Planning Your Assisted-Suicide

I live in Oregon so I can legally request the

Death With Dignity option

at the time I deem appropriate if I choose, so I’ve thought about what medical treatments and interventions I would or wouldn’t accept and how I would want to die if this or that happens to my body and/or mind, whenever it happens.

I’ve been involved with this issue long enough (see article)– I was a hospice volunteer off and on for over 20 years, I’ve sat with numerous people and their families as they lay dying, I’ve been a caregiver and a counselor to the dying, I had a near-death experience 40 years ago (see article)– and I understand more about death and dying than most people who try not to think about it at all.

Most folks have opinions related to self-preservation, love of family and their life, or religious dogma, but a narrow perspective of the whole issue. So I’m just going to think out loud here to give others some food for thought… with the caveat that you continue this conversation with someone immediately after reading this and get to work on your own Advanced Healthcare Directive.

I’m 70+ so there’s that. Having seen first hand and studied what happens to the body and the mind of the majority of people as they age, I acknowledge my personal limits. Knowing my body and what I’ve done to it and for it, I’m hoping to live healthy to at least 75 but no longer than 80. Closer to 75, more likely. Beyond 80 things seem to fall apart more rapidly and sitting in front of a TV all day in an assisted living home with a bunch of other half comatose people is not something I could take for more than a minute. Lying in a  hospital bed staring at the ceiling with no hope of ever getting up again would be intolerable.

Now I know there are some 90-year olds still driving and playing golf or milking the cows and tilling the fields,  but that’s not me. There are also some 60-year old, overweight couch potatoes, who can hardly walk from the couch to the refrigerator any more.They’re on multiple medications with multiple side effects and are mostly miserable most of the time.

One’s past habits and lifestyle have a lot to say about how fit we will be in our old age, and we should be aware of our genes and our base lines so we can keep track of our physical health as we age. If you’re 40 and have diabetes, you’re not likely to make it to experience much of old age. If you haven’t cared about your health during your life, you’re not likely to have a healthy older age.

Of course one can always get hit by a bus or have a heart attack or get shot by a wacko on his own suicide mission. Personally if I’m too far gone and it would take too much or too long to restore me to a reasonable state of health, I would opt not to be resuscitated in the first place.

Certainly cracking open my rib cage, cutting off any limbs or hooking my body up to artificial life support are completely off the table. I want not to live without full use of my limbs or cognitive processes so don’t even think about it. If my heart stops, let me be. If I come back on my own, this time, I’ll talk about it. If my mind starts to disappear, you can bet I’ll be working on my suicide plan, physician-assisted or not, before I forget who my loved ones are.

So you have this pain or these symptoms you’ve been ignoring but it’s suddenly gotten worse and you can’t do things you used to be able to do so you finally go to a doctor and they run a bunch of tests and tell you that you have cancer of the blahblah and they’re going to have to take out your blahblah and then you’ll have to have radiation and chemo and then maybe you’ll have a few good months left but every case is different and they just know you’re going to beat this so here, sign these papers and let’s get started.

And you go… WTF? Because you never thought about it before, never allowed yourself to think it might happen to you or someone you love. You didn’t hear a word the doctor said after “cancer.” Your mind went blank and you felt like the elevator just dropped 20 floors in a second.

You are now spinning out of control but your doctor has moved on to the next patient to give him or her the same devastating news and you’re left to gather your wits and find your way home to tell your loved ones… but the only word that comes out of your mouth is… cancer or brain tumor or kidney failure or multiple sclerosis. Suddenly you’re a dead man walking.

You’ve never thought about it before? Never asked anyone what their thoughts are? Never asked someone who is dying what they think about? Would you want everything done? Do you even know what “everything” means? How much of you abilities are you wiling to do without just to see the next football game on TV?

You suddenly black out and wake up hooked up to machines in an ICU, paralyzed so you don’t try to rip out the tubes and  lines, surrounded by strangers with masks on looking down at you and one of them says sprightly, “Welcome back, Mr. Jones. We thought we’d lost you.”

And you’re thinking, “OMG, I was having this wonderful out-of-body experience. I was surrounded by loving beings of light and you brought me back to this? I’ll kill everyone of you!” But you can’t speak, you can’t move. Those people out there think you’re not aware, but you’re aware of everything, you just can’t do anything about it.

You’re wishing you had written that Advanced Healthcare Directive indicating you wanted no extraordinary measures to keep you alive if you were in this unfathomable condition. Unless you have a few lucid moments to state otherwise or can at least blink your eyes if asked, it is now beyond your control. You could end up a living, breathing vegetable for years.

If one is born disabled or becomes disabled through accident or illness, there is a whole added dimension to thoughts about one’s death. Depending on how dependent you are on others for care and whether you are able to communicate or are even aware of what’s happening, decisions are difficult, riddled with guilt and fear, no one ever sure they did the right thing. If you could convey your wishes, what would they be?

Assisted dying is not an option under the current laws unless you can self-administer. It has been tested by brave people with ALS and MS in the U.S. and foreign courts but euthanasia, which allows a physician to administer a life-ending drug to a person who is unable to self-administer because of their disability, is considered murder and many people fear that is opening assisted dying up to a slippery slope that could lead to the wholesale killing of the most vulnerable among us– the elderly, the disabled, the mentally ill, the poor.

Instead of showing compassion for those who are wrestling with these very personal decisions, some groups of religious protestors and bio-ethicists use fear and scare tactics, dredging up images from the Holocaust and other genocides, or hellfire and eternal damnation, to keep everyone from having control of how they end their own lives. These moral absolutists feel they are right and everyone else is wrong, and they have to protect us wayward relativists from ourselves as if we had no values. We do, just not the same as theirs.

I value human life as part of our eternal spiritual journey, I just don’t believe in the sanctity of life as the right to lifers do. Theirs is a religion based on fear and a judgmental god. I believe our Free Will gives us the right to determine when the quality of our life has fallen below our level of tolerance; that we should have the right to decide when it’s our time to die, and be able to ask our doctor to help us by giving us a prescription that will allow us to chose the time and circumstances of our own death.

Physicians, pharmacists and hospitals who provide a public benefit to a diverse society cannot impose their personal religious beliefs or moral values on patients at the end of their lives any more than at any other time in their lives. They work for us, we hire them… they are not the boss of us!

The alternative, if one is able, may be to blow your brains out or jump off a bridge or throw yourself in front of a train. What a mess! How much more peaceful and spiritual to take a pill and just go to sleep. Would you rather your family watch you suffer or allow you to die in peace? How much better for your family to be by your side instead of you having to go off like an animal to die alone.

A good way to count oneself down is to make a list of 100 things you do every day and cross items off as you can’t do them anymore until you’re down to the last 5 or 10 or 20, wherever you draw the line, then call your doctor for your prescription, pick it up when you are ready, gather your family together to say your goodbyes and have a final toast to your good death and peaceful journey home.

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Reframing Death for the Death with Dignity debate

As I listened to the public testimony at the hearing before the Connecticut legislature last week on HB5326 that would allow doctors to prescribe life-ending drugs to the terminally ill, what stuck me about the people testifying, whether for or against, was an underlying fear of death.

Some who are opposed to physician-assisted dying cover up their fears by proclaiming that human life, no matter what condition one’s body is in nor how ready to let go one is, is worth living and should not be ended prematurely.

Some religious speakers insist their God decides when it is time for us to die and we have no right to play God or that this is an act of suicide which is a sin– conjuring up images of burning in hell for eternity as punishment.

Many of those in favor of a law with similar safeguards and restrictions to Oregon’s Death with Dignity Act, talked about frightening experiences and fearful anxiety associated with the deaths of their loved ones that they felt could have been reduced if there were such a law and their person could have died peacefully at home in their own bed surrounded by family.

That’s all people are asking is to be able to die in peace, on their own terms, not filled with fear, not strapped to machines surrounded by strangers, not in agonizing pain for days or weeks before the body shuts down… and if the circumstances of their deaths are such that a medication would ease their pain and allow them to continue their dying process in peace if that is their expressed desire, then how can we have a law that denies it because some other people who aren’t yet dying are afraid of death, afraid of a slippery slope, afraid of genocide, afraid of impending doom?

Then there’s the fear of being charged with murder if out of compassion for a person’s suffering a loved one helps a person by administering a lethal medication. Families are forced to live with the fear of watching their loved one dying in agony knowing there is nothing they can do to relieve their suffering. The dying person suffers greater fear their loved one will go to jail if they help hasten their death.

Physician’s fall back on an oath written 2,000 years ago when physicians were thought to be gods because of their healing abilities and everyone thought the world was flat. Get over yourselves! They don’t consider that healing the soul and a peaceful death are what we need most of all at the end of our lives, not more false hopes and futile treatments that cause us more pain and suffering with no time to say goodbye to our loved ones.

Yes, palliative care is crucial and will be able to help most people achieve a peaceful death through pain management, but it’s not yet available everywhere, especially in rural areas, and it doesn’t work in all cases so it’s not a panacea. Hospice is not even available everywhere and with budget cuts they are often understaffed and out-of-reach.

The way the law is written almost no one can qualify to begin with. Only if you have a disease, like cancer, either for which there are no more treatments or patient has stopped treatments allowing nature to take its course, can a doctor with any degree of certainty predict a person has 6 months or less to live… which is why many people outlive a 6-month prognosis. Many people get better under hospice care because they are so well cared for and are no longer being subjected to the side-effects from  treatments meant to keep them alive with no quality of life.

And if you say you want to die, according to psychiatry, you are automatically diagnosed with depression; therefore you don’t qualify for the medication. So we’re spending a lot of time and money debating an issue that affects a relatively small number of people as if we were fighting against a trend toward genocide, all because we are afraid that death is the worst thing that could happen to us.

Most people wait too long to request hospice where they can also receive pain management so public education about palliative care is an important factor in end of life care. People are afraid hospice means the end, but it really means time to spend with your family, reconcile your life, get your paperwork in order, wrap up the details of your life, write out your last wishes, complete your bucket list, reconcile your life and say your goodbyes.

Yes, even to have a “suicide party” as one lawyer testified about with much disdain. It seems hearing what your loved ones have to say about you and saying your goodbyes before drinking a last toast is less acceptable, more fearful, than after the fact in an impeccable funeral parlor with everybody crying instead of laughter and hugs around the bedside at home.

Most people die after being rushed into the ER, resuscitated, and hooked up to machines in an ICU for a number of days, usually scared shitless and completely unconscious of the agony their family is going through because they didn’t let their last wishes be known. The last memory the family is likely to have of their loved one is of them dying in fear and agony with no opportunity to say goodbye.

If I were able to take a test that showed I was likely to develop Alzheimer’s Disease, I would be stocking up on pills and planning my exit strategy. If I were told I had pancreatic cancer, I would start working on my bucket list, planning my farewell party, and requesting my lethal prescription. In any case, I would not turn myself over to medical science hoping for a miracle out of fear of death… because I do not fear death.

I died once and I know there is nothing to fear. It’s like stepping out of an old worn out overcoat into the sunshine on a spring day filled with love, peace and joy on our journey home!

To fear death is nothing other than to think oneself wise when one is not.
For it is to think one knows what one does not know.
No one knows whether death may not even turn out to be the greatest blessings of human beings.
And yet people fear it as if they knew for certain it is the greatest evil.

–Socrates

How we die – Dr. Sherwin Nuland died

Dr. Sherwin Nuland, surgeon, bioethicist and author of the book “How We Die,” died last week. He was 83 years old and died from prostate cancer. He felt it was important to describe in his book how we die, physically and mentally, from cancer, heart disease, Alzheimer’s, and other common illnesses so we could have frank discussions with our doctor to help us deal with those aspects of illness and death that frighten us the most.

