Blog Update!
For those of you not following me on Facebook, as of the Summer of 2019 I've moved to Central WA, to a tiny mountain town of less than 1,000 people.

I will be covering my exploits here in the Cascades, as I try to further reduce my impact on the environment. With the same attitude, just at a higher altitude!

Friday, March 6, 2009

Assisted suicide and new laws

After winning over the populace last fall, the Death with Dignity Act became law yesterday in Washington state. The law now allows doctors to prescribe lethal medication to patients who qualify. It was modeled on Oregon's decade old law and I was surprised to learn that these are the only two states where this is legal. For some reason, I was under the assumption there were at least a handful, particularly given how much more acceptable the issue has become to the public (latest Gallup poll numbers from 2007).

Local hospitals are choosing sides already, to some extent. One-third of the state's hospitals have created a set of policies for employing the law while others are refusing to participate. Apparently, the law included an opt-out provision for hospitals, mostly for those hospitals with a religious affiliation, although several Seattle area hospitals are using the provision even though they have no such affiliation.

Not to sound too patrician, but I wasn't too surprised that many of the rural hospitals opted out, but I still can't believe that major medical centers such as Swedish Hospital and Virginia Mason are opting-out as well. At least now I know where to direct the ambulance in case I'm in an accident.

Anyway, before my Mom retired, she was a hospice nurse. Her job was to comfort the families and (medically) comfort/treat terminally ill patients. I frankly don't know how she did it, I don't think I'd have the strength to do what she did, but many of the patient's families loved her as they got to know her at the long-term care facility where she worked (which has since been closed by the hospital for financial reasons).

The oncologists, doctors, nurses and health care workers were huge proponents of providing a comfortable end of life for these patients, many of whom suffered immensely. It doesn't take much to make a patient "comfortable" enough that their desires for death are heeded. What I'm saying here is that medically assisted suicide goes on all the time, whether you want to know about it or not. I'm just glad that it's legal now in WA and that the patient has the right to choose and plan how they go.

Living with a potentially terminally ill spouse also brings this topic a little too close to the forefront for me. When he was first diagnosed, assisted suicide was illegal and I couldn't imagine having to force him to suffer any more than he wanted to for the sake of some antiquated ideals of life and death. I think the thought crosses the mind of anyone suffering greatly at the hands of a terrible disease that, if life were to continue in the same way, they would choose death over it.

For those with a moral aversion to medically assisted death, there is no question or quandary, but for those who do not hold the same beliefs, they end up feeling more at a loss, panicked and hopeless about their condition and their end of life and all it's accompanying worries. I know when it comes time for my Mom (or pretty much any of my loved ones) to pass on, they'll want to take advantage of this law to prevent an extended suffering, not just for themselves, but for their family and friends as well.

As usual, I'm always curious to hear other's opinions on these things. What are your feelings on assisted suicide? Have you experienced a loved one wishing for more help and not getting it because of the law? Is the right to control your own demise a human right, one of which is defined by their own free will? Or should governments and the law be able to take this right away from an individual?

[And, since I know Greenpa will bring this up, there is an environmental impact to keeping people alive either heavily medicated or on life support against their and their family's wishes. So, I don't know how this stacks up to your piles of foreskins analogy, but there you go.]


Robj98168 said...

I personally think it is reprehesnsible that hospitals like swedish and VM don't want to accommadate people who LEGALLY chose to end their lives when all hope is gone. I voted for this law and I expect that it should be followed through. Goddamn hospital administrators.

Matriarchy said...

People in my family have been impacted by ALS, Huntington's Disease, and Alzheimer's - so I am wishing we all lived someplace that a legal discussion of one's wishes were possible. It gives people permission to at least talk about their options. Knowing that "if it gets too bad" you have another option, probably makes it easier to live without so much dread, even if the option is never exercised.

Anonymous said...

i was just reading on the bbc about a married couple, both with terminal cancers, in their 70s/80s, one of whom had been suffering since 1992. they ended their lives together at a euthansia clinic in switzerland.
chronic pain and debility and disability is very hard to live with, and people certainly should have the choice not to.
i do believe humane doctors and nurses -- including, i believe, those who supervised the death of king george V (QE II's grandfather)-- ease their patients into the next world.

Anonymous said...

