Medical Assistance in Dying: Not as Easy as it Looks | Joel Zivot | TEDxEmory

[Applause] [Music] thank you very much so my talk today will not be cheery but I hope that we can leave this discussion with a sense of hope because I think it's a hopeful subject and I'm going to talk today about medical assistance in dying and this talk is also called not as easy as it looks now many people here in the audience look rather young and so I suspect that you're not pondering very much about dying at all let alone with any assistance but I wanted to try to create for you a story and I want to set the mood if you can start please [Music] this is Billie Holiday [Music] here the music that my mother loved we can turn it off now we played this music over and over again when my mother was dying she loved a Billie Holiday and we played it for her she died at home in her bed and it wasn't my idea of the way that I wanted her to die because I'm a physician I'm an ICU doctor and I tried to engage her in conversations about how to die and where to die but she would always push me off tell a joke or say something and we never did have that conversation as to what to do and so we found ourselves at home in her bedroom listening to Billie Holiday over and over again and as a physician I'm an expert in this sort of thing and so I was tasked with assisting making sure that she was comfortable to the extent that I could determine it I watched her breathe and I watched her breathing slow and when she took her last breath I didn't know that it was the last time because her breath had already been irregular and so I waited present there with me was my dad and my brother and my sister and we watched her and she took her last breath and when she died I transformed myself into the technical person that I am the medical person and I called the funeral home and they sent someone and a gurney to take her now where my mother died she lived in a very beautiful elegant place it was a condo by a river and it was a very elegantly designed which is a reflection of the way that she was leading up to her room was a spiral staircase and the spiral staircase was lined with paintings along the way very beautifully and tastefully done and so after my mother was dead I could not conceive of how we would get her body on a gurney down the spiral staircase I couldn't think of a way to do it my brother was there who was kind of hanging back while this was going on I assumed because he wasn't in the medical business this was all quite a lot for him were quite close of course but then he did something that never would have occurred to me in a million years he picked up her body gingerly and lovingly carried her down the spiral staircase and lay her body on the gurney I'll never forget that when we speak about death we tend to use language we use every word except death we say things like passed away passed gone expired at peace departed not only in our culture but other cultures around the world tend to gravitate towards euphemisms for death for dying now as a teacher I teach my students that it is very important that they do not use euphemisms that they must use the word death dead and die and I tell them that if it sounds like profanity and you must stand in front of the mirror and say it until you've got it right until it sounds right I think it's very important to use language and I've had many conversations with people who I've just met and now I have to tell them that someone that they loved that the cared about has died and I say the word die and dead and I look them in the eye and I explain it to them and these are the words that I use in my job as a doctor I recognize that medicine has become both an adversary and an ally of death it's an adversary in that we try of course to stop death sometimes we were successful sometimes we're not actually I guess I should be more clear we are never successful percent of my patients died a hundred cent of you will die as far as we know but there is things that we can do that can at least alter the arc of illness that has not always been the case I work an intensive care unit and so what is normal for me is certainly not normal for you and so this to me is a regular day at the office all this technology all these machines this is normal this gentleman may survive or he may die that's just what we do in top of doing all of this of course we spend a lot of time trying to take away symptoms to treat symptoms and so in this way death and now medicine have begun to work together if you will and so instead of dying like this of course what we would like is something perhaps like this I'm not sure which one I am in here maybe I'm the guy with a crown but it's something that we do to try to create an easy death for people or an easy dime anyway that's what we what we try to do and so much so of course that it's transformed into a whole separate discipline of care something we call palliative care care that is directed now not so much at curing but now at controlling symptoms and where the symptoms are now the primary purpose of the treatment and that's what we do now that knowledge of reducing suffering if you will and of death and dying has been moved to an unusual place now the same knowledge has moved out of the hospital and now into the court system and into prisons and specifically into death row and I find myself drawn here because I recognize that my profession and the things that I do have now been appropriated if you will to displace to death row and why what happening well in order to die to be executed it has to be done in a certain sort of way and you will see here that the similarity between medicine and lethal injection is not accidental it's recognized that some of the things that I do that involve the injecting of medication for example have an effect that if we configured if repurposed can cause death and so others have recognized this and created this method of execution that's referred to as lethal injection now in order to die by the court to die lawfully it turns out that it has to be done in a certain sort of way you can't just die anyway I suppose if an inmate could pick they would probably pick died of old age for example but the