The publicity that surrounds mercy killing by people like Dr. Jack Kevorkian and a few other nuts is extensive. Dr. Wesley J. Smith in his book "Forced Exit" says, "A story of hospice care helping someone die a dignified, natural death in comfort and surrounded by a loving family won't make the news at all unless the person is famous. It is no big deal if a cancer patient is no longer suicidal because he received effective pain control. It's the proverbial dog-bites-man story -- happens every day. Conversely, it rarely becomes a public matter when a patient is somehow coerced into an early death, since the abuser will not be anxious for public exposure."

Dr. Smith also tells his readers, "Pain can be controlled. The most emotionally compelling arguments in favor of euthanasia are that euthanasia is needed to help relieve human suffering caused by illness, that euthanasia is necessary to safeguard the human right to refuse unwanted medical treatment in favor of death with dignity, and that euthanasia is preferable to living with certain disabilities. I do not find these arguments persuasive. Advocates of euthanasia assert that legalization is necessary to make available through killing the relief of otherwise unrelievable suffering and pain. This is a false premise. It is certainly true that far too much pain and suffering go unrelieved, not because we can't provide relief but because we don't.

"The difference between 'can't' and 'don't' is a vital part of this analysis. If relief of agonizing pain and suffering is the overarching purpose for legalizing assisted killing, and if medical science has the wherewithal to relieve pain and significantly reduce suffering, then there is no real need to legalize euthanasia. Rather, there is a need to make the currently available relief universally accessible."

If you have some friend or relative suffering extreme pain, now's the time to insist on adequate medical management of their pain. Less pain and more love will work miracles.

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