His first patient as a med student in a hospital ER died suddenly from a heart attack. He experienced the death of many family members including his mother when he was 11, and was with his father and his brother when they took their last breaths as they died from colon cancer. As a physician, he observed the process toward death of many of his patients in many different ways.

He wrote that death with dignity is a myth and while we would all like to die a good death, it rarely happens that way. Most of the time, patients suffer interminably, often prolonged by aggressive treatments, visits to the ICU, or futile treatments, through pain, humiliation and lack of control. Even under the best of care, the dying process, especially a prolonged dying process, can be agonizing for both the dying person and the family.

As a hospice volunteer for many years, I witnessed a number of deaths and been told about many others by volunteers, nurses and chaplains in support groups. Enough to agree with Dr. Nuland that we don’t always get what we ask for in that regard and when it does happen, it’s just a  coincidence.

More likely, we will be completely helpless or barely coherent and things will go on behind our backs without our knowledge or understanding by people who say they have our best interests at heart. We may want to die at home in our own bed surrounded by family but it’s more likely the last thing we’ll see will look more like a scene from a horror movie in a bright, sterile torture chamber.

Doctors will tell patients and families what they think they want to hear, that there is always something that can be done, that there’s always hope that the next treatment will be the one. Families tell their dying loved ones half truths to protect them, make promises they can’t keep, pretend everything is going well when it isn’t, avoid conversations about how they want to die until it is too late. Everyone follows the philosophy, as Dr. Nuland said he did for so long, that anything is better than death.

911 is called, CPR is administered, ribs are broken, tubes are inserted, bodies are bruised, invasive procedures performed. Maybe patients are put on ventilators and paralyzed so they don’t fight the restraints that bind them to keep their bodies alive. They know everything that is going on but they can’t do anything about it. They are trapped in a private hell while decisions about how to prolong life are debated in the hallways. Their death is terribly, terribly difficult and is the usual outcome of all this activity. Statistically, only a small percentage of these patients make it out of the hospital alive after this frightening experience. An even smaller percentage survive for more than a few months.

What gets taken away from the terminally ill or elderly patient is the opportunity to be at home surrounded by their loved ones during the last few weeks or months as the body shuts down naturally and the person adjusts to letting go. They lose the time to make amends and reconcile their lives, to say their goodbyes and fulfill their bucket lists.

This is what Dr. Nuland came to understand through the deaths of his patients and family members and why he wrote his book to help people make informed decisions about their preferences for end of life care, including when to stop aggressive, invasive treatments and accept pain management for the remainder of one’s life.

During his lifetime, hospice and palliative care have evolved to assume a bigger role in the care of terminally ill patients to keep people out of the ICU and allow them to die a good death at home surrounded by their family. It’s not available everywhere yet. Budget cuts are a problem. And it doesn’t work well for everyone. But it is bringing the business of dying back into the family and changing the practice of medicine at the end of life. Healing doesn’t necessarily mean curing the disease.

Dr. Nuland realized it’s not true that anything is better than death and, for many people, what they would have to go though in order to come out the other side alive is simply not worth the pain and effort for the short reprieve. He came to recognize that death is part of the life cycle and to redefine hope as the belief that something meaningful will happen, that we lived a life that meant something to others and will be renewed through others whose lives we touched.

Although Dr. Nuland wasn’t a proponent of physician-assisted dying, he was a strong advocate for end of life planning, including having The Conversation among family members, appointing a healthcare representative with the authority to speak for you if you become unable to communicate, and filling out an Advanced Healthcare Directive to assure your end of life wishes are carried out.

Being proactive doesn’t mean you are giving up or are by any means ready to die. The Conversation ideally should take place long before anyone is even sick or turns 65 because life can change on a dime and suddenly there is no time. Decisions have to be made immediately, no discussion.

If there has been no conversation and there is no Advance Healthcare Directive, the family is put under greater stress by being forced to make healthcare decisions for you without knowing what you might have wanted. As Dr. Nuland wrote doing everything may not always be the best choice. The question is where do you draw the line for your self? Next– tell someone!

Next month, April 16th, is National Healthcare Decisions Day, download Advanced Healthcare Directive forms by state for everyone in your family.

Get some tools and advice about having The Conversation with your family or with your neighbors, groups, organizations.

Become informed about Death With Dignity laws in your state; download forms from Compassion & Choices

Prepare your self mentally, emotionally and spiritually for your death whenever, however it happens – How to Die Consciously by Diane Goble

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Referral service for end-of-life suicide assistance

When I first read this news release put out by  Right to Life News Today, I laughed all the way through it and kept thinking “Thank God! How else are people going to find an assisted living facility where they can have control at the end of their lives?”

But that wasn’t the intent of the author, an attorney for the Robert Powell Center for Medical Ethics, the National Right to Life Committee’s “arm in fighting to protect the vulnerable born from both direct killing and denial of lifesaving medical treatment, food and fluids.” This group opposes “infanticide and euthanasia with the same determination and vigor with which it fights abortion.”

The author was ranting about a referral service for senior living centers that also provided educational information about end-of-life planning, including the Death With Dignity law through Compassion and Choices of Washington (which has a Death With Dignity law in place).

It’s no wonder he called Compassion and Choices an “euthanasia advocacy organization.” They have that euthanasia mind-set without the understanding of the difference between killing a person without their consent and allowing a competent person to request a medication that will end his or her life near the end of  life, peacefully and painlessly.

This self-righteous attitude implying that what they think is ethical applies to everybody else just doesn’t work in this world anymore and to think they can force their religious claptrap and moral absolutist values on the rest of us is ludicrous.

I understand the concern for wholesale killing of the disabled and elderly and other so-called vulnerable people, but attempting to dictate to adults who have made their own decisions all their lives as if they are incapable of making the right choices about the end of their lives, is completely dictatorial, paternalistic and unconscionable.

Apparently they are opposed to this referral service educating the public about all issues relating to senior care and end-of life care that doesn’t fit their protocols. They don’t like the thought of a “Client Support Volunteer” from Compassion and Choices being available to assist the dying person and the family to be sure the law is followed and there are no mistakes, coercion, or prolonged suffering.

If these Right to Lifers want to be humane and constructive, instead of trying to scare people into believing their dreadful propaganda, they could provide the “information about suicide prevention services, or how to access available medical resources for the counseling and medication that can treat suicidal depression” that they complain Compassion and Choices doesn’t provide. Although, first, they need to learn the difference between suicidal depression and being ready to let go at the end of life– big difference.

Give people choices and trust them to make the right decisions about the end of their own lives. If you don’t want to do it, don’t do it!

At the end of his blog, he provides a phone number and suggests you call this referral service and tell them how disappointed you are that they promote an assisted suicide advocacy group, that you won’t use their services and will tell all your friends not to either.

I called them and said “Thank you for being there.”

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Assisted Suicide vs. Aid-in-dying: Word Wars

“Assisted suicide” vs. “Aid in Dying”: They both mean the same thing in the context of the right of a person to make his or her own decisions about his or her own end of life, but some self-righteous, narrow-minded, dogmatic religious fanatics who are obstinately convinced of the superiority or correctness of their own opinions and prejudices against those who hold different opinions seem to think that if they stir peoples’ emotions up they can win this battle and prevent those who want this choice from being able to have it legally and without prejudice.

It has been shown that words make a difference. Words evoke emotions based on beliefs. In polls where people are asked if they approve of Death With Dignity Acts, the results are skewed against when the word “suicide” is used in place of “aid in dying.” It is an emotional issue that plays with peoples’ fears and insecurities, not just about the meaning in this life but in the next life. Self-righteous religious people hold up their beliefs about the sanctity of life to guilt vulnerable, frightened people into needless suffering at the end of life. They are trying to legislate their version of morality as if they were right and the majority of people who are in favor of Death With Dignity are all wrong.

This one guy who regularly spews his right-to-life platitudes and insists, in his most recent blog, that “aid in dying” is a euphemism for “assisted suicide” is particularly annoying the way he twists the truth to fit his beliefs. HIS beliefs! The man seems to have no compassion, just opinions about what’s right for the rest of us. Just because he hasn’t evolved consciously enough to realize the difference between a distraught person who wants to end his or her life and a dying person who doesn’t want to die but makes an informed decision to leave his body on his or her own terms doesn’t mean he won’t have his Aha! moment on his own death bed and have a change of heart.

It doesn’t really matter whether it’s called aid in dying or assisted suicide. Quibbling over semantics is just a smokescreen. A dying person who knows when this body no longer serves the soul and is ready to go home is the determinant factor.

Just a suggestion but instead of using fear tactics, put your energy into seeing to it that good laws are passed in all states that will protect people from having death forced upon them because they are senile or poor or severely disabled or by external forces and empower assisting physicians to fulfill requests for prescriptions.

We are already doing a good job of killing people with all our air, water and land pollution; not paying attention to climate changes; cutting funding to social programs; and not caring about the homeless or victims of the economic downturn, or the mentally ill who are cast adrift. Aside from all the murders and mass shootings, people in this country are starving to death, freezing to death, dying in the streets, in our forests, in rivers, in the ocean, jumping off bridges because they aren’t able to survive in this economic climate. Nobody seems to care about these people. And yet some people want to stop other people from being able to self-administer prescribed medicine to shorten a dying process they find unbearable. Tch. Tch.

 

Assisted Dying debate on TV show

I gave up TV about 4 years ago (which has made a huge difference in my life, you should try it, just for 30 days and see what I mean) but after all these years I still keep up with one drama via the Internet… Grey’s Anatomy. It takes place in a hospital in Seattle and concerns the daily activities of doctors as do their work, Dr. Grey being one of the main characters. In a recent story line, a surgeon and former Chief of Staff of the hospital, is accidentally electrocuted and subsequently revived by extraordinary medical technology and drastic surgical interventions. He comes out of surgery barely alive, in a coma, on life support.

Does he have an Advance Healthcare Directive? Yes, great. Who did he appoint as his healthcare representative? Dr. Grey who is the daughter of a prominent doctor with whom the Chief had an affair many years ago and who is her superior? He didn’t bother to mention this little detail to her and it came as a complete shock. Not to mention that she was currently in the hospital after an emergency surgery during which she nearly lost her baby. She could barely think much less make a decision about her boss’ life or death.

There was pandemonium all around, everyone trying to figure out what to do with the comatose doctor. What would he have wanted? Surely he would have wanted everything and one doctor kept forcing treatments on him in his own best interests. Others thought it was time to let him go and argued to stop drastic measures.

Well, blahblahblah, more stuff happened and then he actually regains consciousness and sees what has happened to him, all hooked up to this and that, and he pitches a fit. He refuses this, refuses that, let me go, let me go. And this other doctor keeps shoving things in him and making him stay alive.

Cut to another patient who is clearly dying and the doctors are telling him there’s nothing more they can do. He needs to get his affairs in order and call hospice… and he pitches a fit. He wants everything, every test, every clinical trial, every new drug or surgery… bring it all on, I’m not going to die.

Turns out the same doctor who is trying to keep her Chief alive is also treating this dude who refuses to accept death as an option. After much back and forth discussions about choices, she puts the two men in the same room together to let them work it out. Not funny, but it was quite funny… the looks they gave each other!

What I find interesting about this is that this conversation is getting into mainstream homes and more people are going to start realizing how important it is to talk to your loved ones and your physician about end-of-life choices and filling out Advance Healthcare Directives so your wishes are carried out.

