A TGB READER'S STORY: The First of May
Living with Cancer

The Alex and Ronni Show Plus Medically Assisted Suicide

Yesterday, my former husband, Alex Bennett, and I recorded our biweekly video. We caught up on my condition with pancreatic cancer and talked a great deal about Jeopardy! host Alex Trebeck's recent diagnosis of the same disease.

We also spent some time on climate change, on both Trebeck's and my personal feelings of our great, good luck having so many people who send us much love, concern and care about our disease. We even managed to sneak in a short mention of “Jeopardy James” at the end. Have a look:

In the comments on Monday's post titled, High Rates of Suicide Among Elders, TGB reader Ellen asked,

”Are you, Ronni, considering suicide? I support whatever decision you make. Realize also that there is a suicide hotline phone number. Call them first.”

Not “considering suicide” it, Ellen. I have chosen it – medical aid in dying - when the time comes.

Although we have discussed this before on this blog, it has been awhile. I live in Oregon which more than 20 years ago passed the first “death with dignity law” - also known as “physician-assisted suicide” and “medical aid in dying” along with a few other names.

In April this year, New Jersey's governor signed a bill making that state the eighth to allow terminally ill patients to request prescriptions from their doctors for medication to end their lives. It will go into effect on 1 August.

Of course, using these laws is a bit more complicated than just saying, “Hey doc, I'm ready for those pills.”

All the states that allow medical aid in dying have similar restrictions in place. Among them:

The patient requesting the drugs must be mentally competent

He/she must have fewer than six months to live as diagnosed by a physician

The patient must initiate the request for the drugs

The request must be confirmed by two people who are not the patient's physician nor employed by the health care facility treating the patient

If the patient wishes to proceed, he/she must wait at least 15 days before making a second request

The patient must administer the drug him- or herself

Wikipedia has a good short overview of how the laws generally work.

The State of Oregon's website, About the Death With Dignity Act, has pretty much everything you would want to know about it. Here are links to the pages about the laws in the other states that allow it, where there are also links to more resources:

District of Columbia

I will do a more thorough post about medical aid in dying but if you are interested in knowing more now, this will get you started.


Great picture of you right off the bat, Ronni!

Good to hear you're thriving. And I agree, climate change is the most important game-changer the planet is facing. Where are protests these days?!

I suspect a big part of the reason weedkiller containing glyphosphate is for sale in grocery stores is that Monsanto has enough financial clout to keep it from being banned. I really question if there is a future for mankind given our lack of will to address the things that are going to kill us. We actually exploit our capacity to destroy our environment which is unique to our species. Again, homo sapiens is one of the newer species and I'm pretty sure Earth will bounce back pretty quickly after we're gone.

Thanks for giving readers a thorough description of death with dignity. Another great resource is the HBO documentary “How to Die in Oregon”.

? How does physician assisted suicide work in the event of diagnosed dementia or Alzheimer/s Disease?
Any thoughts?

Ann Stock...

As noted in the story above, "The patient requesting the drugs must be mentally competent."

The only real argument is against the many restrictions - particularly the diagnosis of death within 6 months requirement. I understand the reasons for the restrictions: I just don't like them!

Ann Stock -- Dementia patients have no access to any form of Medical Aid in Dying, because they are not considered mentally competent. This is the reason why there has to be a legal way in the future for a competent adult to state ahead of time how long they want to live BEFORE they become demented. For me, this would be stage 6 (double incontinence, not recognizing family members) of the 7 Alzheimer's stages (by stage 7 the person often cannot walk or talk, and is like an infant being cleaned and turned by others).

Any such option to choose ahead of time will be politically very difficult, so at this point Alzheimer's patients just end up in a semi-vegetative state for years in expensive Memory Care, while their families gradually lose any savings they had. I posted about this towards the end of Ronnie's prior post on increasing suicides among elderly people.

Why do states supposedly honor advance directives written in advance, but not when it comes to Alzheimers? Makes no sense.

