Controlling the quality of dying

When it comes down to the last weeks and days of an excruciating dying process, it’s all about options.  If I am terminally ill, determined by my physician to be within six months of dying from an incurable and irreversible disease, then I want my physician to be able to prescribe medication that will allow me to end the anguish for me and my family, medication that I – and only I – will decide whether or not to swallow.  I want the right and the means to take the pill that will allow me to die with dignity.  That’s why I will vote yes on Question 2.

Thoughtful opponents on the other side, including many in medicine, argue that I shouldn’t have that choice and, more, that I shouldn’t need it due to advances in palliative care and hospice. But sometimes those are not enough.  My beloved father-in-law, ironically a physician and cancer researcher, suffered the tortures of hell from lung cancer that had mestasticized to his bones and liver, and hospital caregivers refused to give him enough morphine to stop the suffering of his last days.  He had a right not to go through that. He devoted his life to medicine and caring for others, and medicine and his caregivers let him down at the end.

This referendum would require the patient to make an oral request and then, at least 15 days later, put his or her request in writing. Two witnesses would have to attest that the patient is, to the best of their knowledge, capable of making the decision and not under duress.  The attending physician’s assessments would have to be confirmed by a consulting physician, and any physician who did not want to assist in this dying process would not be required to do so.

Physicians say their role is to be healers.  But in the situations envisioned by this proposed law, healing is not an option, and a physician’s role is to relieve suffering as the patients wishes.

As Dr. Marcia Angell, Harvard physician and former editor of the New England Journal of Medicine, has said, this isn’t physician assisted suicide.  “It is assisted dying,” she said on Channel Five “On the Record” program yesterday. Suicide is the act of someone choosing death over life.  In the terminal phase of an end-stage disease, life is not a possible outcome.  By self-administering the medication under the circumstances envisioned by Question 2, the patient is choosing the manner of dying.

A study of the 15 years in which Oregon has had such a law on the books, also according to Angell, 80 percent who chose to self-administer had widely metastasized cancer, 10 percent had end-stage emphysema and 10 percent had end-stage ALS (Lou Gehrig’s disease).

For me, if I am at the end and suffering unendurably, with that suffering only going to get worse, I want that pill on my night table.  I may, in the end, choose not to use it, but I want the option to die a more humane and dignified death.

I welcome your comments in the section below.

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