I’m hoping since their hospital is in the state of Washington where the Death With Dignity Act is law that they will take the story line to that level to help more people understand that it’s not about killing people, it’s about letting people die when they are ready to let go near the end of their lives on their own terms.

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The Slippery Slope of Physician Assisted Dying/Suicide

Sisters Sunset 8/21/13

I’ve been reading (pro and con) articles, blogs, opinions, press releases, news stories, surveys, law suits, legislation, etc. about Death With Dignity Laws and the attempts to pass them from all over the world for the past year and as a result of all I’ve learned I’ve come to the conclusion that there is a slippery slope when it comes to physician assisted dying. In all of the states in the U.S., Canada and other countries where such laws have been passed (in no particular order):

1. There is an increase in palliative and hospice care, and services have expanded and improved to include transitions

2. Medical students are now being trained in pain management and end or life care

3. More doctors are having conversations at the request of their patients about end-of-life care, regardless of whether they get paid

4. More people are having conversations with their families about what they want at the end of their lives

5. More people are talking about death and dying as if it is part of life not as a tragic event nobody wants to think about or plan for

6. More people are getting to die at home in their own warm bed surrounded by their family as they wish instead of in a cold, impersonal ICU hooked up to machines and tubes, surrounded by strangers who wear masks

7. More people are dying peacefully rather than being scared to death about death

8. More people are filling out Advance Healthcare Directives

9. More people are working on their Bucket List, reconciling their lives, asking forgiveness, expressing gratitude, and preparing themselves mentally, emotionally and spiritually for their journey out of their body

9. More emergency room physicians are complying with Advance Healthcare Directives and life or death situations are handled the way even the unresponsive patient wants not the way protocol dictates

10. More people are filling out POLST (physician Orders for Life-Sustaining Treatment) forms with their primary physician and are being spared drastic resuscitation measures they don’t want at end of life

11. More chronically disabled people are expressing optimism that they will have more control over their end of life decisions

12. More people are meditating, eating healthier and exercising to improve the quality of the rest of their lives instead of subjecting themselves to invasive life-prolonging, often futile, medical treatments in their last days

13. Fewer people are accumulating huge medical bills at end of life for unwanted invasive medical procedures

14. Fewer dying people are resorting to drastic, messy, inept suicide attempts or homicide/suicide acts that often end in failure and horror for the whole family

15. Physicians are accepting responsibility for being with their patients until the end of their lives instead of abandoning them when there is nothing more they can do medically or when the patient decides to stop medical treatment but wants to continue to be monitored

16. Fewer people are trying impose their morals and values on other people about their end of life choices

17. More people who are near death are requesting assistance from their physicians in case their dying process becomes unbearable… fewer of them actually take the medication because palliative and hospice care are keeping them comfortable longer and allowing more people to experience a more peaceful transition

Good laws need to be written to protect physicians from prosecution and the dying from being killed against their will while allowing release from their body by their consent.

We have to guard against extremes but abide by reason and compassion.

Comments on New England Journal of Medicine Article

sunset07

Comments on

New England Journal of Medicine Article

I came across an article in the New England Journal of Medicine offering the scenario of a 72-year old man in the end stages of pancreatic cancer who asks his doctor about assisted dying. The question to the forum is: should it be permitted or not. They provided a professional pro and con opinion then opened it to comments.

Below are quotes from among over 200 comments from physicians, medical students and people like you and me from around the world who endeavor to keep up with the conversation on this issue. Please refer to the article for full details. I did not correct spelling or grammar. I grouped them here by U.S. states,  other countries, and a group of unknown origin, after selecting those I found most interesting on both sides of the debate. I actually found a pretty even split among all the comments on the site, but my sample didn’t end up reflecting that same distribution. I color-coded the first word of each comment I posted to give a quick overview (PRO / CON). My comment is at the end.

UNITED STATES

Physician from Arizona: I was trained to heal and even though I understand the fact that a patient would like to end his/her life with “dignity,” I don’t think I could bring myself together and help them do it.

Physician from California: We have to remember that everybody is the master of his/her own body and choosing the option of dignified death should be the right of the patient and not the physician, lawyer or society at large.

Physician from California: Once the request for hastening dying is balanced against the depression that is intrinsic to the dying process, then the autonomy of the terminally ill cancer sufferer is at the top of the priority chain of ethical principles.

Medical student from California: It is high time that we have an alternative to our inevitable end. We must be entrusted to find a collaborative approach to death as we do with birth. Birth is joyous and assisted. We celebrate it. We welcome it. Death should have its rituals as well. It should be free of fear. It is a very personal choice and a difficult one. It should be honored.

Physician from California: Life is sacred and we must obey the natural law not to kill.

Physician from California: Physicians not only have a right to assist patients with suicide they have a moral duty to do so. The concept is complex and necessary restrictive guidelines need to be in place.

Elder law attorney from Washington, DC: It is the height of unethical behavior for a doctor or relative to substitute his or her opinion of what is best for a dying person’s well being for the patient’s. Using the “art of healing” as a reason to deny a dying person his or her wish is a paternalistic, self-referential shield that fails to engage the patient in his or her life decisions. Patients are not passive recipients of the wisdom of doctors.

Physician from Florida: Today, why are we not lord and masters of our own bodies? Do we belong to the state, or some religious organization? If we do not own and are therefore not able to control our own bodies, who does? Why, legally, does the state have the right to tell us what we can do with our own body, our most precious possession?

Physician from Florida: He is neither suffering nor is he in an unresponsive state (the two specific situations that he did not wish to be in). If by ‘prognosis’ you mean that he understands that there is no cure for his disease, then that realization, by itself, almost certainly does not qualify for life terminating drugs.

Widower from Hawaii: (After declining treatment for pancreatic cancer) With daily visits by an oncologist and surrounded by all 16 family members, aged 3 months to 86, my wife, mentally alert, phoned thanks and good-byes to relatives and close friends around the world. There was no bitterness, no hesitation, never a moment unattended, awake or asleep. She breathed her last in my arms on day 8 and I regard it as our ultimate expression of mutual love in a long life filled with love.

Professor (emerit.) of Surgery from Illinois: Once such a request for help comes from their patients to end their suffering, doctors cannot shy away by cynically claiming, “the last thing” is your problem-not mine. We are in this problem-together!

Physician from Illinois: I am a retired internist. The past 5 years I have had the privilege of being a volunteer at our local hospice. Hospice/palliative care is now able to provide caring and supportive care to the majority of our patients. There is, however, a small minority for whom assisted suicide would be the kindest choice.

Patient from Louisiana: If I experience a complication or progression of my illness that results in a terminal situation, I have made it clear I do not want extraordinary measures made to treat or resuscitate me. If I am suffering and in the terminal phase, I should have the option of physician-assisted suicide or some legal method of obtaining the necessary drugs to end my life. To deny patients this option is an unethical and cruel abuse of our humanity.

Surgeon from Maine: I have argued for assisted euthanasia for many years, including presenting a case at a meeting of the MMS, when they were discussing the issue many years ago, as a delegate from Plymouth, MA.

Physician from Massachusetts: The doctor should not be involved in providing the means. Why not ask the priest or the lawyer to help provide the means?

Physician from U.S.: 78-year old retired general/oncologic surgeon, currently in good health but well aware that a terminal illness like pancreatic cancer could arise at any time. I am the master of my own destiny, I should have the right to choose and would hope that my personal physician could assist me in my choice. I am disappointed that Massachusetts voted not to allow “Death with Dignity.”  I have always felt that the concept of holding out “hope” for terminally ill patients is not only unrealistic but often cruel in not recognizing the reality of ultimate death.

Nurse from Massachusetts: …nurses are the ones who spend more time with them, have an explicit framework to specifically assess and diagnose spiritual distress, changes in role and family processes, and other critical aspects of quality of life, and are far more often present for individual and family at death. Similar polls of nurses are over whelmingly in favor of death with dignity initiatives. It is unfortunate that this debate is so often framed in terms of what physicians want to do. Far better that we all should do what patients ask of us; patient autonomy has always had primacy in nursing practice.

Physician from Michigan: Some physicians feel a heroic obligation to save a life against all odds, to the point not only of futility but absurdity, and in doing so they feel a rewarding sense of accomplishment. They force their beliefs against the wishes of the victim (pardon me, the patient).

Physician from Minnesota: Physicians are highly trained medical professionals who promote and restore human health by diagnosing and treating disease.  When disease-associated pain is present, they alleviate it. Taking a patient’s life only creates pathology it doesn’t treat any disease. It is oxymoronic to see physician-assisted suicide as providing any form of health care. Indeed outside of the privileged doctor-patient relationship such behavior would simply be recognized as homicide.

Physician from Minnesota: No PAS should not be legalized.  I don’t care what kind of consent process or how many behavioural science consultations or screenings you do. We are undoubtedly starting down a slippery slope, especially as we enter into an era of increased regulation and financial constraint.

Physician from New Jersey: As it is my desire to pass gently into the good night when my time is come, if I can assist a fellow human to leave this world gently and by choice when their time is nigh, then I believe it is the moral choice.

Physician from Ohio: When my terminally ill wife with colon cancer indicated she did not want to keep going, her message was conveyed to her hospice caretakers who ensured she would be comfortable. As a physician I personally did not feel comfortable managing a medical situation for which I was not prepared for.

Physician from Oklahoma: Is there a day in the future when people will be asked about their acts or not? In other words, is there “Allah” (God) or not? If you believe in Allah and that there is day of judgment where you will be asked about every single act, word you spoke or listened to, look… then you need to have good answer to why you helped someone kill himself.

Elderly woman from Oregon: I do not think we are puppets of some idea of a supreme being, we rather seem designed to learn and apply knowledge to our individual circumstances, and at near age 86, I hope to choose to end my earth time in dignity with euthanasia under specific circumstances and have outlined those in my directive.

Physician from Oregon: The greatest benefit of the law in Oregon has been its effect in enabling communication. This issue is not simple. The Oregon law does not give Oregonians the “right to die.” But it does give Oregon clinicians and family members the right to assist in their deaths, under carefully prescribed circumstances.

Physician from Pennsylvania: Individual vs Societal Rights. I have never understood how a society that prides itself on self-reliance, individual courage, free will, and the rights of the individual, feels justified in removing these rights from individuals at the end of their lives.

Physician from Pennsylvania: I respect the views, some very eloquently stated, of those selecting option 1. My vote is for option 2.

Physician from Tennessee: Why can’t we accept and recognize that patients have the right to decide when to end their lives with their pain controlled, their dignity preserved and with our support? Why do we abandon our patients and their families in such a difficult times? Properly screened patients (and families) should be allowed to make this decision with the support of a physician who can guide them through the process and relieve them from guilt and remorse.

Physician from Utah: If society deems carefully planned and supervised suicide as an option, why does it have to be PHYSICIAN-assisted? Anyone could be trained to perform this function – certainly it is not part of a physician’s training.

INTERNATIONAL

Physician from Albania: He always asked me whether I can do something else to make his misery go away. I never quite understood what he meant by that until I got a call from the medical examiner. They asked me whether I knew Mr. X and was he one of my patients. I said yes. They told me police had to break into his apartment that day. They found him dead on the floor. He had killed himself using a kitchen knife. He should have had a better option and I should have been a better physician.

Physician from Belgium: With good palliative and terminal care most of these cases can be handled without the need for euthanasia or assisted suicide. We have to introduce the ‘ars moriendi,’ the ‘art’ of dying, facing existential and spiritual problems.

Physician from Brazil: We are doctors not murders. I myself am a religious doctor and I know that lives belong to God. We are living a life that does not belong to us. We are here to proceed the evolution of our Espirits and so are our patients. We do not have the authorization to end someone’s life.

