Death with Dignity
As you know, there is a question on the Massachusetts ballot next week about "Death with Dignity." Whatever your views on this matter, this is a vitally important issue. There have been strong feelings expressed on both sides, and surely each of us is entitled to our own opinion. My personal conviction is that each of us is also entitled to our own decisions about our lives and, when possible, our deaths. I suspect that anyone who has been diagnosed with cancer or any other potentially life-threatening illness has given some thought to these concerns. Some years ago, Blue Cross (I think it was BC although it may have been Tufts) had a policy of mailing evaluations to all of their clients who were in therapy--that is, who were using the mental health benefit of their insurance policy. Intended for the general population and trying to get at the possibility of suicidal ideation, one question was "Do you think often about death?" I received a semi-hysterical call from a case manager at Blue Cross who said: "Do you realize that all of your patients are potentially suicidal?" Of course, she was absolutely wrong. All of my patients had been diagnosed with cancer, so death was part of their world view.
Let me share a very personal story that informs my views. My mother felt very strongly about not wanting to live in a permanently compromised state with no hope of recovery. She had all the available legal documents (living will, notarized statements, etc) in multiple copies in her medical charts, her desk drawers, in each of her children's possession. Many, many times she asked me to promise her that I would push the pills and a glass of water near her so she could take a lethal dose if she chose to do so. When she was in her mid-70s, she needed hip replacement surgery. I remember taking her to the orthopedic surgeon for a pre-surgery visit. As we stood to leave, she turned to him and said: "If anything happens to me, it is okay. I have had a wonderful life. Let me go." I suspect that he thought this was a rather odd comment before a routine (for him) surgery, but he nodded. She had the surgery as scheduled and, as they were closing, she threw a blood clot, and stopped breathing for several minutes. Those several minutes were long enough that, once (days later) she awakened in the ICU, she never recognized anyone again and spent the next seven (!) years in the Alzheimer's Unit of a very fine nursing home. She required total care, and she, as a sensate and beloved woman, was gone. Here is what my family learned from this tragic experience: DNR orders are suspended in the OR. If a person insists on putting a DNR order in writing before surgery, the surgeon has the option of not doing the case (and likely would make that choice). Although I intellectually understand that a surgeon feels that her responsibility is getting the patient out of the OR alive, it surely seems to me that there should be some room for common sense and respect of the patient's wishes. Recognizing that her experience is not explicitly what this ballot proposal is about, it is still in the same ball park. If my mother had a moment of lucid thought after the surgery, she most surely would have swallowed those pills. I grieved mostly because of what happened to her and partly because of my inability to deliver on my promises and to respect her very clear and direct requests that her life not be maintained in the circumstances that occurred.
I have a very close friend in Portland, OR who has a similar job to mine. As you know, there has been a death with dignity law in OR for some years, and it has not been heavily used. My friend has known two women who opted to terminate their own lives when death was near. In one instance, she spent that last evening with the patient's family and close friends, all sharing a meal (the ill woman drinking only a little water) and then sitting/lying/surrounding her, playing music, talking of their love, when she swallowed the pills and went to sleep.
This is a short article from The Economist about this issue. Since The Economist is hardly a radical publication, its' publication there speaks to how mainstream this issue is becoming. If you live in Massachusetts, please vote next week. On this ballot question, you must follow your own conscience and heart, but vote.
Over my dead body
Helping the terminally ill to die, once taboo, is gaining acceptance
In Massachusetts, voters will decide next month whether a terminally ill patient with less than six months to live should be able to use a doctor's help in committing suicide. If they assent, as the polls suggest, the state will be the third, after Oregon and Washington, to legalise assisted suicide. New Jersey introduced a bill last month to decriminalise it. The Montana Supreme Court has ruled that doctors cannot be prosecuted for prescribing lethal drugs for terminally ill patients.
When Jack Kevorkian, an American doctor jailed after admitting helping 130 patients to die, first went on trial in 1994, assisting suicide was a
crime everywhere save Switzerland. Now the trend is spreading far and wide (though not in Asia or in Muslim countries where it is still taboo).
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