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CME credit opportunity–Medical Aid in Dying: Your Clinical Guide and Practice Points (Medscape)


Doctor Spotlight: Tom R. Fitch, M.D.

Tom R. Fitch, M.D., is a retired oncologist, hematologist and palliative care physician living with multiple myeloma and non-Hodgkin’s lymphoma. He is advocating for the option of medical aid in dying in his home state of Arizona. 

Over the course of more than 30 years as an oncologist, hematologist and palliative care and hospice physician with the Mayo Clinic, I cared for thousands of patients with advancing terminal illness. I was often present at the time of their deaths. Sometimes, despite our team’s best efforts, those deaths were very difficult. 

I saw how the default approach for many of these patients — who had great doctors who cared deeply for them — was too often one treatment after another, with very little conversation about prognosis, the significant limitations and high risks of further disease-specific treatments, the patients’ values, goals and wishes, or alternative end-of-life supportive care options. Unfortunately, many physicians caring for patients with advancing terminal illnesses have never been taught the effective communication skills needed to compassionately discuss these difficult topics, especially dying and death. 

This medicalization of end-of-life care is far too common, and I just saw too much unnecessary suffering as a result of it. I wanted to make a difference. In the early 2000s, I began to help develop a Palliative Medicine program for Mayo Arizona. Our approach was to educate the public, patients, and healthcare providers and administrators about the importance of informed consent, advance directives, palliative care, hospice care and other options for end-of-life care, such as voluntarily stopping eating and drinking (VSED), withholding life-sustaining treatments or devices, and palliative sedation. 

I also believe that medical aid in dying should be part of that spectrum of end-of-life care that should be available to people with an advancing terminal illness. 

In states where aid in dying is authorized, having that option provides comfort and peace to people with a terminal illness. It empowers them to be in control of their dying process. If things go poorly, in the face of refractory suffering, they know they have a way to make their deaths peaceful and meaningful. 

When I was working in palliative medicine, I would ask my patients to write a letter to themselves and their families about what a meaningful, purposeful life meant to them — what they cherished, who they loved, what goals they had — and how they wanted to be cared for if those things were no longer possible. 

Now, I’ve written my own letter. 

In April 2018, I discovered I had both multiple myeloma and low-grade non-Hodgkin’s lymphoma. Thanks to the availability of meaningful treatments for multiple myeloma and lymphoma, my situation is currently stable. I’m on immunotherapy drugs and steroids that I tolerate pretty well. I’m hopeful for an extended prognosis. 

Yet despite the aggressive treatments I’ve received, I’m not going to be cured of these cancers. My lymphoma is in remission now, but at some point, it will come back. There are lots of treatments available for keeping the myeloma in check, but someday, the current treatment will stop working, and there’s no guarantee the next one will work. 

For me, what is most important is that I recognize and can communicate in a meaningful and loving way with God, my wife, our three daughters and grandchildren, and close friends. My favorite thing in the world is small gatherings of family and friends with wine, a charcuterie and great conversation. I want to be able to talk about our faith, social justice issues, world events and March Madness. What I fear most is to end up in that never-never land where I would idle, neither here nor there. 

Without the option of medical aid in dying in Arizona, I pray my life doesn’t end like that, suspended between consciousness and death. Moving elsewhere to access aid in dying was not feasible for many of my patients, and it would be very hard for me, too. I’ve been in Arizona for 34 years and I have a wonderful home, a tremendous supportive community of friends and great confidence in my care through the Mayo system.

I can only hope that my death will still be peaceful and meaningful, surrounded by my wife and children, maybe singing some special hymns that I love, perhaps “It Is Well with My Soul.” Maybe I’ll be watching a University of Kansas basketball game. I better be drinking some wine. Whatever it looks like, I should get to define what is a meaningful life and death for me. No one else should get to define that for me.