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Monday, 02 December 2013

Physician-Assisted Suicide

My friend Wendl Kornfeld sent me a link to an impassioned rant from Dilbert creator, Scott Adams, about his 86-year-old father's final months. This excerpt gives you the gist of it:

”If my dad were a cat, we would have put him to sleep long ago. And not once would we have looked back and thought too soon.

“Because it's not too soon. It's far too late. His smallish estate pays about $8,000 per month to keep him in this state of perpetual suffering. Rarely has money been so poorly spent.

“I'd like to proactively end his suffering and let him go out with some dignity. But my government says I can't make that decision. Neither can his doctors. So, for all practical purposes, the government is torturing my father until he dies.

“I'm a patriotic guy by nature. I love my country. But the government? Well, we just broke up.

“And let me say this next part as clearly as I can.

“If you're a politician who has ever voted against doctor-assisted suicide, or you would vote against it in the future, I hate your fucking guts and I would like you to die a long, horrible death. I would be happy to kill you personally and watch you bleed out. I won't do that, because I fear the consequences. But I'd enjoy it, because you motherfuckers are responsible for torturing my father. Now it's personal.

[...] “I don't want anyone to misconstrue this post as satire or exaggeration. So I'll reiterate.

“If you have acted, or plan to act, in a way that keeps doctor-assisted suicide illegal, I see you as an accomplice in torturing my father, and perhaps me as well someday. I want you to die a painful death, and soon. And I'd be happy to tell you the same thing to your face.

There is more. You can read it here.

If you think, perhaps, that grief has sent Adams temporarily around the bend, I disagree. In addition to this circumstance, there are other monstrous transgressions (cutting food stamps comes to mind today) that produce in me the same kind of rage. And I feel as righteous about that rage as Adams does.

Although it was not a reason for me to choose Oregon when I moved here three years ago, it is a certain kind of comfort to know that it is one of four states where physician-assisted suicide is legal.

In fact, Oregon led the way, passing the first U.S. Death with Dignity Act in 1994. The states of Washington, Montana and, in May this year, Vermont have followed. (You can find out more about individual states here.)

You might think that having a living will or an advance directive or whatever it's called where you live will protect you from a prolonged, agonizing death. Not necessarily. Doctors and family members - maybe for reasons of misguided hope, religion or fear of guilt - override those wishes all the time.

Further, as Adams notes, our animal friends can be treated better in death than people. Just yesterday, The New York Times reported on the new-ish phenomenon of pet hospice which

”...entails ceasing aggressive medical treatment and giving pain and even anti-anxiety drugs. Unlike in hospice care for humans, euthanasia is an option — and in fact, is a big part of this end-of-life turn.”

With or without hospice care, some of you, as I, have probably wept while holding a beloved cat or dog as the veterinarian ended its suffering with an injection.

Why wouldn't we want the same for a human loved one? In most cases, the state makes that a crime.

With absolutely no evidence that doctors are dispatching large numbers of sick or old people to early graves, those who oppose physician-assisted suicide laws tend to cite the slippery slope argument. But in 2012, 77 people in Oregon chose suicide – hardly a rush to judgment (day).

As serendipity would have it, just a few days ago Pew Research Center published a new survey about end-of-life medical treatments including physician-assisted suicide. Opinion is almost evenly divided:

Assisted Suicde

The thing about physician-assisted suicide is that, Sarah Palin notwithstanding, there are no death panels. In four states, it is a private, individual choice that in a sane world would have been available for Scott Adams's father.

At The Elder Storytelling Place today, Carl Hansen: Common Sense

Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post


I saw a documentary (forget name) that explained how MOST of medicare funds go to the dying who are just suffering and unable to get off machines. They showed an elderly woman in a one hospital who'd been there a year or so...couldn't place her anywhere and they told how much it was costing: enormously! Her son didn't want the life-sustaining machines taken off her even though doctors said she was brain-dead (stroke).

I have a recently updated health care directive and hope it will be honored...but who knows? Wish I lived in Oregon.

The entire subject of physician-assisted suicide is fraught with emotion and misunderstanding.

In the past two weeks I've published two posts on my website about it (not giving a link because I don't what to be seen as spamming).

The point is that they provoked a great deal of interest precisely because people feel so strongly about the issue.

I was glad to see this post here on Time Goes By.

Ronni--Scott Adams inspired a posting on my own blog titled, My Hero. Unfortunately, your comment about our end-time wishes' not being followed is right on. More's the shame.

The problem is that no state allows assisted suicide for anybody with dementia and dementia is actually the worst way to go, the one that causes the most suffering of all. I have had friends die of cancer and you can still have dignity intact pretty much right to the last few days. With dementia you will have a living death for years before you pass. Assisted suicide laws would not help all the people stuck in long term care at $8,000 a month.