When my mother was dying - lung cancer - it was so very bad at the end. She didn't ask to be assisted (she was too far out of it for that), but she was suffering so badly and the loss of dignity was so horrible to see that I wished my father, when he was medicating her, would overmedicate so she could slip away quietly. I did not suggest it, because it would have offended him tremendously, but had I been the one in charge of her medication, I would have considered doing it.

I do not believe the government should have any say in such intimate matters. And it really is very intimate, as private as sex, which is something else the government needs to stay away from. While I was respectful of my father's aversion to assisted suicide, he is an individual, and individual choices, in my opinion, trump all else.

healinggreen said...

We were just discussing this issue yesterday at my store, b/c a friend was having her dog put down to end its sufffering. I think its amazing that what we are so comfortable doing for animals and consider "humane" is illegal for a human being to choose for itself in this country. I know that the "morphine drip" helps a lot of people go at the end if they are already weakened, but its good to know that options are increasing for those who are sick and suffreing but not in that end state yet. There should be medical options, not just nooses and bad combinations of pills.

Anonymous said...

Having lost a spouse to cancer, when he was 49 from lung cancer, I'm convinced that assisted suicide is merciful. Until one has lived with someone they love suffering and is totally powerless to relieve their anguish, perhaps it is easy to assume death itself is as "neat" and "easy" as they show on TV & the movies. It's not. I’ve never understood why if animals are suffering we humanely assist them but refuse to grant that to people.

Lee in KY

Anonymous said...

I am strongly in favor of assisted suicide being legal. One thing that always seems to come up in people's arguments against it that utterly baffles me is that people argue that it's someone "taking the easy way out". Well, yes. I thought that was the point. They are taking the easy way out and thus avoiding months or years of needless pain and suffering and expense for themselves and their loved ones. There's this expectation that disabled or chronically ill people have a responsibility to be heroic for all us healthy people who don't want to think about them, and that suffering is virtuous.

It becomes more fraught in the case of deciding to whether take someone off life support who is no longer capable of expressing a choice one way or the other, but this is what living wills are for.

Anonymous said...

I voted for the law and am glad it passed here. But here's something I hadn't thought of - I work at a benefits company (though not in the benefits department) and this week I heard a snippet of a discussion about this... assisted suicide is going to be treated like regular suicide, as far as medical and life insurance benefits are paid out. So they won't pay for the medications or any other "assistance" and life insurance isn't paid at all. Not the money should be a reason to make you not choose this end if it's what you choose to do, I just hadn't thought of it. I wish they would alter the plan language to allow for it, but I don't see that happening.

Sam said...

Everyone I've mentioned this too has been very bothered by my cavalier attitude toward it. I am 100% in favor of assisted suicide. I've planned on my own death and gone over all the details (morphine drip + slow starvation), my husband plans on doing it with me assuming we're both alive. I'm not sure if it was Helen Nearing, but I think her husband/life partner did it this way which originally gave me the idea. Because we have no kids and other heirs, it seems easier.

One thing I'm hoping for is that morphine is a bit more legal than now when I'm ready. I don't want to go hunting around for a dealer in the ghetto when I'm hobbling around on a walking stick.

Anonymous said...

The thing no one talks about is the impact health INSURANCE companies can have with this law. What happens when a patient wants to keep living, to keep fighting, but it's cheaper to have a medically assisted death then to continue taking perscription drugs and getting treatments. I don't like the potential that the insurance companies now have to basically give someone a death sentence by refusing to continue care even if someone wants it.

I'm totally against this law and Ihave read a lot about it. As well, I watched my own father live through lung cancer for 8 years against all odds.
But if his HMO had ever had the choice to deny him care or treatment, he couldn't have afforded to continue it on his own.
By the end of his life, he was in a lot of pain. He tracked his medication carefully, and the number of perkiset he took each day was allarmingly high (he was allergic to morphine). But thankfully he continued to fight and live as long as he could... there were things he wanted to see happen before he went (like me getting married, among other things).
If his insurance company had the power to deny him care, I'm sure they would have... cancer and the resulting complications are expensive.
Though I can see the otherside of it, I'm glad this is not the law in our state. At the very least until the insurance companies are finally taken down (lol, like THAT will ever hapen).

One last thing - sorry this is so long - what about life insurance? If you choose legal, medically assisted suicide, does this invalidate your life insurance policy? Would it leave your family in the lurch, with a funeral and medical bills to pay off after you've left?? Is that ethical?

Anonymous said...

LOL... looks like anonymous and I were thinking he same thing at the same time.