court has another idea but still there is a provision in the Bill of Rights the Eighth Amendment that discusses this concept that punishment cannot be cruel and it turns out that this concept of cruelty is not so easy to determine and of course when we say cruel punishment we're really talking about the experience of the person executed now you can imagine that if you took a survey of all of the people executed and you ask them did they experience their own death as cruel I would imagine that most of them would say yes my death was cruel now the method of capital punishment is important and I'm not talking today about the rightness or wrongness of capital punishment here I'm talking about the method and you can see that there are other methods that have been used in the past to execute people that have come and going and the reason why these methods go is not because of legislation but because the public the witnesses experience the method is cruel so we don't hang people anymore we don't gas them anymore we don't shoot them anymore and we don't electrocute them anymore what remains is lethal injection now how do we know that lethal injection is or is not cruel first of all we assume that it is not because when we think about these sorts of things with people dying say in hospitals we don't think of that as cruel we don't configure it as cruel we rely instead on the eyewitnesses I witnessed an execution I was asked by an inmate to witness his execution because he hoped as a doctor that maybe I could glean something from what I saw what I observed I tell you that it's a difficult thing to watch and I've seen many people die it's a curated event you don't really get to to be yourself they take away your watch they take away your phone they take away your pen or a pencil or paper so you're in this room trying to see something through glass and determine what exactly it is that you see this is Marcus Whelan's we can't ask Marcus Whelan's whether or not his execution was cruel I watched it I saw him and I couldn't really tell there was not much to see I was expecting to see something and I couldn't see much it began and then it was over and I couldn't even tell how much time had passed and so I was left with this feeling that something is amiss something is wrong because witnesses can't tell if you ask witnesses who were witnessing executions those that think that the person executed should die think that what they saw was right and people who are against execution who think that the person shouldn't die think what they saw is wrong and so Witnesses are unreliable and so I was left well what else can I do to try to sort this out so what happened was I came upon a file of autopsies was given to me of people who were executed and I began to realize that there was perhaps something here an autopsy is a way of examining people after they died and to try to tell a story that could not otherwise be told autopsies have been around as a as a modern intervention for several hundred years but the story of dissecting the body goes back many thousands of years now what this is is a list of people that have been executed and what's important to note here and by the way you'll see the Marcus Whelan's is on this list which is the execution that I saw what I want to point out to you here is the lungs here there's a right and a left lung and what's listed in this column here are the weights of the lungs why is this important well the lungs have a normal weight we weigh them in grams and in this list what it shows you is that all of the weights here of these lungs are about double what the normal weight of lung should be and so you ask yourself how is it that that happened if execution and lethal injection killed people instantly then the body would be unperturbed there would be none of this organ failure and I want to tell you that I've left off other organ systems here that also fail in the consequence of execution so what I learned from this was lethal injection was not a kind of peaceful death but in fact it was progressive organ failure with fluid building up in the lungs and I couldn't see it I couldn't see the lung congestion in Marcus Welland I couldn't see the congestion in his trachea not at the time but the post mortem showed it now medical assistance in dying is actually configured to be quite a lot like lethal injection is the same kind of medications that are used sometimes in a very similar fashion injected intravenously or taken as pills of the same class of drugs now we don't of course do autopsies on people who died after being dying as a consequence of medical assistance why would we but if we did I suspect that what we would see would be a picture quite similar in fact to lethal injection of course I say there's no autopsy but my impression again is that it would be very similar to what lethal injection would show and so I want to leave you at the end with this idea that I recognize that people may believe that they want to control the way that they die I understand this and they believe that they may want to have a doctor assist them but I have to tell you that I'm not a very good killer at the best I only dabble in killing and if you need something better than what I can give you that I'm afraid that you're going to have to look elsewhere and I say the same thing about lethal injection like medical assistants and dying it's not what you think it is I think that the autopsy really shows this and instead of medical assistants and dying I would like to leave you with the idea that perhaps what a doctor might help you with is medical assistance in living there are things that doctors can do that can reduce the pain at the time of dying but it's somewhat of a limited activity but I believe that in the case of my mother when I was there I think that she had arranged it to be such I provided some comfort and I think I did the best that I could do and so with that I will leave you thank you [Applause]

Channel: TEDx Talks

Views: 41,531

Rating: 4.5037594 out of 5

Keywords: TEDxTalks, English, Health, Criminal justice, Death, Ethics, Human Rights, Law, Medicine, Prison

Id: qsLEODxl35Q

Length: 16min 26sec (986 seconds)

Published: Wed May 30 2018