A friend of mine is currently involved in a horrific legal situation related to pain relief and her 93 year old father. Barbara is a compassionate nurse with impeccable integrity. See the story at the compassion and choice web site: www.compassionandchoices.org or the Steve Lopez article at http://articles.latimes.com/2013/nov/05/local/la-me-1106-lopez-dyingwell-20131106 Ronni, you are fortunate to live in a state that supports death with dignity.

This issue must be tied up in religious beliefs, who makes money from those kept hardly alive, arguing among family members, and, ohh - laws based on our right for life, liberty, and the pursuit of happiness, whatever that means….
I hope other states follow Oregon and others. I expect black market solutions are already out there - if one can afford it, and this will grow with time. Cannot imagine our government agreeing on how to implement this when we can't even provide health care universally in the US.
If my family ends my suffering, I've told them to end my life in any way possible, legal or not. That will be an act coming from love.

I agree, I am proud of Oregon for this too. Also, I admired Dr. Kevorkian. I never understood why he was looked upon negatively. He was a humanitarian and instead of labeling him Dr. Death they should have called him Dr. blessed end-of-suffering!

I have a friend whose father was extremely wealthy. My friend would of (of course) stood to inherit some of his estate....BUT his estate is being used to keep my friend's stepmother "alive". This is also to the tune of around 8 thousand a month.

Not only does my friend and her sisters not get any $$ from the father's (previous) vast wealth, it's clear that the cushy place that the stepmother is currently kept in will simply send her off to a dismal "cheap" nursing home when the $$ is all dried up. It's all so stupid!

I wholeheartedly agree with physician-assisted suicide and you are, indeed, fortunate, to live in Oregon, Ronni.

Your post comes at a strange time: I've been researching the British sites - Dignity in Death and Compassion in Dying because I want to get some Advance Directions sorted out here in Spain and their documents are not as good as those of the above organisations.

End of life!!! It should be a personal decision. After being an EMT for 12 plus years and volunteering 2 days a week for many years in our local hospital I can see absolutely no reason for anyone to suffer needlessly, perhaps for years, only to die bereft of any sort of dignity. AND your family CAN'T help you unless you want them to end up on death row! As a previous post pointed out: follow the money!

I agree this is personal. And I wish we could have a healthy national dialogue. I have experience with both of my parents. My dad had a stroke and while he wanted to live after 10 grueling weeks of tortuous treatments and lack of treatments, he demanded the doctor to remove the respirator and passed away with-in the next 24 hours. It was a wonderful gift he gave to all of us. My mom who suffers from vascular dementia, has had multiple TIAs with the recommendation of medical care, had a pacemaker installed 6 years ago - and it has 6 more years on the battery. She continues to lose her brain and I get to see the ravages of memory related disease on all the other residents who live in the Assisted Living Facility where she lives. Her body was going through the natural shutting down process and if the pacemaker had not been placed, I believe her heart would have just up and stopped. Technology has prolonged her living, but not improved the quality of her life. She has to have regular blood draws because she is on blood thinning drugs; and she often gets bruised. Routinely she thinks she missed a meal (even 5 minutes after eating) and has gained 40 pounds. She thinks her parents are alive and gets upset because my deceased brother doesn’t come by to visit her. She doesn't know her own age or what month it is. I don’t believe she needs to be assisted to die; but it certainly would be a blessing if we could just get the pacemaker turned off and take her off the blood thinning medication and allow her to slip away rather than medically force her to stay alive. I know that medical care can be fantastic and each situation is different. I would just like the option to change courses when it is more compassionate for overall quality of life.

My mother died of dementia. She valued her life until she lost it. On her 90th birthday, during her fifth year in a nursing home, she told us, "As long as you're alive, there is hope."
She was in no pain, she built a life for herself at the nursing home she stayed at, she saw one of her daughters almost daily, and her sense of humor was intact far longer than her memory was.

You've addressed my worst fear -- a painful, lingering death with no one willing or able to end my suffering. Why do we treat our pets better than our human loved ones?

Colorado has been liberal enough to legalize pot. Maybe it will also legalize physician-assisted suicide in my lifetime.

Assisted death was my primary reason for moving to Oregon. There are also other reasons of course, but assisted death was my first priority. However, the disease I have usually causes a kind of dementia in the end stage and I do have concerns about my wishes not being honored for this reason. I still have some research to do. As for those who want to hang on to their last miserable breath, or worse force their pain ridden dying parents to hang on to the bitter end,may God forgive them.

Mary Jamison makes a point, as do all the other comments. As long as a person is content, and has a reasonable quality of life – we should all be cheering them on. And her mother isn’t the person we’re talking about here.

What needs to stop is extreme medical intervention when multiple bodily systems are failing, and treatment holds the possibility of making their remaining time worse. It happens over and over, and over. Most times with the blessing of the patient who doesn’t want to die, thinks the doctor ‘only has their best interests at heart’, and of course maintain the hope they’ll be one of the ‘lucky’ ones who isn’t beset by the myriad side effects of major life prolonging surgeries.

