On May 3, Dr. Stanley L. Bukowski, a third-generation physician from Buffalo, testified before the State Assembly Health Committee in opposition to the legalization of physician-assisted suicide. For 34 years, Bukowski has been a primary care internal medicine physician with experience in caring for the chronically ill, the disabled and the dying. The following are excerpts from his testimony.
In caring for seriously ill and dying patients, a physician's duty is to first listen to the patient tell his story, examine the patient, collect test results, formulate a plan, engage the patient and family in the plan, and coordinate with the care team. The goal is to relieve physical symptoms; provide a cure if possible; educate the patient and family; give emotional support; and most of all, to be present to the patient. The more burdensome the symptoms, and especially when cure is not possible, the more important is symptom relief and personal support, i.e. palliation. If the disease is expected to cause the patient's death, palliation applied to the whole patient becomes central.
Medical treatments, techniques and medications progress over time. But the subject of medical care, the human person, is always a person, endowed with a dignity that no suffering or disability can take away. Even though "loss of dignity" is cited as one reason people take their own lives, people do not lose their dignity by suffering, or by becoming disabled, or bedbound, or even incontinent, or curled up with contractures, or unresponsive. It does not matter what they have lost. They are still our brothers and sisters in the human family. We are intimately and inseparably connected. Our dignity is their dignity, and vice versa.
The question is whether those who are caring for the patient, including the doctor, honor that person's dignity, and so honor themselves.
Genuine palliative care honors, respects and serves the dignity of the human person, regardless of his or her condition. It uses every necessary resource for pain and symptom relief. But assisted suicide eliminates the patient. We throw up our hands and capitulate on relieving their symptoms. Instead, we help them go away. Permanently. How can that possibly honor the patient? It dishonors them and us. In palliative care, we care for the patient, comfort the patient, and especially accompany the patient to the natural end of his or her disease, supporting them with our own humanity as the ultimate treatment.
Pain control is a mandatory, non-negotiable first step in addressing the other sources of suffering in the dying patient. Suffering persists because the patient is facing his or her losses. This can easily cause a patient to lose hope in his or her own worth and meaning. A physician's duty is to witness by attitude, word and action, that everyone's life has meaning, even at the end of it, even though there is suffering. We wrap the patient in a pallium, i.e. a cloak, of pain relief and symptom relief, care, encouragement and our very presence.
A prescription for a deadly dose tells the patient quite the opposite: "When your final months and days are difficult, and you think that you are no longer worth anything, I will not tell you otherwise. I will help you make yourself not be. I will agree with you that your fear and suffering have diminished you to the point where you no longer have value, and my prescription testifies to this."
To intentionally cause the death of a patient, regardless of reason, is fundamentally incompatible with being a healer. It creates an inescapable internal conflict. A healer who aids in taking a life is divided within, even if it is at the request of a suffering patient.
A patient's fear and anxiety about what is to come, even when pain is well-controlled, may understandably cause him or her to lose heart and lose hope. But the doctor's task is to bring clarity, give relief and support, and restore hope.