I enjoyed the Alex and Ronni Show, and the Death with Dignity bit. In Canada we have recently enacted a federal law which seems to be close to that of Oregon.
I think everyone agrees (even the lawmakers) that something needs to be in place to allow that same dignity to those who decide when their brains are healthy to determine the circumstances of their passing. But it’s a problem. A person may be physically healthy but mentally incompetent. Who decides at what moment the incompetence is sufficient to warrant assistance in dying? Are financial circumstances factors? Are there inheritors waiting in the wings tapping their collective feet, or am I a pauper from whom no financial gain will be forthcoming. Do we lay the responsibility at the feet of on or more psychological caregivers.
I believe there is an answer, but it must be carefully considered. I’d like it to be in place before it’s my turn, but I want it to be done right.

I'm grateful to live in a place where we have a death with dignity provision. We however live in fear that bec they can, Congress may overturn our voter-enacted law. It is, bec we don't want to move, another reason to keep the House "blue."

The discussion of people with any form of dementia not having the same rights is terrifying. Are there bills going through state houses to change this?

An interesting and thought provoking post, Ronni, thank you and all your readers commenting.

Re:" He/she must have fewer than six months to live as diagnosed by a physician."

As a Registered Nurse, I find myself wondering what sort of physician would indulge in that sort of gross prognostication with any patient unless or until it involved pulling the plugs on all the support devices that were literally keeping them alive.... e.g. O2, feeding tubes or IVs, etc.

Even the respected Oregon law seems too complicated and exhausting to someone with profound fatigue as a daily issue. Plus, you must have 2 doctors agreeing. I think I'll just wing it when life loses any purpose for me.

Am I breaking the law? Technically yes, so "they" can arrest me if they can find me. My ashes will be adrift in the Columbia along side my husband's. The plan is the we go for that swim together. He has been waiting in a lovely cedar box for 8 years. He was such a lovely and patient gentleman for our 58 years together.

My own 96 y/o mother simply decided it was her time and she stopped eating. It does work, albeit slower than a chemical approach. But now the internet gives us other resources. I'm doing my homework.

Mary is right. There is an absurd contradiction in allowing anyone of any age to put into place far in advance of actual events an Advance Directive that precludes life-saving measures while refusing to allow Alzheimer’s patients to make reasonable arrangements for not prolonging their own life while they are still capable of making such decisions.

In fact, there is no dignity in requiring the individual whose death it is to deal with mountains of bureaucratic and politically motivated bullshit just so they can do something that by rights should be their decision and theirs alone at any time they choose. Until we have assisted suicide on-demand, there is neither dignity nor personal agency involved in the process.

Glad to see you perking along so well, considering — hat looks good on you. I, too, am pleased Calif. has a law permitting assisted suicide as had thought, until this legislation passed, I might need to consider moving to a different state. I do want the choice of being able to exit this life on my own terms under certain circumstances should they develop.

I have said that if my mind goes, even if my physical body remains strong, then I don’t want to continue my existence. It won’t be me — to me or my family and friends — so what would be the point? However, the whole issue of administering my wishes if I have declining mental functioning is quite a sticky wicket. There is a major risk of abuse, so great care would have to be taken in writing and implementation of such a provision.

Perhaps as more diagnostic knowledge (with the ability to monitor it) about actual brain activity in relation to function is revealed, dementia, Alzheimer’s and other diseases, injuries(?) with significant cognitive deterioration will be considered for inclusion for the right to die. They likely would have their own set of requirements before implementation could be met. Meanwhile, I guess we lay people just keep examining the possibilities and options if the conditions should happen to us.

Charlene, if you find resources on the internet, please share if you can. Maybe I'm not sure how to search but I've tried and haven't come up with much practical information. If I don't just keel over when the time comes, I'm prepared to enact VSED (Voluntarily Stop Eating/Drinking). However, if I have a choice at that point, I'd rather speed it along a bit--without resorting to something messy like a firearm! I worry about finding myself in a position of having no control over my end of life, despite having all the paperwork lined up plus a clearly-written personal statement.