Sundays Child said...

What would you choose?

To live your final days in pain, gasping for breath, medicated to near unconsciousness with morphine, or breathing only with the help of a machine, being at the mercy of over-worked nurses who feed you, wipe your chin, change your diaper, decide what you are going to wear and when you are going to wake and sleep, while you can't remember who these people are visiting you and calling you Mom, let alone what day of the week or year it is?

Or ... while comfortably relaxing in a (pick one) hammock / recliner / bed, looking out onto the view of the (pick one) ocean / mountains / forest, surrounded by family and friends (or not), with soft music playing (or Metallica), after enjoying a lovely meal of (pick one) steak / lobster / apple pie and ice cream .. you take a handful of pills, or get an injection and quietly, peacefully, painlessly .. pass away.

I know which one I would prefer!!

scifichick said...

I think that just like anything else, this is a personal choice and as such should be legal. I don't think the government should decide whether you can do it or not, I think the person involved should. And I agree with someone else here who said that just knowing that there is an option to end the suffering, might make it just a little easier. I am just against people being kept artificially alive in general, on life support, bed-ridden, and on huge amounts of medication for years. Perhaps this law would give the people and their families a legal way out.

Anonymous said...

Well, I'm the odd man out here. I am personally opposed to assisted suicide for religious reasons. I am also against keeping people doped up and artificially alive, but that is another issue. However, while I'm against it, I don't care what other people choose to do and would never want to impede their personal decisions.

Robyn M. said...

There was a sermon at my church, maybe last year, on assisted suicide presented by a man who runs a hospice in our town. Near the end, in such an emotionally charged statement that made myself and many others begin crying, he said (roughly), "I have patients who watch videos of inmates being put to death in our nearby federal prison. There are so many of them who would pay anything to have the small mercy which we accord to the most depraved killers. Anything at all."

As several other people have pointed out, there will be real regulatory issues with assisted suicide, but this is not a stopper, it is an issue to be dealt with. Policies do need to be crafted to ensure that this right is not abused by insurance companies, nor unscrupulous hospitals, physicians, or others. But that can be done (and has been in other countries with great success).

Anonymous said...

Unfortunately, the day when health insurance companies are regulated, in any way shape or form, is so far off that all of us will have already made the assisted suicide decision for ourselves (or had it made for us by said companies) and even our children may not even get to see it.

Like others on here, I am against being kept artificailly alive by machines, and what have you. But that's what a living will is for. Not assisted suicide. And, in that case, a life insurance company should still pay benefits. Life support vs. legally assisted suicide are really two different issues.

Oldnovice said...

I don't have any experience with this, but I did have a coworker (about my age) who dealt with her mother dying from something that offered a great deal of pain. She told me that family needed to phrase things correctly to medical staff, as in ... "Ease her pain" and that once the appropriate phrase was delivered, a morphine drip was administered with increments until the patient quietly passed away (from an overdose).

She told me this maybe 35 years ago, so that was even prior to Kevorkian, I think.

OTOH, I felt a bit odd being asked for a "do not resuscitate" form when my mom was in a nursing home. She was in her early 90s and even her doctor would say to me, "You DO know that the average lifespan is 78, don't you?" As a babyboomer, I think this will be way more common for my generation simply because there are so many of us and we're "hogging" the resources to the exclusion of younger people.

Anonymous said...

Like you said, making someone so "comfortable" that they pass on happens all the time. Hopefully laws like this one will take away some of the ambiguity and conflict, and make things more clear cut for those who choose this route.

Humble wife said...

You make the rural folk sound so ignorant. This falls in the same category as abortion for me.

By the way I too have a spouse that is dealing with incredible chronic pain...

Just a quick question, if your husband gets to the point where this may be a serious thought for him, and then you both agree...what impact do you think it will have on the children?

My dad was killed before I was born and I for one missed him all the time.

I hope not to have crossed the line asking you, but this would never be an option for us...and am surprised to see it for those with small children.

Kim said...

I think it's a great step forward. My big concern with the law (other than the fact that so many major medical centers are choosing to not only opt-out, but specifically prohibiting even affiliated physicians from participation) is the fact that the law requires the drug to be administered by the patient. What is this going to mean for all those patients who are too sick to self-administer? It means either a loved-one or a medical provider will be forced to break the law to help them end their lives...or the person will still be denied the right to choose to end their own life in spite of otherwise qualifying.

equa yona(Big Bear) said...

