Last week, I spent the better part of an hour in a video meeting with a physician at the medical center where I have been treated for pancreatic cancer and COPD for the past three years.
The reason for our conversation was Oregon's Death With Dignity law or, as the doctor referred to it and which phrase I much prefer, Medical Aid in Dying.
Oregon was the first U.S. state, in 1994, to enact such a statute and it went into effect in 1997. Since then, seven more states and the District of Columbia have adopted similar statutes.
• California (End of Life Option Act; approved in 2015, in effect from 2016)
• Colorado (End of Life Options Act; 2016)
• District of Columbia (D.C. Death with Dignity Act; 2016/2017)
• Hawaii (Our Care, Our Choice Act; 2018/2019)
• Maine (Death with Dignity Act; 2019)
• New Jersey (Aid in Dying for the Terminally Ill Act; 2019)
• Oregon (Death with Dignity Act; 1994/1997)
• Vermont (Patient Choice and Control at the End of Life Act; 2013)
• Washington (Death with Dignity Act; 2008)
Here is a map of the United States showing the status of each state in regard to this kind of legislation:
According to the Oregon Death With Dignity annual report as quoted at the Death With Dignity website,
”In 2019, 112 Oregon physicians wrote 290 prescriptions to dying Oregonians who qualified for the Act; 188 people died using the medications obtained under the law.”
The 102 people with prescriptions in 2019 who did not take the prescribed drugs may have died without using them or may yet take them. Some people, I am told, like the feeling of control in having the drugs handy.
The up-front requirements to use the law are that the patient be at least 18 years old, a resident of Oregon, capable of making and articulating healthcare decisions and diagnosed with a terminal illness that will lead to death within six months.
There are several additional hoops to maneuver but they are not too onerous. First, the person must verbally request the drugs from the attending physician on two occasions, at least 15 days apart.
The attending physician and a consulting physician must agree on the diagnosis and the prognosis.
In addition to those two verbal requests 15 days apart, the patient must complete a written request form that requires two witness signatures. One witness may not be a relative or a physician who treats the person.
The doctor I spoke with Thursday helpfully told me that for $7, a UPS store will witness the document. I thought this odd, even kind of funny at first but I can understand that a relative or friend – and certainly an acquaintance – might not want to be part of such a request.
If either of the two physician feels the patient's judgment is impaired, the patient must be referred for a psychological examination.
From what I can tell, pharmacists can refuse to fill prescriptions for these lethal drugs. The doctor told me there is one pharmacy in Portland that does fill them. The price, he said, is about $700. Private insurance may pay the cost. Medicare does not.
A doctor need not be present when the patient takes the drug although he or she may be there if the patient asks. However, only the patient can administer the medication.
The drugs, the doctor told me, come in a bottle to which apple juice is added. The drugs cause no pain. The patient feels woozy almost immediately upon drinking the mixture, he said, and will fall into coma in four to five minutes. Death comes usually in 30 minutes to two hours. Rarely, it can be longer.
The patient can rescind the request for the drugs at any point in the process. There is, of course, no requirement that the drugs be used.
I'm writing this because I thought you might be interested and, having had the conversation only a few days ago, it is fresh in my mind now. You may have noticed that throughout, I have referred to “the patient” and not to I or me.
That is because it is hard to talk about my own death this way. (Or in any way, I suppose.) I thought, having understood from the diagnosis three years ago that I would eventually die of this cancer, I had it under control, that I accepted the eventuality and had made peace with it.
Apparently this is not so. Yet.
The question has come up now because, as I reported not long ago, the cancer in my lung is growing and due to the additional diagnosis of COPD, my immune system is too damaged for more chemotherapy that otherwise – in theory - could slow the cancer's growth.
Now, with the coronavirus that attacks lungs, chemotherapy is even moreso not an option.
So I contemplate my death a bit more urgently now. I am making peace with the fact that I will never have all the bits and pieces of my life in good order for the dear, dear friend who will be stuck with sorting it all out when I am gone. She says to me, don't worry about it. I'm trying.
My question to myself right now is how to live in the time remaining. And I do mean, live. But also, that is not to deny what is happening to me. The disease, doing what it must, marches forward even into its own oblivion. As do I.
Dying is part of living and I doubt that is something that will slip my mind. So maybe I need to find a balance.
Is there a place where life and death and meaning at least intersect if not each become part of a whole? Not that anyone has ever been able to define the meaning of life.
Undoubtedly, I'll have more to say later. Meanwhile, if you want more information about Death With Dignity laws, here are a couple of links to get you started:
For individual state laws, search “death with dignity” and the state's name.