Physician from Brazil: I believe that our society must allow the final expression of free will once the individual is faced with the alternative of avoiding suffering and loss of all his dignity so let the choice for an “ending” according to his moral values be a real one.

Physician from Canada: They would prefer that the patient suffer rather than risk upsetting some abstract and totally subjective set of values. They would hold us all hostage for the sake of their morality. The hypocrisy and sanctimony of their argument is an infinitely greater risk to our freedom than any abstract notion they would force upon us.

Physician from Canada: Listening to a request for death but never carrying it out can be the height of hypocrisy. And individual autonomy is what this question is all about not your book learned ideas of other values and ethics for the collective.

Physician from Canada: This is a personal matter for the individual facing death and has nothing to do with a proper debate on the modern process of death. It is high time to drop the moral blackmail and use of loaded terms such as ‘therapeutic homicide’.

Physician from Canada: Religious dogma of “only God is giving life and only God can take away life” should not be the rational, the actual basis of laws.

Physician from Canada: people with advanced ALS or multiple sclerosis who cannot move more than their eyes often will chose to be disconnected from life support. Some of them would like to have the option of a well performed general anesthesia that would allow them to die comfortably before they reach this advanced stage. Why deny people this option is beyond understanding.

Physician from Canada: We have all watched people suffer and silently wished for the end. Many of us have provided opioids at doses needed for pain control, but that could cause respiratory depression. But we know very well that there is a clear difference between that, and deliberately bringing the end sooner. To raise my hand to kill… never for me, and never (I hope) for my profession.

Physician from Canada: We do not chose to be born. Life happens. I understand that suffering is difficult, distressing and terrible for both the patient and the family. But let’s face it, it’s part of life. NO ONE goes through life without suffering at some point. It is part of being human. Not accepting it seems to be annihilating the core fact of our humanity.

Woman from Canada: A person who dies meets his maker, or so believe most Americans. Our maker has something to say about willfully taking a human life. I do not belong to myself, being created by a higher power, and do not have any inalienable right to determine my death.

Physician from China: Physicians should not be the one to make decision to end a life. But morality is a basic human right and an individual choice. Patients with end stage disease should have the right to die with dignity.

Physician from Dominican Republic: A doctor is a healer not a killer. Death is not part of life because life ends when we died. Living is to watch the sun every morning and the moon every night. A doctor saves the life and the souls of his patients everyday no matter how difficult it is sometimes…

Physician from Egypt: Timing of death is related only to our God. I think we cannot go for helping patients to get suicide, the image of doctor is only to help patients to get better as to improve pain control, relieve symptoms. Practically speaking in this situation of advanced pancreatic cancer, we give strong narcotic with laxatives and usually the survival is very limited to a few weeks maximim.

80-year old man from France: The debate about end of life conditions is nowadays very hot in our country. I strongly believe that the respect of patient’s wishes will not deserve palliative cares, but on the contrary facilitate their development. As wrote Seneque in one of his letter to Lucilius : “the best death is the one I wish”.

Physician from Greece: A colleague once confided softly: “If I am ever in that state, please kill me mercifully.” Recently, Richard Lehman of the BMJ made a bitterly humorous request to be given a strong i.v. anaesthetic and a massive dose of potassium chloride, in case of a massive stroke. Do we as physicians dream of the right to a dignified death for ourselves, but refuse to consider it for our patients? Our ethics have not changed, but medicine has come to a point where we are prolonging wretched conditions of debilitation, humiliation, pain and misery.

Physician from Greece: What constitutes bad medicine, and also fuels the euthanasia argument, is the overaggressive management of advanced cancer with multiple toxic therapies that add only misery to the patient’s last few days/weeks/months. Providing death on request only erodes the status of the medical profession, and is beyond the jurisdiction of medicine.”

Physician from India: A right to die a dignified death by a patient who has fully intact faculties is not an issue to be brushed aside.

Physician from India: I believe life is a gift of God. We have no right to terminate it. We should continuously struggle to minimise the sufferings of our patients and not to indulge in practice of physician-assisted suicide.

Physician from India: The role of the Physician should be just saving life. The patient then has a choice whether to go to the Physician or not and next to the person who could assist him with ending his life (someone whose only training is this and not currently practising any other kind of curative medicine).

Physician from India: I have worked in oncology units and have experienced the pain and sufferings those terminally ill patients undergo. We can have euthanasia with proper regulations in place. We cannot provide any better life to them by any means, so why deny their peaceful termination of their own hopeless journey!

Physician from India: Death is inevitable and is not to be feared and dreaded. We are not in the normal course of life given the luxury of choice as to when and how we die. If given a choice between needless pain and suffering to both the patient and family; the obvious choice is assisted suicide.

Physician from India: I agree with the general principle of physician-assisted suicide. I think doctors who work hard to save a patients life, who have spent time with the patient and have the trust of the patient are in the best position to bear the moral responsibility of taking a patient’s life.

Physician from Italy: Please remember that the Nazi euthanasia program was the foundation of the destruction of the European Jews.

Physician from Italy: The only person who has the right to decide when and how to die is the patient. Religions have nothing to do with it. Our job as physicians does not end when the patient cannot be cured. We must take care of him/her to the end, and that entails also, if the patient so desires, assisting suicide.

Physician from Italy: The choice to kill oneself is the paradigm of a personal choice. As such, it should not involve other persons either relatives or kin. For the same reason physician-assisted suicide should not be done in patients like that described in this case vignette.

Physician from Lebanon: We doctors are born to help those who want to live and not to euthanize those who want to die, that is the dignity of our profession.

Physician from The Netherlands: Discussing the possibility should be legally and professionally obligatory to be one of the “treatment options” right from the first diagnosis! And as such part of palliative care.

Physician from The Netherlands: Banning euthanasia and physician assisted suicide doesn’t mean it never happens. It just means you don’t know how often it happens.

Physician from Pakistan: I understand and accept both points of view. As an oncologist I have spent many a nights fretting and being upset about unnecessary suffering and not being able to make them as comfortable as they should be, but at the same time I do not think I have the courage to knowingly help patients for euthanasia.

Physician from Pakistan: Help patients relieve their sufferings. Dr assisted suicide should be permitted

Student from Peru: When a patient is in the terminal stage in any disease and you as his physician can not give him quality of life then why you have to make him suffer? “Primum non nocere” always… and in this case making him suffer is harming him in spirit.

Physician from Portugal: Medicine is about “healing.” Decisions about suicide at will are not and should never be medicine. If considered a “right” and allowed by society, please create a “legal executioner or hangman” for the job.

Physician from Portugal: The issue of assisted suicide is not a purely medical issue: it involves legal, anthropological, spiritual and ethical issues, which largely exceeds the medical problem. The balance between the safeguarding of life, and mercy and compassion for the suffering often creates gray areas of difficult decision.

Physician from Russian Federation: There is a risk of an abuse of authority if the physician is a maniac or physicians are associated with criminals. Ethical and moral aspects of this issue are very complicated and open to questions.

Physician from Saudi Arabia: Patients with major depressive disorder with suicidal thought and intention are considered in critical state and urgent action is needed to protect them and prevent them from suicidal attempts — so why would we facilitate death in a patient with terminal illness?

Physician from South Africa: Where it is legally authorized, the physician may help those who are in despair to end their lives, if any medical intervention has become futile.

Physician from Spain: Thou shall not kill. Sometimes being a doctor is very difficult. Of course we have to better help the patients when dying and to alleviate them is an essential part of our professional caring. But I strongly feel that to allow killing is a terrible mistake.

Woman from UK: You can privately, quietly, ensure the right dose of the right medication is given with no questions asked. Before you respond from your positions of power and control, please consider what it is like for ordinary people.

Student from UK: Indeed the very idea of a killing doctor almost presents as an oxymoron, however with the training and in-depth understanding that all doctors must possess it seems to me that a doctor is the only humane and realistic choice of assistant to suicide.

UNKNOWN ORIGIN

Physician: When you kill someone you forever remove the virtue of hope, which is so inherent in the work of a physician. When all our drugs and all our armenmentaria are gone, we can always give hope as long as there is life.

Physician: We are doing this everyday through Hospice. We just don’t call it assisted suicide. Terminally ill patients should have the right to choose their end. And helping a patient walk through death’s door with everyone’s consent should be a privilege not denied to their physicians.

Patient: My husband and I have plans to take our lives when we become unable to care for ourselves, mentally or physically. We don’t want to burden our children with our care and believe that the money we would spend on hiring caregivers would be better served paying for our grand children’s education. We are living too long now and the cost/benefit ratio is too low to sustain.

Physician: I favor physician-assisted suicide. It is the ultimate compassionate act in the doctor-patient relationship. To deny it would be to abandon the patient.

Physician: I would hope, that under such or other similar circumstances, I would be given the choice to end the misery. I do not think that anyone else should be able to enforce his/her convictions of prolonging my ordeal for me.

Physician: My father died free of pain (from a recurrent cancer) with the help of a generous dose of morphine from his primary care physician. My mother and I were grateful that he could say goodbye in peace.

Medical student: …listen to what they are saying, analyze if it’s logical. Every case is different. As a doctor, my first duty is to listen to my patient, only he knows his pain and mental anguish. Mr Wallace … fears that such a day would come and wants to opt out of experiencing that condition. I completely understand his fear and respect his wishes. I am okay with assisting him as per his wishes. And I won’t be a murderer if I do so, not in my eyes at least.

Physician: I believe if a person has a terminal illness that causes him/her to suffer, to live an uncomfortable life, the person that is stable should have a decision of life or death … as long as the procedure is assisted by a doctor.

PhD: A person, no matter the age, who is terminally ill should have the right to Death With Dignity and this includes euthanasia

Physician: After practicing as a critical care physician for over 30 years, I am still puzzled as to why is it wrong to assist those who wish to die while in our care? If changes in the practice of medicine now give us the additional responsibility to walk with those on their way to end, we should respectfully perform that task. Not everything we do in medicine is to our liking or edifying. Assisting in a peaceful death may be one of those unpleasant tasks we need to accept reluctantly. I think that is a service to the society.

Physician: Few of us are prepared to swear with a straight face to Apollo, Asclepius, Hygieia, and Panacea, and the ancient oath not only proscribes assisted suicide but also abortion. Likewise some commenters have hearkened to a simplistic version of Judeo-Christian morality and vitalist belief that mere human beings should never weigh in on quality of life or take actions that hasten death. Bottom line is that we must learn more and engage in a more substantive debate of this subject.

Following is my comment– Someone here wrote: We do not choose to be born. Is that a scientific fact?
What if we DO chose to be born… into this body at this time in history on this planet in this country in this community to these parents, into this dysfunctional society, but instead of dying at the end this body’s ability to function we are transformed into our true essence and return home filled with new adventures to tell our loved ones about and lessons learned for the growth of our eternal souls? Then part of healing involves facilitating the soul to exit the body in as peaceful a way as possible by practicing the art of conscious dying, which does not preclude assisted-dying or euthanasia.
This is my understanding of the process after having died and come back to tell about it, and spending the last 40 years studying about it. Actually, we do chose to be born, it’s a great honor and privilege, and when it’s over, it’s great to be going home again. Talk about a paradigm shift!! Hello! The earth is not flat. The planets revolve around the sun. Time to wake up 🙂

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Physicians, Nurses & Pharmacists and Assisted Dying

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Physicians, Nurses, Pharmacists & Assisted Dying

Trying to come up with a Death with Dignity law that will cover all the contingencies and please all the stakeholders is next to impossible, but it is a process and we have to start somewhere. My interest is in encouraging the discussion so the best laws will be written to protect all of us while giving us the freedom to make our own healthcare choices.