Humble Wife, country folk aren't necessarily more ignorant than city folk. But you are more ignorant than most. I believe you definitely crossed the boundary, especially for someone who claims the Bible as your favorite book. Chronic pain is not the same as mortal illness.

Alison Kerr said...

I absolutely recommend that each and every one of us, whatever our beliefs, get educated on end of life issues. A number of years ago I watched the PBS series On Our Own Terms. That series gives details on assisted suicide in Oregon. More than that, it is a good education on something I think we all need to know more about. Death is hidden away and is practically taboo in our society. Don't they say that we have the most fear of the unknown? Getting educated will help when someone you know reaches the end of life, whether that be soon or later.

Humble wife said...

Big Bear- I simplify my husbands disability. He is 6'4 and was permanently disabled neck and back in an auto accident on 1 jan o5. So mortal pain and neck and back...hmm I think I am well qualified to speak.

And as to my favorite book, the Bible speaks loud and clear. For Crunchy having to discuss this is devastating to me, as no one will win. If the disease takes its toll then the children will deal with the course of events in life. But if her husband ends his life the children will only see that choice.

Talk to children whose parents committed suicide. Then perhaps you will get the whole picture. Remember as parents we have more than just our pain to endure. It sucks and is pretty dang crappy but we do have the children to consider.

Forgive me for not being as direct about my husband and my life story on this blog. Neck and back injuries when paralysis and limited mobility are a factor make me one who can speak.

I once again am devastated that this is being discussed like one would discuss shaving armpits or not.

I pray that this will never be on Crunchy's plate. I pray that modern medicine saves the day and that being angry that I suggested this is the only memory one will have. I pray that her husband lives until he is a gray old man and sees several great grandkids.

I am sorry to not tow the line as others that read this blog. I have been and will continue to read Crunchy's blog for the views that she shares, as it helps me either to reinforce my difference with her or sometimes convinces me I am wrong.

I speak today with a heavy heart. I am not trying to make one feel guilty, just to consider the children. My dad was in the Army. The older children resent him and have issues with the fact that he chose to stay in the Army during Vietnam. This is important because my dad has been dead 42 years and the children now some grandparents themselves are NOT over the fact that dad stayed in the army. I cannot imagine how we would be if he chose something else.


Ashley said...

*sigh* my grandma would want to be in Washington if I told her about this.

I provide care for her (actually, my grandpa and I provide care). It's been hard to see her decline rapidly but got harder when the doctors prescribed a huge regimen of meds that halted the decline. She's still getting worse and though she has a few good days, most of her days are in delirium or wishing she was dead.

It's hard not being able to help her.

When the choice is suffer immesurable pain daily or die... in her case I'd be wishing the same.

Guess that means I'd better move to Washington.

Ashley said...

...Let me put it this way...

my grandmother has no control over any body part or function below her diaphragm (even that has caused issues these past few months). She is unable to feel anything below her ribcage either. She has seziures almost every day, lasting from 5 minutes to hours after which her mental state is severely affected. She is scared, she is in constant, tremendous pain, and if she was in a nursing facility (which I have worked at) they would have recommended end-of-life care already.

Her kids are grown. Her youngest grandkid is a teen. She knows that the situation we are in makes things difficult for everyone, and it makes her feel worse that she does already.

If things do get worse than they are, the doc can't give her any pain medication stronger than what she has, so yes, I would say I can speak with authority as well.

My grandmother does not want to continue "living" like this. A living will would only give us the ability to make decisions regarding her care if and when she becomes unable to do so herself.

All we can do is sign it (just in case) and fill out a DNR (do not recessutate).

This topic isn't a win for anyone or any side. But if we're going to fight for a right to choose or a right to life, we should also be afforded the right to end that life when it becomes physically unbearable.

Crunchy Chicken said...

I'd be curious to see how the life insurance companies handle death benefits for assisted suicide as well. As for health insurance companies, they already make life and death decisions by denying patients expensive therapies or not qualifying them for medications and procedures, etc. (see the movie, Sicko, for more on that one).

Humble wife - It's certainly easy to say I would prefer to have back pain and paralysis over a terminal illness, but that's without having to live/deal with the day to day pain.

What I can say, however, is trying to deal with pain knowing that there is no cure for an extremely aggressive cancer that has survival rates along the lines of 3 years with aggressive treatment and that the end-of-life scenario is horrifically painful (albeit, blessedly short) is really a whole different ball game than dealing with pain that is not terminal. The question becomes, what's the point of suffering if you have a for-sure death sentence?