Advance directives only follow your wishes if death is imminent. What do you do with the dementia patient who falls and breaks a hip, but whose lifespan is unknown because general health is normal. How do you work with that person to rehabilitate them? And can you leave them without the new hip to suffer? My uncle had this happen and he died in spite of the new hip.

My father shot himself when the pain from prostate cancer got too bad. Almost all the people I’ve known who don’t see the doctor for the major life saving tests, and get the cancers they’re most at risk for – want to be saved when it’s found at Stage 4. Perhaps a clause that if you don’t take responsibility to make the screening effort, if you develop the disease, you’ll be on your own financially?

What do you say to the 85+ year old who says they don’t want ‘extraordinary’ measures, but who wavers when told there is a surgery which will extend their life 85-90% of the time and without it they’ll die?

At least the ‘Death with Dignity’ act woke the medical establishment up to the fact it was doing a pathetic job of pain management. But it’s never simple.

Even physician-assisted suicide has some real limits. The state of Washington, for example, has had very few cases.

One reason is that physicians --even when they've cared for a person for years--refuse to assist suicide. That may cause the person to seek out a new doctor who will agree to it, but they hesitate to take on a new patient for that purpose.

There was a tragic case reported in the Washington Post several years ago, when a doctor shot his elderly wife who was in the last stages of Alzheimer's Disease.

He was her caretaker, and (nearly 80 himself) he feared that he wouldn't be able to care for her much longer. After shooting her, he turned the gun on himself. So tragic, so unnecessary.

As a society, we are scared out of our wits by the fact of death -- I attribute the confused polling you cite to that condition. Getting to a saner discussion about legal suicide for those who choose it demands of us that we, collectively, grow up a bit. At least since the '90s, our rulers have largely preferred to encourage us to be frightened, resentful children in all our social choices.

I too share Adams outrage on this issue and though it may offend some religious folks, it is this silly notion that some unseeable sky man out there somewhere is supposed to be in control and thus, vis a vis the absurd interpretations of scripture by religious zealots permits this kind of torture to people suffering from terminal illnesses.

Where is there a Dexter when we need him to end the life of those who would participate in this inhumane torture?

I live in Washington, one of the other four states with physician-assisted right-to-die laws. Sarah Palin notwithstanding, I should have the right to end my life if it is no longer worth living due to intractable suffering which, for me, can include loss of autonomy, dignity and "personhood". The decision should be made by ME, along with my husband if he is still living, and my physician. The government should have no role in MY end-of-life decision-making.

It is sadly ironic that the Republicans--ostensibly the party of "small government"--want to control so many aspects of our personal lives, including birth and death, in accordance with their ideology. They seek to prevent very sick old people from dying, yet cut food stamp allowances and seek to cut Social Security benefits! Both disproportionately impact older women and minorities.

Like many TGB readers, I have a POLST and an advance directive and can only hope they will be honored when the time comes. I have also prepared a 3-page letter outlining my wishes and stating in no uncertain terms my total rejection of high-tech, existence-prolonging interventions if I am very old, very sick and there is no hope that I will ever again "be myself" following a severe illness or injury.

I believe that death is a natural part of life. My husband refused treatment other than palliative care. I was heart broken, but I supported him and made sure that his advanced directive was honored. He would have preferred assisted suicide, but he managed to go quickly on his own terms. I have a similar advanced directive in place.

In my directives, I don't even make anyone guess as to how high my chances of survival may be. If I cannot or will not assent to an operation or to having machines attached to me, it is not to be done!!

Here's an interesting difference between our two countries: the most recent survey showed that 70% of Australians supported Physician-Assisted Suicide and 12% opposed it. Of course, we're a far more secular country than America which may have something to do with the results.

Thia is a topic I've become somewhat obsessed with. After spending nearly two years taking around-the-clock care of my mother-in-law at the end of her life with dementia, I had just gotten to the point, nearly a year after her death, that I thought I could watch could watch Amour, but it may still have been too soon. My MIL was 93,and though it was hard on our family in many ways, to have taken on her care after her husband passed away, we're thankful that we were able to do it. She and her husband spent ten months in an assisted living facility when he became disabled due to a fall and head trauma. She was still very physically able, despite her advanced dementia, and I have no doubts that taking her back to her own home after his passing was the best thing that could have been done for her. Her last remaining sibling, a sister who will be 100 in March, has been languishing in a nursing home for nearly ten years. She doesn't have dementia, but her mind has become less clear over the years that she has been in there. She never wanted to go into a facility and she's made it clear very day since how miserable she is there. Sadly, her health is pretty good, so who knows how much longer she will continue in that manner. Adams is right; sometimes we are kinder to our animals than our family members.