The laws in Oregon and Washington are showing that fears of wholesale murder haven’t materialized. Old people are not lining up along the highways at the state line to be killed. The slippery slope is holding. But there are still issues that need to be addressed to improve the law and stop the legal battles that only hurt the patients while filling the pockets of lawyers and the media.

Physicians have been polled in states where the law has been brought to the attention of the voters and a good many of them don’t want to participate. If a patient asked, they would say no.

Some claim allegiance to an oath written around 400 BC, 100 years after Hippocratesdeath, during a time when citizens were being fed to lions and butchered in the streets, that says Primum non nocere (Latin for “First, do no harm”). Actually it didn’t quite say that originally, but “I will keep them from harm and injustice.” I don’t think that has the same meaning today.

It’s hard to believe 2400 years later that an educated person would swear an oath to Apollo Physician, Asclepius, Hygieia, Panacea, and all the gods and goddess… of the Greco-Roman pantheon (at which time it was believed the earth was flat and all else was on a dome that revolved around it). No wonder they came to have a God-complex!

Hippocrates was considered the father of medicine during the time the Roman Empire was at war with just about everyone else as they conquered the lands around the Mediterranean. He was the first to recognize that illnesses come from natural causes and were not punishment from the gods, and he promoted natural healing and disapproved of the use of potent drugs. At the time, dissection was taboo in Greece so he didn’t know much about anatomy or how symptoms related to disease.  Their values and lives were quite different and more people died violent deaths than suffered debilitating and long-term chronic diseases like people today face. Then, 40 was old.

The truth is most medical school graduates today either don’t swear any kind of oath or use a more modern version, but let’s consider do no harm. Some synonyms for “harm”– (deliberately inflicted) hurt, pain, trauma; also wrong, wickedness, iniquity, sin. So it seems physicians don’t consider it harmful to allow a patient to suffer in agony for days or weeks as they are dying, but they do consider it harmful to end a dying person’s suffering by hastening his or her impending and inevitable death by a few days when that is what the person wishes.

Seems to me forcing patients to stay alive for more torture and medical insults is deliberately inflicted hurt, pain and trauma. A sin? Oh, please, save us from the beliefs of people who seek to impose the will of their imaginary gods and goddesses on the rest of us.

So apparently, according to some, helping to relieve someone, who is in the process of dying, from unbearable suffering or pain is doing harm. Really? Have you ever sat with a loved one who is dying that way, begging to die, begging for that little pill to set them free?  (See my article “The Right to Die” [1979])

The other part of the oath some physicians invoke states: I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.So when Socrates, considered the wisest man in Greece at this same time, was sentenced to death for speaking his mind, he gladly accepted the hemlock and his death rather than face exile. I wonder what Hippocrates thought about that. And here we are today debating about whether a person can choose to die or not when faced with death. Is one right and one wrong or are both right and the law should allow for individual choice?

The Hippocratic Oath also states To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else. So it’s a paternalistic, sexist document– and when was the last time anyone saw a physician who didn’t charge fees?

I don’t think we should throw the baby out with the bath water but can we get over this Hippocratic Oath defense and get practical? This is 2013, laws (and oaths) need to be relevant to the times and we need to get up to speed.

People who are conscious as they are slowly dying often see their loved ones waiting for them on the other side (read any books by Dr. Elisabeth Kubler-Ross). They’ve been traveling back and forth, out of their body, between one world and another, for days or weeks and are excited about going home.  One’s final struggle is between wanting to stay and wanting to go. Some refuse to give up and fight to the end, and that is their choice; however when one is ready to go, when one requests it, let them go. The end is the same. It’s what’s in between that needs to be addressed.

Seems to me cruel and unusual punishment to force dying people to stay alive when they are ready to go, and it’s not just about pain relief. Some religious people believe suffering is part of life and seem to imply the more one suffers, the better. They believe in the “sanctity” of human life because they believe there is only one life. What if they are wrong… like the Greeks and Romans were wrong concerning Zeus and Juno and their brood?

As long as we identify with our body, we want to stay in it but once we realize we are more than our body, that we are spiritual beings temporarily living as humans in a physical world, we get the whole picture and realize that we don’t die when our bodies die…that our conscious awareness continues after our bodies give out. We just wake up, step out and move on.

My feeling is that to be done compassionately, and to dispel many of the concerns brought up by other stakeholders, a physician should be committed to his or her patients until the end. That means if a patient declines further medical treatment and requests assistance with dying, a physician should rightly be at the bedside supporting, informing, preparing, administering and monitoring until that patient expires.

I’ve read about doctors who abandon their patients to hospice when they think there’s nothing more to be done. This could be expected of surgeons whose forte is surgery, who see patients as organs or diseases, but greater compassion is expected of primary care physicians who may know the family as well as his or her patients.

Palliative care and hospice care should be given as options from the beginning of the diagnostic process and offered as a choice along with invasive options,  drug therapies and clinical trials. Patients don’t seem to realize they can opt for no treatment or to stop treatment at any time. Doctors don’t bring these issues up unless patients ask when they are uncomfortable talking about death as if it meant giving up.

There’s concern about the accuracy of a “6 months to live” prognosis. Hospice patients often outlive their 6 months because they get so much comfort and attention from the highly compassionate hospice caregivers that they live longer. Instead of spending one’s last months having more surgeries, more treatments, more side effects from drugs, more pain and suffering only to die hooked up in the ICU, patients could have the opportunity to have well thought out end-of-life conversations with their families. They may get palliative care so they are pain-free and able to fill out Advance Healthcare Directives, complete their bucket list, write their memoirs, wrap up unfinished business, complete their life review and give away treasures to family before transitioning to hospice care where they get to say goodbye to loved ones and have a going away party before they pass peacefully (with or without assistance).

When doctors treat their patients holistically, there’s still a lot that can be done when it comes to healing body-mind and soul. Physicians generally just haven’t been taught how to deal with death with their patients. There were no courses in med school until recently due to all this controversy, but lately things are changing and new physicians are finding courses available to help them relate to their patients as people and understand death as merely a transformation of energy. In my opinion, those who have already graduated need some continuing education classes.

Do I think “physicians” are the ones who should ultimately fill this role? Not necessarily. As I just mentioned, they’re not trained for it and it doesn’t fit their mindset. The whole physician-training process needs to include dying in a holistic healthcare continuum for their attitude to change. MDs may be the only ones who are permitted to prescribe the medication, but a newly-designated medical specialist (e.g. MD or RN with PhD in Thanatology) could be at the bedside to protect the patient’s interests following certain guidelines and carry out his or her end-of-life wishes for a quick and peaceful release.

This way, someone capable would be at the bedside if anything goes wrong (e.g. patient falls asleep before ingesting all meds, patient throws up meds, something goes wrong with an IV line), as well as pronounce the patient and sign the necessary paperwork. Just as it takes great compassion to be with the dying as a hospice nurse but not all nurses have the passion to become hospice nurses, only certain physicians will have the sensitivity necessary to assist patients who request assistance with a quick and peaceful pre-planned death.

They may be those women and men who realize death of the body is just a transition, a transformation of energy from one state to another with continuation of consciousness, and that assisting the dying to have a peaceful and meaningful experience helps to heal the soul as it is leaving the body.

Polls show that a lot of nurses are opposed to participating as well. Back before the November election in Massachusetts last year, an organization of nurses put out a statement of opposition to passage of the Death with Dignity Act. Hospice nurses who are more attuned to the needs of the dying could develop a transition guide specialty, but they would have to shift their mindset beyond only stopping eating and drinking being acceptable. It’s OK for a person to starve to death over a week or two along with their other ailments, aches and pains as they are dying? It’s OK to pump them full of morphine so they are comatose for days? It’s OK to force people to live but not OK to allow them a peaceful passing? It’s not OK to be OK with dying and wanting to speed up the process if one is dying anyway? Hmmmmm….

There’s a wonderful book by two hospice nurses, Peggy Callanan and Nancy Kelly, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying, in which they talk about their experiences at the bedsides of hundreds of people as they were dying. They describe how wonderful and how terrible it can be for the dying and for the families in different circumstances. For some people, they say “I’m going now,” close their eyes and take their last breath.  For some, it’s like a fight to the finish to rip the soul out of the body. We don’t know how it will be when it’s our time, but those who have gotten their prescription say they take comfort in knowing that they have the option if they decide to exercise their desire for death with dignity. It doesn’t mean they will, in fact, most do not. Some have a peaceful death without it. Some wait too long and are not able to take it without assistance.

The other issue that comes up here is euthanasia, which means a physician or another person administers the lethal dose either by mouth or injection. This is where it gets tricky with the law because it’s considered murder to kill another person. It’s not illegal to commit suicide, but no one can legally help you do it. You don’t want your relatives to be put in prison for helping you out but you may be incapable of doing it yourself. That whole thing with Final Exit and the helium bag over the head– it’s just insane that a person should be forced to resort to such measures, but it’s got to be better than blowing one’s brains out.

For people facing Alzheimer’s, should they be eligible for a dignified, peaceful death before succumbing to the agony of losing their mind? For someone dealing with MS or ALS or locked-in syndrome, should they be eligible for assistance if they decide they want out of their progressively worsening condition? I don’t think people should be required to live that way if they don’t want to… whatever their reasons. If they’re OK with it, fine… live on.  I certainly don’t believe in wholesale killing of the elderly and disabled, and am fully aware of Hitler and others like him, which is why I believe we need good laws to protect the vulnerable but still allow freedom of choice. This is still America, not Nazi Germany.

As for people in a vegetative coma, if it were me… just shoot me now! But I stress the importance of filling out Advance Healthcare Directives at an early age because you never know what accident, medical procedure or infection might suddenly put you there and leave your loved ones with gut-wrenching decisions about the care of your body because they don’t know what you would have wanted or some well-meaning organization steps in and decides you must be kept alive because you might wake up 20 years from now… and some people do, and loved ones tend to hold out for that hope. You need to decide how long to wait before it’s OK with you to pull the plug.

Perhaps we need a new definition of murder? My dictionary says– “the unlawful premeditated killing of one human being by another.” Could we just add— without consent? So if a person consents to euthanasia, it wouldn’t be unlawful. Or if the definition exempted ending of life under the care of a physician at patient’s request. It just seems to me that a simple injection would be easier on a person than swallowing all those pills now required for the process and that a responsible person should be there to make sure all goes well, no mistakes, no question the person made his or her own decision willingly, and that the death was peaceful. And who else’s business is it besides a patient and his/her doctor any way? This paternalism is getting really boring.

Another voice is the pharmacist. Now some of them are citing religious or moral values that say assisted-suicide is murder and we’re not going to dispense these prescriptions so people can kill themselves. I don’t know that they have a right to question a physician’s judgment or not fill a prescription. They fill all those prescriptions for psychotropic drugs so many people are hooked on without question turning us into a nation of prescription drug addicts who often overdose, but someone who wants out early at the end of their life must be denied because some pharmacist doesn’t think it’s right or it goes against his beliefs. I don’t think so.

They dying patients are the ones who suffer when these people force their judgments and beliefs on vulnerable people who just want control over their own lives and a peaceful death. Religious organizations and moral absolutists pour money into negative propaganda to scare people into thinking someone wants to make it easy to kill off old, sick and disabled people thereby denying the rights of dying people who are capable of making their own end-of-life decisions. They squash support for personal freedom in healthcare instead of funding educational programs to help people make informed decisions about their end-of-life healthcare options. They have their priorities backwards. Help to strengthen the law to protect the vulnerable but don’t force your beliefs and opinions on people you don’t even know.