Many years ago at 26 I seriously considered leaping from the Golden Gate Bridge after a series of young-adult "life disasters", but (obviously) I didn't follow through. That might still be an option--if they haven't put up a "suicide barrier"--but it's a long drive from where I live now, and I'd probably get lost which could totally screw up the entire plan.

I strongly believe that when and how I exit this world should be up to me! If I develop dementia down the line, I hope I will know in time to implement "Plan B".

I'm surprised by Charlene's comment. After all, a doctor has to say a patient has 6 months or less to live in order to qualify the patient for hospice. Naturally, doctors get this wrong all the time, plus there's mounting evidence that hospice prolongs life. Would anyone hold it against their doctor for getting it wrong if they live another year instead of the predicted 6 months?

Thank you Cassandra & others for providing some direction for people who may develop dementia & Alzheimers, & the requirement of mental competence to choose physician assisted suicide.
I feel that an advanced directive could state the criteria for when life is no longer meaningful for an individual & provide aome options. I am terrified of the effects that prolonged care would have on my children & grandchildren. Perhaps we could work to legalise such an addition to go further than a DNR directive.

FWIW I am aware of instances when DNRs are not observed; VSED has taken some a couple weeks and is much easier said a person will do than actually doing it, especially once cognitive function alters long before body declines.
Do hope this discussion continues, especially issues for the body when the mind goes as with dementias.

Ronni seemed a bit snippy -- or is the word snitty these days? -- when she was corrected by her former husband on the video. She seemed to want to deny the confusion of having said "Parkland Hospital" when she meant "Parkland School" where a school shooting occurred.

As only an old person could, I instantly grokked why she made that mistake. Parkland Hospital was where JFK was taken after he was shot. "The President was taken to Parkland Memorial Hospital where he was pronounced dead" are words that those of us who were alive in 1963 will never forget.

I'm not happy with the "six months to live" rule either I think it should be much longer 12-18. My mother was denied hospice care because her doctor insisted she wasn't dying soon. She "looked healthy" and much appeared younger than she was. Before we could get a second opinion she was hospitalized and died there. I'm on for broader rules for dementia too. We need those options too. Meanwhile I am busily adding items to my living will as I think of them. I do live in Washington so at least there is that if I choose. However the only hospital in town is a Catholic organization so we need to do our homework.

In response to Stephanie :

I was quite at ease with our family Dr. making the 6 months call to qualify for Hospice care. I was truly grateful to them as I cared for husband in his final months in Nevada. The Dr. RX is likely required because Medicare will cover nearly all of the expenses .

The suicide issue is a different matter, at least for me here in Oregon. Getting 2 Doctors to agree on almost anything is sometimes daunting and getting a second appointment even with one's personal physician is often 4 to 6 weeks away. I waited 3 months to see the endocrinologist my primary wanted me to see at OHSU because I was a new patient to him. Big sigh!! It was an expensive and futile effort, but I learned a lesson.

A response for Elizabeth Rogers' request:

I started on this search after reading a story in The NYTimes Magazine.(You can still find it online if you are interested.)"The Last Day of Her Life" By Robin Marantz Henig May 14, 2015. It is a well written tale of one woman's dilemma and her solution.

When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when and how?

That is how I learned about “The Peaceful Pill Handbook.”. It provides information on euthanasia and assisted suicide for Seniors, the elderly and the seriously ill.

Now at 82 I can understand her concerns and desire to make the final exit as gracefully as possible.

There is a wealth of confusing data out there in the cyber jungle, Elizabeth, so beware.
I tend to use many grains of salt online and try to read it like eating chicken...enjoy the meat and spit out the bones.

Go for it, Ronni! And you look beautiful in the photo.

I believe the restrictions will be modified; there are just too many of us to care for. I want Advance Directives that allow, in the case of my mental incompetence, for my designated POA to initiate the process. (Here in Quebec we do not have to self-administer the meds.) Why can't I say now that I do not want to be alive in certain conditions?

I've seen these issues up close: 1. You might have a difficult time finding those two other persons if you have not lined them up way in advance; 2. If you are in a faith-based facility like some nursing or assisted living facilities, they will require you to go somewhere else to carry out the process.

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