Why do we want to become doctors? What motivated us to write personal statements and endure interviews? Regardless of the specific incident or the general motivation, it can be all summarized in one sentence: We are here to save lives. After all, this is what physicians do.
Preventing death is part of the original Hippocratic Oath, which was written between the third and fifth century B.C.E. It says, “Neither will I administer a poison to anybody when asked to do so … Similarly, I will not give to a woman a pessary to cause abortion.” According to the socially accepted standards, the sanctity of life must be preserved by doctors regardless of the situation. We all agree that killing a patient is immoral, but the question is whether prolonging life is moral or whether it crosses into the grey area of medical ethics.
Unfortunately, theory often becomes conflicted when contrasted against personal experience. Around two years ago, my grandmother was diagnosed with liver cirrhosis. The drugs that she was prescribed were metabolized by the liver and came with their own set of adverse effects, including arthralgia, myalgia, anorexia, jaundice, esophageal varices, spider angioma, caput medusa, anemia and edema. One by one, the symptoms started appearing just as the books and the online sources had predicted.
At the time, I was a senior pre-medical student intrigued by my grandmother’s disease. However, these were no longer just symptoms on a page. They were now causing real suffering to my grandmother who I loved dearly. During my research, I learned that my grandmother’s illness was causing severe hepatic encephalopathy. Because of her advanced hepatic cirrhosis and disease presentation, I realized that her life expectancy was short.
In most cases, I imagine that family members remain optimistic and want to try every possible treatment that may sustain life. Similarly, my family did the same. Because my grandmother was incapable of making her health care decisions due to lack of mental capacity because of hepatic encephalopathy, my uncles were left in charge. They agreed on a plan that they thought would fight disease but in reality caused needless suffering. Understandably, they wanted to try every possibility to keep their mother alive. They saw the pain she was in, but the vision of their strong, capable mother never left them. They were fighting to fill the gap between what they wanted and reality. Despite all interventions, my grandmother died a few weeks later.
In retrospect, I regret that she was not allowed to die peacefully. I now am compassionate towards those who opt solely for palliative management in terminal illnesses. As a society, we often overlook the necessity of palliative care and focus solely on the life-saving interventions. Sometimes, a doctor’s job is to relieve suffering rather than to provide life-prolonging treatment. As health care providers, we should acknowledge our limited ability to heal and offer palliative care as a reasonable option to all terminally ill patients.