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COMING NEXT: Discussion about The New England Journal of Medicine open forum about whether physician-assisted suicide should be permitted or not in a particular case scenario.

Death with Dignity – October 2012

Overview of National News – October 2012

(NOTE: For list of articles quoted, go to Categories: Assisted Dying & Euthanasia: Assisted-Death Debate – October 2012)

The major news throughout October has been about the vote in a few days in Massachusetts for a Death With Dignity law, similar to the proven-effective laws in Oregon and Washington. The laws provide similar guidelines and safeguards for those dying patients who want to request a prescription from a physician to hasten their deaths if they decide to and for those physicians who may write the prescriptions.

Is it a perfect law, no. Do some of the opponents have legitimate concerns, certainly. Do they have a right to impose their beliefs on others, no. Is it a work in progress, yes. We need rational debate not fear tactics and threats of being banished to hell to consider all sides of the issue.

I found it interesting that I only came across relevant articles from 12 states and Washington, DC in October. Most articles mentioned the growing debate about the Massachusetts ballot issue to be voted on November 6… however, the one Illinois article discussed the controversy over a proposed  assisted-death bill being introduced in Quebec and the one article from North Carolina had the anti-euthanasia advocate from Canada claiming fraud and abuse at Dignitas in Switzerland. They may be testing the waters.

In Oregon, where the Death with Dignity law has already passed, some of its financially-strapped hospitals are now facing take-over by the Catholic healthcare systems whose execs tell the town folks nothing will change… well, except that abortions (unless to save the life of the mother) and writing prescriptions for a life-ending drug won’t be allowed “on their dime.”

The people of Ashland kicked them out but they continue to target other towns in Oregon and Washington. According to a Catholic Bishop in Wisconsin, supporting a woman’s right to reproductive freedom (abortion); death with dignity (euthanasia); important scientific research (stem cell research); and marriage equality for gay and lesbian citizens are all “intrinsically evil” and, of course, we are all going to hell in a handbasket.

BTW, a gay bashing group from Mississippi sent the opponents of the Death with Dignity law in Massachusetts $250,000 to help them with their campaign. It became a hot news item and they were guilted into sending at least some of it back, although they continue to accept contributions from the Catholic Church (whatever happened to separation between Church and State?) and other dubious supporters for the media blitz this week leading up to voting day.

Unfortunately, it seems their media blitz is working because the gap that according to polls was a slam dunk for passage has been shrinking the past week. Don’t take anything for granted if you want this to pass. Get out and vote, and tell your friends to vote their choice.

It seems that in some states people are beginning to look at this issue and talk amongst themselves about how they want to die when their time comes. If it passes in Massachusetts, some claim it will open the floodgates for other states to get it on the ballot. One writer prophesized: “Coming soon to your state!”

The next states getting close to having a Death with Dignity law on the ballot are New Jersey, Hawaii, Vermont and Texas… and, who knows, maybe even Montana will make it official soon!

People in those other 38 states need to wake up and pay attention not just to what’s happening in Massachusetts, but all over the world on this issue because this is an idea whose time has come. And it’s not going to go quietly away.

Overview of International News – October 2012

In Australia, euthanasia advocate Dr. Philip Nitschke is urging Tasmania’s Upper House MPs to open their minds to what he calls progressive legislation. A discussion paper on legalising voluntary euthanasia is due out in the next few months. A euthanasia bill will have to pass the Upper House before it can go to parliament next year. The issue of gay marriage has only just been dismissed from the Tasmanian Parliament but already Christian groups are preparing for the next moral battle while MLC Paul Harriss has dismissed the debate as a Green-led agenda.

Actor and Bell Shakespeare theatre director John Bell who supports the rights of patients to choose to end their life says it is not a morose or negative cause. ”We’re not about embracing death … we are about celebrating life. Once the quality of life is gone, life is not worth very much,” he said. ”I don’t want to reach that stage of being incontinent, helpless, totally dependent. It’s a dreadful way to end a life that’s been a very happy and blessed one.” John said that often children of parents are particularly torn by how to care for their dying loved one. “They often feel guilty about wanting the parent to go, and therefore not being able to let them go and not knowing how to do it.”

Sarah Edelman, clinical psychologist and vice-president of Dying with Dignity, NSW, says that under current law it is legal to starve oneself to death over several weeks in a hospital bed and to commit suicide using violent means. (In fact, it is difficult to end one’s own life peacefully without appropriate medication or ”insider knowledge”). However, it is illegal to access medical help to die peacefully when faced with intolerable suffering and no prospect of recovery, or when dying is slow, painful and undignified. Politicians should be asked why this is an acceptable state of affairs.

From a woman in Sydney– “Right now there are two people in my life wanting to die. My 19-year-old university student friend Josh made his intentions really, really clear last week. He stood in front of a train. It didn’t kill him and he is vigorously being kept alive in intensive care. My 86-year-old dad, Bob, who lives in an aged care facility, regularly quotes the Ol’ Man River song ‘I’m tired of living, but scared of dying.’ So with all this talk about the possibility of legalising euthanasia, what’s the difference between Josh’s suicide attempt and assisted suicide should my dad Bob want it?

David Leaf, a Dying with Dignity NSW board member, said mounting evidence that supported legalising euthanasia was being ignored. He said assisted dying programs worked, with no evidence of heightened risk for groups considered vulnerable to euthanasia, including the elderly, uninsured, poor, physically disabled and mentally ill.

Dr Leaf criticised Father Brennan and “other Catholic lobbyists” for using emotive terms like “legal killing,” “suicide,” “death by doctor,” and “lethal injection” in their input into the debate. “I’m not anti-Catholic, but I’m anti-bullshit,” Dr Leaf said.

More than 200 Australian doctors have banded together to call for law reform on voluntary euthanasia, but few of them would want to administer a fatal drug dose. “But doctors wouldn’t be administering the drug, because that responsibility could instead lie with the patient who would self-administer the dose, which is what happens in countries where it is legalised,” Dr Marr said.”This is not about the suffering of doctors, it’s about the suffering of the patients and that’s what the doctors signed up to our organisation recognise.”

When the swimming champion Murray Rose died on a quiet Sunday last April, he was at peace. His wife, Jodi, believes palliative care and a supported death at home helped create that peace. “There’s no greater transition than death – and you want it with dignity,” she said. “He loved being at home so I knew in general that if there was any way he could pass away at home that was our ideal scenario. I did not do it alone. I could not have done it alone,” she said. The provision of palliative care in NSW is at a critical juncture: historically underfunded services are struggling to meet increasing demand while federal funding appears to be drying up. The Roses’ experience is unusual in NSW, according to the Palliative Care Plan. One third of people who die of cancer and 90 per cent of those who die predictable deaths from other conditions do not receive palliative care.

And this is one of the problems everywhere it’s being debated. People say palliative care can help relieve the pain and suffering that often comes with the dying process. First, palliative care isn’t available everywhere, in fact hardly anywhere– it’s a new field. Second, there aren’t enough trained medical people to administer and implement palliative care programs to handle the growing need (think Baby Boomers). And third, what is available is expensive and mostly not covered by insurance– including Medicare, which will pay the MD but not the nurses, the social workers, the caregiver assistants, or the chaplains necessary to make it truly a palliative care program.

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In Belgium, deaths from “voluntary euthanasia” are approximated at 2 percent, – 2,000 annually. At a recent conference in Brussels, a Belgian doctor reported that organ transplants are being done on euthanized patients and that Belgium leads in this practice. Dr. Van Raemdonck reported that nine successful lung transplants from “voluntary euthanized” patients have been performed since 2007.

If a person who is an organ donor is brought into the emergency room and declared brain dead, his body can be kept alive by machines until his organs can be harvested. What’s the difference if a person who is dying wants to be euthanized at some point so that his still viable organs can be harvested for transplant? I’m sure there will be outcries from the right that people will want to euthanize granny and sell her lungs when this gets around.

A filmmaker researching a film about dying interviewed two doctors who told him, “Unusually, the Belgian palliative-care movement and right-to-die movement developed alongside each other. Today, following legalisation in 2002, both palliative care and euthanasia are available alongside each other in the mostly Catholic-run public hospitals as part of an integrated system of end-of-life care. Under Belgian law there two key preconditions: incurable illness and unbearable suffering. The euthanasia usually takes place in the presence of friends and family, often accompanied by prayers, music and even champagne.

In the city of Hasselt, Fr Marc Desmet, a kindly palliative-care consultant and Jesuit priest, brought us to meet an older woman, Delphine Van Hoebrock, the evening before she was euthanised. He held her hand gently as he checked whether she had any last doubts. She seemed remarkably certain and sanguine about her choice, although I couldn’t help sensing some loneliness too. It was both emotionally charged and strange to spend time with Delphine on the eve of her chosen death. Heartbreakingly sad also, even though we knew her only fleetingly. Even an assisted death is a sad and lonely affair, it seems, no matter how much it is desired.

***

It looks looks Canada is set to become the next country to allow assisted dying. The Quebec legislature passed a report early in October, after two years of work from the Dying With Dignity Committee. The action was part of the Parti Quebecois’ election agenda (Parti Quebecois is the minority government in Quebec at present) and likewise had the backing of the all-party National Assembly committee.  The Liberals have remained silent on the issue.

Nonetheless, the Criminal Code still prohibits medically assisted-suicide. Social services junior minister Véronique Hivon asserts that Quebec can pass the law without the support of Ottawa as “Quebec has jurisdiction over health and also over professional qualifications” which “gives us the confidence to introduce this medical aid in dying in our bill.” The passing of the law will place Canada under the umbrella of other countries who exercise physician assisted-suicide such as Switzerland, Belgium and the Netherlands along with a few American states.

Wanda Morris, Executive Director of Dying With Dignity-Canada, believes Canada has a clean slate where” we can introduce any criteria for eligibility we choose, and we can adopt whatever safeguards we feel are necessary.” Canadians can look to the decision of B.C. Supreme Court Justice Lynn Smith who had access to detailed testimony from both sides, experts from around the world and the results of cross-examinations from both teams of lawyers.

Among her conclusions: there is no slippery slope; the safeguards work. “In my opinion, opponent’s presentation of data from Oregon and Netherlands is generally incomplete, frequently filled with factual inaccuracies and distortions, and often meant to construct a false empirical foundation for what is essentially a moral opposition to the practice of physician-assisted death.”

Ottawa, on the other hand, has filed its arguments in an appeal of a B.C. decision that struck down the prohibition on doctor-assisted suicide, arguing the trial judge was wrong to conclude the law is unconstitutional. In documents filed with the B.C. Court of Appeal, the government says the law reflects a reasonable belief that allowing assisted suicide would put vulnerable people at risk of being coerced or even forced to end their lives. The government says the law reflects Parliament’s desire to discourage and prevent suicide in all cases, and it should be up to lawmakers, not the courts, to decide if that needs to change.

Quebec grassroots group Living with Dignity director Linda Couture expressed alarm at how fast the government is moving, noting the new government hopes to have a bill passed by June next year.

Consistent with Canadian law, most of the country’s medical governing bodies are opposed to assisted death. So taking a principled stand, even within the quiet confidence of colleagues, can trigger career-ending attacks from within.They have to worry as a physician how the public, their patients, and their colleagues are going to view them. Whenever you depart from the traditional viewpoint in medicine, it’s going to be uncomfortable.

Some doctors fear the hot-button issue is drawing focus away from a different, and widely used form of end-of-life care. Dr. Romayne Gallagher works with the palliative care program at Providence Health Care, which aims to alleviate suffering for the dying. However, even though Canada has offered palliative care since 1975, it is still largely unavailable to most Canadians.