From that perspective I would much rather my husband be a complete quadriplegic than have the type of cancer that he has, because at least I know his long-term survival is high (and by long-term I mean more than a few years out). His quality of life would certainly not be great as a quad, but at least he'd have life and the chance to participate and see his kids grow up. That's something he doesn't get to choose for himself now. But, who know unless they are in the situation? Maybe he'd feel more like a burden and not want to live, but not have the choice? It's easy to wish you have one thing over another because whatever you have always seems worse than what everyone else has. In other words, life is truly nasty, brutish and short.

As for the effects on the kids, I sure as hell know the effect on them. How can I not contemplate it daily? I am reminded of it when I look in their faces and drop them off at school and listen to the other parents talk about their mundane existence, the kind that I wish I had, where my biggest decision is what kind of furniture to buy. Not, how will I survive this and how will the kids handle being fatherless? The kids already deal with the treatments that we have subjected my husband to so that he can survive, at least for a while longer, to see his kids grow up and be in their lives as much as possible. That alone, I'm sure, is traumatic enough for them. I wouldn't wish this sort of hell and treatment on anyone.

Finally, the death with dignity act requires specific circumstances before allowing distribution of terminal sedation, the biggest stipulation being imminent death (within six months) from an incurable disease. You make it sound like I'm going to off my husband prematurely just because we can.

So, if you get the impression that I discuss end-of-life issues as cavalierly as I do shaving my armpits, well, then I'm certainly not showing you my cards as I tend to hold them close to my chest since the alternative is far too emotional for me.

To say I'd much rather be in your shoes is an understatement.

knutty knitter said...

My grandmother made her own decision. After a massive stroke she lost almost every function except breathing and eating. She spat the food out and that was that. She was given water to keep her comfortable and allowed to die. This took about a week. She could have been kept alive with tube feeding etc but she would have hated every second and neither of her children could have lived with that so they gave permission to let her go.

My father died of cancer and could well have done without that last hideous week. He should have had the choice I think, to say enough.

viv in nz

flutter said...

I whole-heartedly support assisted suicide as an option for individuals who seek it. It is a mitzvah to allow our loved ones to live and end their lives as they wish.

Anonymous said...

insurance companies & Medicaid pay schedules already doom people who are dying anyway to die in pain.

My grandmother went into hospice, where the excellent palliative care stabilized her condition - so she was moved to a nursing home where no one on staff could give her opiates.

She had been *so happy* in hospice, and she was so frightened and miserable in the nursing home. And of course she died there - "stabilized" for an old lady with a bad heart just means "not gonna die today", not "going to recover."

There are issues for yonuger people who don't have terminal illnesses wanting to choose suicide from depression - especially for people who become disabled, there's an adjustment period after which people aren't suicidal anymore. I don't know of any way to write a law to protect those people.

Mary said...

My father died of complications related to MM 3 years ago at the age of 58 and I am "glad" that we had the choice to end his dialysis which meant we chose to end his suffering by stopping a procedure that was essentially keeping him alive. He was no longer responsive to us and we were just waiting out the days until his death. stopping dialysis allowed that to come sooner.
Many people suffering with terminal illnesses do not get to point like he did where there is a a life sustaining medical procedure that can be ended to stop their suffering. This new law gives them a way to end their lives in a more dignified way and end the suffering of them and their families.
We would do anything to have my father in our lives and to have my child know her grandfather but once you know that is no longer an option and end of life is close it is good to have an option to end the suffering of everyone involved. This is a personal choice and everyone should have the right to make that choice. And speaking from experience believe me this is not taking the easy way out as at the end of a terminal illness there is no easy way out.

Anonymous said...

As a veterinarian I am so glad we can perform euthanasia....and I cannot say how many of my clients tell me they wish they would be afforded that choice.

Donna said...

I don't have a lot of experience with this, but it seems to me that there is a world of difference between ending your life by discontinuing life support, increasing pain medicine or refusing to take medicine that is keeping you alive (all the kinds of decisions that are made everywhere, every day) vs. suicide by Rx. I am totally comfortable with the former, and extremely uneasy about the latter.

Anonymous said...

aw, sweetie, i didn't realize how rough things were at your house. sending good green vibes over there. pay no attention to the freaks saying ridiculous things behind the curtain.