End of life: can there be both death and dignity?How will I die? It's a question we likely all occasionally pose to ourselves...
How will I die?
It’s a question we likely all occasionally pose to ourselves but often feel powerless to control. Some states are changing that as they wrestle measures to support the right of patients to determine their life’s end. Called “Death with Dignity,” it is synonymous with physician-assisted suicide. In Nebraska, Iowa and 32 other states, assisted suicide is considered a criminal offense. That’s not the case everywhere. A closer look reveals the controversies are more than just a thumbs up or down vote.
Predicting death: In Massachusetts a bill proposed that physicians could help with a planned death when the patient requesting assistance had six months or less to live. Opponents successfully argued that skills in predicting death are inadequate. The bill was missing a required evaluation that you or I deserve if we’re choosing to end our lives, just to assure that the critical decision is being made with a sound mind. The state medical society clarified that a physician’s role is to heal and comfort, and at the final vote the majority of public voters agreed, 51 percent to 49 percent.
Comforting rather than ending life: Maine held the vote in their House of Representatives where it was defeated 95 to 43. The two main physician groups in the state opposed the bill, arguing successfully that adequate pain management and comfort care (together considered “palliative care”) should be the emphasis during the last days.
Offering a choice: Vermont recently approved a law allowing physicians to prescribe a lethal dose of a narcotic to a terminally ill patient who requests it. Similar to laws in Oregon and Washington, the patient’s physician and a consulting physician must confirm that the patient has less than six months to live and is able to make a voluntary and informed decision. Counseling about alternative end-of-life health care services such as hospice care must be provided. The patient’s request must be made twice, spaced at least two weeks apart. Lastly, the physician must not administer the drug; the patient does the act.
“Well Accepted”: Researchers reported last April that over two years of study, the Death with Dignity program at the Seattle Cancer Care Alliance was “well accepted” by patients and clinicians. From 114 inquiries, 40 participants received their lethal prescriptions, and 24 died after medication ingestion (the other 16 died without taking their drug). Eleven of those receiving a prescription lived beyond six months.
Everyone agrees on one thing: You and I should make our wishes clearly known regarding our own end-of-life goals. One helpful option is to make a formal statement as an advance directive, which allows each of us to address the kind of medical care we want if we are too ill or hurt to express our wishes. Decisions on breathing machines, tube feedings, organ donation and more can be made in state-specific documents at caringinfo.org.
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