So medically assisted death is still not an option in Canada, but it’s  only a matter of time before it is. And we’re talking a few more years, not decades. But Canadians are already finding ways to spare themselves unbearable suffering, because there are organizations out there willing to educate them about the alternatives. And those organizations are watching with interest as several court cases wind their way through the justice system — cases which could turn the tide.

Meg Westley witnessed two people die. One died painfully and slowly of the cancer ravaging her body. Another was relatively well, but decided to hasten his death before Huntington’s disease took its terrible toll. Both, she believes, were abandoned by Canada’s ban on assisted suicide.

“I think it’s barbaric that even though people want to go, we let them suffer on,” said Westley, a University of Waterloo communications professor and president of the right-to-die advocacy group Dying with Dignity. “It is about compassion,” she said. “Give them the assistance so they don’t have to suffer if that’s their choice.”

The wrenching experience was made worse knowing Nagui Morcos died when he still had months, even a couple years of relatively decent health to enjoy with his wife, family and friends. But Morcos knew he could not get the help needed later when he was no longer physically able to end his life on his own. Watching life slip away from this cheerful and passionate man who talked repeatedly of the great moments he would miss reaffirmed the unfairness of Canada’s law against doctor-assisted suicide.

Gloria Taylor, the 64 year-old Okanagan woman who had amyotrophic lateral sclerosis, or Lou Gehrig’s disease and fought to change Canada’s law on assisted dying, died in early October. She was gradually losing control of her muscles and feared dying of the disease. Together with two others, she launched a lawsuit claiming that the Canadian Charter of Rights implied a right to choose the time of her death. Judge Lynn Smith agreed and struck down the law, but suspended her judgement until after the inevitable appeal. However, she did give Ms Taylor a personal exemption from the law, making her the only person in Canada allowed to have recourse to doctor-assisted suicide.The Association says Taylor’s death was sudden: she developed a severe infection resulting from a perforated colon. Given the acute nature of the illness, she did not need to seek the assistance of a physician to end her life.

An Ontario man also with ALS ended his life this month. Part of his final statement reads as a kind of social treatise on the role of government in the final choices of Canadians. “Any liberal, democratic system respectful of human rights should provide for a legal and humane way to exit this life at a time chosen by a rational person and with appropriate safeguards and assistance. Unfortunately, the Government of Canada and Canada’s Supreme Court do no do so. While Canada’s law criminalizing assisted death may have been conceived to protect life, it can have the effect of doing just the opposite. I am now looking for ways to die that I must implement myself, that is while I am still sufficiently strong to take all the necessary steps myself. Having in mind the nature of ALS, this will force me to terminate my life earlier than would otherwise be the case.”

“People are dying too early because of laws against assisted dying. People are killing themselves while they still have the ability to do it.” Wanda Morris, Executive Director of the national organization, Dying With Dignity, advocates with great passion and compassion the urgent need to legalize assisted dying for individuals who have been diagnosed with a terminal illness or a progressive incurable physical illness.

What choices are they left with? With the blasé patter of an airline attendant explaining the protocols of oxygen mask use, the 71-year-old retired librarian removes a microwave bag and pulls it over her head, her face shrouded beneath clear plastic, her features blurring, her graying bun compressed into a soft helmet. Slowly, her fingers begin to pinch a seal around her neck using Velcro strips she attached at the open end of the bag. Her voice muffled and faint, she points to the spot where a tube is to be inserted. “I would probably use helium,” she declares, deadpan. “A few deep breaths and you fade off.”  She is Ruth von Fuchs of the Right to Die Society of Canada who says, “No one wants to die alone. Most just want someone there to hold their hand.” Von Fuchs is a death midwife.

The Social Science Research Laboratory at the University of Saskatchewan – the only facility of its kind in Canada – created the Taking the Pulse survey in its group analysis lab, which includes multiple departments from across the Faculty of Arts and Sciences. Their research found that 59 per cent of Saskatchewanians surveyed believe they should have the option of doctor-assisted suicide when the end is nigh.

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A senate committee in Colombia voted 10-4 to send a proposed measure to regulate euthanasia to the full Senate for consideration. If approved the measure would be sent to the Colombian House of Representatives for a vote.

A representative of the Colombian bishops, Father Pedro Mercado Cepeda, pronounced that “No circumstance can make it legally acceptable to intentionally cause the death of a human being.  The right to life is constitutionally inviolable.”

Now here’s a country where people are lying dead in the streets due to the drug cartels and Father Pedro here is making a moral issue of people who probably have no healthcare to begin with and just want out of the misery of their lives. Take care of the people and stay out of politics Father!

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The Law Commission in India has made a recommendation to the government to initiate measures to enact a comprehensive law on passive euthanasia, subject to certain safeguards. “It’s not objectionable from a legal and constitutional point of view,” the commission, which advises the government on legal issues, said.

Dr. Pallavi A. Roshi says  “This decade has brought a significant change in a doctor’s point of view. Many of us have changed the focus from ‘only care’ to ‘cure and comfort’ to ‘only comfort,’ when cure is impossible. Although doctors should strive to extend life and decrease suffering, they must also accept death as a defining characteristic of life. Sometimes, so-called heroic methods may lead to needless suffering instead of preventing death. So, when the incurability of a disease is confirmed, there begins the journey of palliative care to make the end of life easy, and assuring the patient of a dignified death.”

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From Ireland… Sadly, cases like Jenny Grainger’s, who had to stand by and watch her mother stop eating and drinking to have a better death than she might otherwise have had, are not uncommon. Barbara Grainger (75), who had a motor neuron disease and was a lifelong supporter of euthanasia, told her daughter that she wanted to die and asked for her help. Barbara also wanted the tragic story of her death made public in the hope of helping bring about a change in the law which governs people’s right to choose when and how they die. She wanted to go to Switzerland to Dignitas, but unfortunately she wouldn’t be able to swallow the barbiturate pill given there. So she decided that she would die through a voluntary refusal of food and fluids.

Too often, we see accounts of people travelling abroad to die, or attempting to end their lives at home, sometimes alone to avoid implicating loved ones. For this reason, as well as the many people who suffer unbearably against their wishes, many people in Ireland are campaigning for a change in the law.

One writer says, “if we agree that people like Barbara Grainger  should not have to suffer against her wishes at the end of her life, which the vast majority of us do, then we must continue to fight for a law in the UK which allows dying, competent adults the choice of a peaceful and dignified assisted death. No one should have to contemplate travelling thousands of miles for assistance, or weeks refusing food or water to have what they consider a good death.”

Another writer goes on about all the reasons it’s a bad idea, slippery slope and all, and proclaims– “The vulnerable and sick need support and reassurance they won’t suffer alone. It is sometimes difficult for families to give this support, so there is a duty on society to provide it. The compassionate response to suffering is not to encourage suicide, but to offer the palliative care and psychological support the sick need to help them live.

Perhaps in a perfect world. Once again, I’d ask where is that support? In most cases, it’s either not available or too expensive for the people who need it most. We need to meet people where they are, not in some hoped for future.

“Regardless of their religious or political background, this is an issue which affects everyone and politicians need to take a stand and help bring about the change in the law, which currently robs people of their right to choose,” says Jenny Grainger. She has been inundated with messages of support since she shared the heartbreaking story of how her family stood by her mum when she chose to end her own life through the voluntary refusal of food and fluids. Because she did not have the option of a quick and pain-free death through euthanasia, Barbara lingered for 24 days before her heart finally stopped.

An Irish assisted-suicide campaigner will not face prosecution over his visit to an elderly multiple sclerosis sufferer (MS) who took a fatal overdose to end her life because there is “insufficient evidence.” Tom Curran, who says he will risk up to 14 years in an Irish prison to assist his partner Marie Fleming — also a MS sufferer — to die at a time of her choosing, was interviewed by British police following the death of a wheelchair-bound grandmother of five. Ann Veasey (71) died in August 2011 at her nursing home in Harrogate, North Yorkshire, after she overdosed on pills she had bought online from China.

On the face of it, there is an overwhelming case to permit assisted suicide. For the greater, if not far greater, part, it would apply to people who have lived a life, made it into the upper reaches of the average span, and, were it not for a debilitating condition, would want to cling to life. Why should somebody in that position be held prisoner by nothing more than a societal taboo? Why should that person not be afforded the comfort of knowing that they were ultimately existing on their own terms? On the other hand, there is an argument that any introduction would lead down the slippery slope to elderly people being pressured to consent to their own death.

We live in a society that values choice. We choose our careers, our partners and almost every aspect of our lives. It is then a strange situation that we are ultimately unable to choose the nature of our deaths beyond a small number of options. As the Tony Nicklinson and Marie Fleming cases reach their conclusions in the media and the courts, we may have to reassess this strange paradox and address how we ourselves want to die, on our own terms or on the terms of our final illness?

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From Italy, an online newspaper aimed at providing the last breaking news on welfare policies, an article about the advance of euthanasia in The Netherlands.

Pioneer in Europe, with a law issued in 2002, the Netherlands explicitly guarantee to its citizens the right to interrupt treatment if they want to or can no longer stand their disease. The same right has been then recognized in Belgium, Luxembourg and Switzerland. This latter rejected a few days ago a proposal to ban assisted suicide to foreigners in its territory, thus confirming the outcome of a popular referendum held last year. After all, there is no risk that the country can be invaded by ‘mild death’ tourists: in the last few years, the number of sick persons – mainly from France, Germany and the UK –  emigrating to Switzerland to appeal to the assisted suicide law for a decent and aware end of life (even in the most serious cases of depression) was cut by half.

If in 2006 there were 199 cases of euthanasia among extra-EU citizens, in 2010 this number dropped to 97. Perhaps because, over the years, other European countries have authorized treatment interruption in different ways, while in others euthanasia is still a topic in political and social debate. This is the case of France, where President Hollande announced a palliative care reform last summer. Not the case of Italy, though. “Euthanasia” still remains an unrepeatable word here. Meanwhile, Vatican’s spokespersons in Parliament, probably alarmed by the refusal of any form of therapeutic obstinacy opposed by cardinal Carlo Maria Martini, push for the approval of a law on the living will with dubious constitutional outlines.

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Retired film director Michael Winner has considered ending his life at a euthanasia clinic after doctors told him he has just 18 months to live. The moviemaker from New Zealand, who has battled ill health in recent years, revealed this summer that liver specialists have given him between 18 months and two years and he now admits the prognosis led him to look into the controversial Dignitas institution in Switzerland. The 76-year-old opened up about his research  insisting he was put off by the amount of paperwork required to go through with assisted suicide.

He says, “I checked Dignitas on the computer and you need to go through so much. It’s not a walk-in death. You don’t just go in and say ‘Here I am, do your worst.’ You have to go through a whole series of papers and re-examinations just to die. You have to fill in forms and things and you have to fly there, go back twice…

“I think the idea that people should be able to have an assisted suicide is absolutely highly proper. Why should people elongate life when it’s no good for them? People should have the right to terminate their own life. If you’re dead, you’re dead, so who cares? I’m very happy to snuff it. I’ve had enough time on earth. I’d be happy if someone gave me the plug to pull.”

