Keith White, MD, and Tom Creelan: It's comforting that the option is there
Keith White, MD, has never assisted in a dying patient's suicide, but he's not opposed to the practice or to his state's Death with Dignity law. "I feel that the patient should be able to determine how much suffering they can do and when they're going to die," said the Independence, Ore., family physician. "I don't know how that affects other people -- besides upsetting their sensibilities."
Despite his support for the law, Dr. White said he doesn't bring the subject up with his terminally ill patients. "It's comes up maybe three or four times every six months," he said. "It's mostly old people or people with a terminal illness who can see the end coming. It usually starts with 'I don't think I'll even do it, but ....' "
Artist Tom Creelan, one of Dr. White's patients, has kidney cancer. He said suicide isn't something he's seriously considering, but he likes that it's a choice available to him.
"I would have to be in dire, dire straits and in untreatable, unbearable, excruciating pain to even consider it," Creelan said. "But knowing that option is there, if I choose it, does give me some comfort -- knowing that I don't have to suffer unbearable pain -- if it comes to that."
Married with twin 22-year-old sons, Creelan was diagnosed with cancer in July 1999 and given about 6 months to live. He believes that, in part, the peace of mind he feels knowing assisted suicide is an option may have helped his longevity.
Dr. White thinks there could be some truth to that. "Health is sort of between your ears in many ways," he said. "It's also in your heart and how you feel. I don't want to make any big health claims, but that's what I've heard from patients."
He added that Creelan knows his position on physician-assisted suicide.
"He knows if he wants to do it, I'm fine with it," Dr. White said. "It's an option. The bigger part is end-of-life care, and physician-assisted suicide is just a small part of that."
When treating a terminally ill patient, Dr. White said he finds that it's best not to delay giving bad news.
Creelan said he appreciates the open communication with Dr. White. Hearing bad news is never easy, he said, but it's good to get the conversation over with so a person can get on with whatever time they have left. "I think the scariest words people can hear in their lives are: 'You have cancer,' " he said. "I think everyone who hears those words goes into shock."
He said the news can have a "no-cebo effect" (the opposite of a positive placebo effect), where people give up and wait for the inevitable. While for others, including himself, the news makes them take stock of their lives.
"Every single day is like a lifetime," Creelan said. "This may sound strange, but -- in many ways -- cancer has enriched my life.
For a cancer patient, he said "every day and moment become almost sacred and something to be embraced and celebrated. I like to focus on staying alive -- not how I'm going to die."
Creelan began a series of color-pencil skyscapes a few months before his diagnosis. He continued on his art through his illness and believes it may have been his best work ever. "In retrospect, it was a premonition, and it foreshadowed that things are going to be changing," he said.
The 30- by 40-inch drawings capture Oregon's blue spring skies covered in black and white clouds, and were featured in an art exhibit posted in the governor's office in Salem.
"When they said they wanted it scheduled for September 2001, I said 'I don't know if I can make it,' but I did," he recalled. "I just got an exhilarating feeling, and I forgot I was sick."
Dr. White attended the reception for Tom's work. "I was astounded and impressed, and my wife was astounded and impressed -- and she has an art degree," Dr. White said. "It meant a lot to me to be there because, a lot of times, I don't get to see what my patients do."
On April 9, Creelan came down with pneumonia and was forced to retire from teaching after 30 years, but he is not giving up. "I want to live as long as I can, as comfortable as I can," he said. "There's a lot of value in being alive, and it's something I want to cling to for as long as I can."
Note Tom Creelan died July 18 in his home of natural causes. According to the Salem Statesman Journal, his last drawing was an incomplete work showing a field and pool of water. He titled it "Unfinished Reflection."
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Copyright 2002 American Medical Association. All rights reserved.