Interesting and thought provoking...I actually had a decent experience when my husband was terminally ill. He had an agressive, fast growing lung ca and there was no hope he could make it. My doctor (long since dead himself) kindly and without me really being aware of it, increased his morphine every day. The end was quiet and I bless my doctor for his method.

I strongly recommend the HBO documentary "How to Die in Oregon." It's hard to watch, but brilliant in its approach and even-handedness.

I have worked in quality assurance in three healthcare facilities. From my observation, it is generally the families that can't let go of their next of kin. The majority of the doctors are more than willing to order "comfort cares", but the families want every measure taken....Also, I would guess that the majority of elderly that hang on for years with no quality of life also are not making any money for the system. Most of them are on Medicaid...When I think of all the care facilities across the United States and all the people living with a questionable quality of life, I just go into panic mode. What are we doing...Surely it can't be ethical or moral....to condemn people to this existence.....It certainly is not economically enhancing for the facilities. Most of the care facilities are in the red. In fact, in my state several have gone out of business. In years past they did operate in the black, but not any more. Therefore, at this point in time, staffing is getting cut and most care is bare bones.

I guess I'll put in a plug for POLST/MOLST orders. We have the MOLSTs here in NYS. For those who really don't want anything extraordinary done, a MOLST has more teeth than advanced care directives. It's a medical order signed by a Dr or other authorized health care provider to give or not give treatments (DNR, intubation). You can find out more at www.compassionandsupport.org.

Such an important issue. I just read the latest Scott Adams book and feel like I know him a bit better, so this post is very sad.

I not only had an advanced directive drawn up, I talked to all of my relatives about my wishes. My children are in complete agreement about my wishes, but to make absolutely sure they complied with them I told them that if they tried to change anything I would come back and haunt them. I do think they believe me, knowing how stubborn I can be. ;-)

Like you, Ronni, I also live in Oregon. I've had the discussion about physician assisted suicide with my personal doctor so he knows where I stand as a hearty healthy 70 year old..and with my children. My 2 sons stick their fingers in their ears and go la-la-la-la when I bring this up, thats why my youngest daughter is my decision maker.
I had responsibility for financial and medical issues for my very ill mother in law for almost 20 years. the last 3 she was in so much pain, yet congress has been sitting on a bill that would allow nursing homes to treat pain in seniors aggressively . It was so frustrating to have her tell me "Please let me die..let me die" but as she was mentally unstable and had not made prior arrangements she suffered, in terrible pain with Ovarian cancer…too ill for surgery and untreated for pain until 3 weeks ago when she was finally released from her miserable life.
The doctor on call wanted to rush her to the ER but I had put a POEST (I think thats what it's called)-a no emergency services, no internal feeding, not even oxygen. the on call doc argued with me several times and said "You're killing your mother."
I answered..finally..let her go-she wants to go. He called me every thing he could think of but was not able to go against the Living Will that was in place.
Please, everyone, make sure you have one in place with your doctor and a relative who you can trust.

It was a terrible experience made worse by a supposedly caring doctor.
Elle in Beaverton

Thank you Ronnie for writing about this topic that generally most folks who are living in denial will never talk about..

It is nice and important to talk about these things.
I do not believe the report that almost half the people believe in physician-assisted suicide. Those studies are skewed to ask the questions in ways that make it mean to leave a door completely closed to all at all times and in all circumstances! So...presto, finally! The statistics the statitician wants!
I do not believe in assisted suicide. If you want to kill yourself to avoid suffering, do it now while you have the wherewithal. No doubt you are already suffering. Stop whining for somebody else including society to bear the burden of your suicide.
Physicians are educated to heal and they chose medicine as a profession that heals. When a doc steps outside those parameters, he or she is ROGUE and if you want ROGUE go for it, but don't try to lay this burden of your death on the health care professionals.
You contend so few chose the option of assisted early death when it is legal....doesn't that give you a clue as to how MOST people feel about the end of life issues!
"Life IS pain, princess! and anybody who says differently is selling something." What they are selling is an economic "concern" that errupts anytime somebody old who is not gonna get well is using up society's resources, ie Medicare. These discussions never hit "take me serious" discussion level before MEDICARE. Oh, course we don't have DEATH PANELS. We call them ETHICS COMMITTEES.......we call them CASE MANAGEMENT MEETINGS. we call them ADVANCED DIRECTIVES that we shove in your face everytime you appear on the scene. We LOVE you, honey, but now the season is over.
PS Dementia is awful, but the real sufferer is the care giver, so...who do we kill? The suffering caregiver or the person who never did you any harm and is living out his or her life to the best of his or her ability? Allowing people to die is noble. Killing them, not so noble. But it is quick and easy. Speaking of easy, it IS easy to kill yourself. Quit eating springs to mind.

I agree with him 100%.

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