“If you have the right to die, it’s a completely different feeling than if you do something that is not legal,” Anne Mohrdieck said. “It’s different for me and it’s different for the people around me. It is to die with dignity. “Everyone has different abilities to cope with the suffering. If my ability does not allow me to have a quality of life in any way, and I choose a better option would be to go out … then I’d be enraged if that possibility would be taken from me or wouldn’t be given to me.”
Mary Stewart says euthanasia is just a euphemism for hetero-homicide – getting someone to kill you. After 30 years as a nurse, Mrs Stewart says it will confuse the role of health professionals, who swear an oath to heal and provide comfort.New Zealand medical practitioners anecdotally report having been asked by their patients for assistance in dying gracefully, and many of them have complied. However, rather than following a protocol with built-in safeguards and safety standards, the process is unregulated. For patients and family members who decide to take things into their own hands, the outcome could be devastating.
Advanced care-planning initiatives and advance directives in New Zealand already address patients’ objectives and desires for refusing medical treatment in emergent situations. If those conversations expand to include aid-in-dying options for the terminally ill, then patients have a true grasp of the entire spectrum available to them. Further, it allows family members to discuss options and support each other, rather than have secret conversations and fear of legal prosecution if they follow a loved one’s requests. Medical practitioners have clearly defined processes in place, and medical protocols they must follow to comply with legislation. This protects medical practitioners from having to guess at an appropriate dosage or surmise which drugs to use. The process is defined and has paperwork that shows protocols are followed. There is no legal ramification for following their patient’s wishes. Further, medical practitioners may opt out of the process, which protects their rights to their own personal beliefs about death and dying.
And under the headline of Euthanasia Opens Floodgates of Nastiness— Once assisted suicide becomes legal, anyone old and frail and rich will be expected to do the decent thing by whoever stands to profit from their death. Athinly-disguised legal murder will become routine, especially as lack of respect for the old, and the belief that they don’t have any quality of life anyway, is underscored by the ease with which you can ”help” them die.***From Russia, On the death ofbard Ada Yakusheva– I had heard that Yakusheva was battling cancer, but what I hadn’t realized is that her doctors had denied her pain medication, on the basis of some bureaucratic error. When her relatives confronted them about her suffering, they were curtly told, “everyone suffers.” Only on her final day alive was Yakusheva allowed some dignity and peace. A hospice doctor had her transferred to a palliative care facility. She was given a shot of morphine, curled up, and slept for what was probably the first time in a month. The following morning, Yakusheva passed away peacefully.

The other issue here is, of course, the attitude of the actual doctors. Most are simply not trained to make their patients comfortable. Once it is clear that the patient is dying – a lot of them simply stop caring. And even though palliative care is certainly a major aspect of healthcare in modern Russia, many doctors still resist any urge to call a colleague who works in that field, if only because they don’t want anyone taking over their case. Yakusheva’s doctors went as far as to accuse her relatives of trying to use the dying woman’s condition to score drugs for themselves. The fact that this happened to a well-known personality speaks to the enormity of the problem.

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In Scotland, there is concern that the Swiss assisted-suicide clinic Dignitas helped 217 Britons to die in 10 years. It is understood that the Dignitas Clinic in Switzerland has more than 900 Britons on its books and has ended more than 20 lives a year on average since it was set up ten years ago. The new figures from Dignitas and progress of Ms MacDonald’s latest bill has led anti-assisted suicide campaigners to warn against a change in the law.

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South Africans are discussing how voluntary euthanasia is legal for citizens of Holland and Belgium, and doctor-assisted dying is legal in a few states in the US, and in Switzerland. Lord Joffe is confident it will be legal in the UK in the not too distant future. When asked which he thought was easier — voluntary euthanasia or doctor-assisted dying? He felt it was easier to get someone else to kill you, than to kill yourself. On reflection, the reporter  could only agree. Yet no matter whether it’s voluntary euthanasia or doctor-assisted dying you’re after, the driving force behind legalising it is simply dignity in death.

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According to a new study by the University of Zurich, Switzerland, one in four people who accompany someone to commit assisted suicide suffer massive psychological distress. Researchers at the university spoke to 85 people who went with a family member or close friend to an EXIT euthanasia clinic one to two years after the assisted death of loved ones. A quarter suffered from post traumatic stress disorder while 16 percent had depression. Five percent were found to have long-term grief. The results state that problems can surface 14 to 24 months later and that a death not from natural causes was a heavy burden for those who supported the deceased. Although the research didn’t include a direct comparison with the effects of a natural death on a loved one, the study was compared to others. This showed the researchers that post traumatic stress disorder was more common for people close to an assisted suicide case rather than a natural death.

They don’t mention the other 54% who apparently weren’t heavily burdened or traumatized– and I wouldn’t be surprised to find out that the whole ordeal of having to take one’s dying loved one somewhere to die, as opposed to being in one’s own bed in one’s own home surrounded by loved ones, has a lot to do with the agony of it all.

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Dr. Peter Saunders, a former general surgeon and CEO of Christian Medical Fellowship, a UK-based organization with 4,500 UK doctors and 1,000 medical students as members, says the current British Suicide Act is thereby shown to remain fit for purpose. Through its blanket prohibition on all assistance with suicide, it continues to provide a strong deterrent to the exploitation and abuse of vulnerable people whilst giving both prosecutors and judges discretion in hard cases. It strikes the right balance, is clear and fair and does not need changing. The Swiss vote means that the small number of British people travelling to Switzerland to end their lives will probably continue but we should continue to resist any calls from pressure groups to weaken the law here in the UK.

A poll conducted by Christian Concern surveyed more than 150 MPs across all parties and found that only 29 per cent supported proposals to introduce assisted suicide, whilst 59 per cent were opposed to the move and 12 per cent were undecided. The poll also found that the majority of MPs believe that a change in the law would result in an increase in the number of suicides, and 72 per cent felt that it would place vulnerable people under pressure to end their lives prematurely. Almost 60 per cent were of the opinion that the current economic climate would result in more patients opting for an assisted death to avoid placing a financial burden on family members and carers.

Regarding the case of Tony Nicklinson, who chose to starve himself to death after losing his last appeal for euthanasia in September, a reporter from the Christian Institute wrote: The case of a man who campaigned for doctors to be allowed to kill him will not go to the Court of Appeal, High Court Judges have ruled. Lord Justice Toulson said the case was “plainly a matter for Parliament.” Tony Nicklinson, who suffered from a condition known as ‘locked-in syndrome’, wanted doctors to be able to end his life.

Now judges at the High Court have turned down an application by Jane Nicklinson to be made party to the proceedings. Lord Justice Toulson said: “We do not consider that the proposed appeal has any real prospect of success. Mrs Nicklinson has vowed to appeal the decision. However a second locked-in sufferer, whose case was heard alongside that of Mr Nicklinson, has been given leave to appeal.

Meanwhile, Jane Nicklinson says, “It is not easy to admit feeling relieved that the love of your life, your soul mate, has died.” But that is exactly how Jane Nicklinson feels about husband Tony Nicklinson, the assisted suicide campaigner who died of natural causes six weeks ago. Mrs Nicklinson understands that she might come across as callous or uncaring, especially by those who opposed her family’s very public battle to change the law so that locked-in syndrome sufferer Tony could be legally helped to end his life. But for anyone who has cared for a loved one with an intolerable terminal or degenerative condition, Mrs Nicklinson may just be articulating what many find too difficult to admit.

The widow is expected to call this week for Scotland to become the first part of the UK to change the law on assisted suicide. She will appear at a conference in Edinburgh with the MSP Margo MacDonald, who has already tried and failed to make assisted suicide legal north of the border. The conference will also hear from Ludwig Minelli, founder of Dignitas, the assisted dying organisation in Switzerland. Among Ms MacDonald’s new proposals is a suggestion that a “licensed facilitator”, a so-called “friend at the end”, would have to be present when someone was at the point of ending their own life. The facilitator could be a doctor, social worker, or close friend but not a relative or anyone who stood to gain from the death.

Exactly what I’ve been proposing– Transition Guides, death midwives, doulas. It doesn’t have to be a physician since they are so attached to Hippocrates and don’t understand how important healing of the soul is at the end of life. We need a new specialty and a new perspective about the end of life.

Now doctors have a new worry– Doctors are required to provide access to a patient’s records under the Data Protection Act 1998 if a ‘subject access request’ has been made. However, new GMC draft guidance for fitness-to-practise decision-makers, due to be published later this year, advises it is a criminal offence for doctors to encourage or assist a person to commit or attempt suicide. GPs should explain this to patients when faced with demands for medical records for this purpose, the guidance says. The GMC says that GPs are required to provide medical records under the Data Protection Act. However, if a GP suspects this will be used for the purposes of assisted dying, the GP will be contravening the 1961 Suicide Act by providing the medical records.

Which means if you plan to go to Dignitas, don’t tell your doctor when you ask for your medical records.

Dignitas has seen an average of 18 British citizens coming through its door each year since 2002 and many have chosen to be very open about what compelled them to travel abroad to die. Having control over the timing of their death and avoiding a painful, lingering end have been the over-riding wishes of people like Dr Anne Turner, Peter Smedley and Jackie Meacock as they made their final journey to Zurich. For those who travelled with them, there was always the fear of prosecution but, to date, no-one who accompanied any of the 182 Britons has been prosecuted.

The European Court of Human Rights in Strasbourg last year, ruled that while there is a “Human Right” to suicide, the state has no obligation to provide citizens with the means to commit suicide. Grégor Puppinck, the director of the European Centre for Law and Justice explained, “The Court notes that the vast majority of member States place more weight on the protection of an individual’s life than on the right to end one’s life and concludes that the States have a broad margin of appreciation in that respect.”

During a panel discussion with Human Rights solicitors, Richard Stein observed that the argument that there can never be adequate safeguards to protect the vulnerable  is being used as a “smokescreen”, and, equally, the notion that disabled people cannot exercise their free will to die because it reduces the value of disabled lives is a “hugely patronising” one.

All this reflects a big shift towards secular thinking and individual autonomy as well as growing worries about the medicalised, miserable and costly way of death that awaits many people in rich countries. Assisted suicide typically gains overwhelming public support; legislators, pro-family lobbies, churches and doctors’ groups tend to be more squeamish. They fear that legal, easy-to-get assisted suicide will have dire social and moral effects.

More from Dr. Peter Saunders– Now that the Tony Nicklinson case is over and the next assisted suicide bills (from Falconer in the House of Lords and Macdonald in Scotland) are not to be debated until next year one could be forgiven for thinking that the relentless media pressure for the legalisation of euthanasia might relent for a few weeks. But no – first we have the pronouncements of junior health ministers Norman Lamb and Anna Soubry giving their support for the legalisation of assisted suicide and now the BBC, in its role as cheerleader for assisted suicide, is making an international news story about the fact that it is ten years since the first Briton went to the Dignitas suicide facility in Zurich to kill himself.

As fall-outs between pro-life campaigners go, this one has yet to surface, but it could turn for the worse. The tension is over whether or not the Liverpool Care Pathway (LCP) is being used as a form of euthanasia. In June Dr Patrick Pullicino, a neurologist, claimed that the Pathway was an “assisted death pathway”. According to the doctor, patients are being placed on the LCP without clear evidence that they are close to death, while the sensationalised Daily Mail headline ran: “Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year” – where 130,000 is the total number of patients who are put on the LCP out of the 450,000 that are terminally ill. In other words, the majority of people who are close to death are not put on the Pathway.

Since it was rolled out across the country in 2004, it has received three glowing audits, the endorsement of this Government and, just this month, the public support of 20 respected organisations representing millions of patients, carers, doctors and nurses. Yet last week the Association of Palliative Medicine bowed to pressure from a lobby of Roman Catholic doctors, pro-life groups, some media and a small number of distressed and grieving relatives to order a review into the Pathway. Was this a victory for patients’ rights or capitulation to media hysteria and public misunderstanding?

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This will be the last month I’ll be listing all the articles that come to my email box because it just takes way too much of my time. I will, however, continue to read new articles and contribute to the debate about aid-in-dying from my perspective.

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