The poet Dylan Thomas said it best for those of us of advanced age: "Do not go gentle into that good night; rage, rage against the dying of the light." But what if there is no good alternative to quietly turning out your light?
In Connecticut (the home state of insurance giants), a legal and moral battle rages that may have national implications. Two physicians have sued the state for an action that could eventually allow patients to choose a peaceful, drug-induced death to avoid the pain and terrors of a terminal illness.
As CNN's Randy Kaye reported, "While courts have addressed constitutional questions connected with aid in dying, no court has directly considered whether a mentally competent, terminally ill patient's desire to bring about a peaceful death should be considered a 'suicide.'" That's vital; for a suicide is generally against the law and the family of the person who dies may suffer spiritually and legally, including the loss of insurance and other claims.
Thus, Connecticut physicians Dr. Gary Blick and Ron Levine are suing the state and asking that the state's laws restricting assisted suicides should not include cases in which mentally competent, terminally ill patients take their own lives to avoid pain and suffering. The suit, which a Superior court judge has dismissed on technical grounds, was prompted in part by several cases in which people have been punished for helping friends or relatives die. Right-to-die advocacy groups are expected to appeal.
In the most publicized case, in 2004 John Welles, who was dying of cancer and suffering, pleaded with a friend, Hunt Williams, to give him a pistol. Williams did as his friend asked. As Welles walked away in the woods, Williams shouted "God bless" and heard the gunshot. Welles died and Williams was convicted of "assisting a suicide." That's a felony in the state.
Blick's suit was aimed, in part, to clear and free Williams and also to win permission to end a dying patient's suffering. Said Blick, "We're not talking about hooking up a potassium chloride drip and have our patient's heart stopped. We're talking about terminally ill patients who I've counseled over the years and that I would like to give them prescriptions and help them die with dignity."
Blick, the Medical and Research Director of CIRCLE Medical, is a specialist in infectious diseases and HIV-AIDS, which raised for me a question. Not a few years ago, AIDS was considered always fatal. Now it's not. How many AIDS victims took their lives rather than wait for the life-saving treatments now available?
Nevertheless, if Blick and Levine are successful in their campaign, Connecticut could join a growing number of states that recognize the right of a terminally ill patient to end his/her life with the help of a physician. The recent HBO film, "You Don't Know Jack," was a sympathetic portrait of Jack Kevorkian who was jailed for helping a number of people die, most them not his patients. But he brought life to an issue that is growing. Recent polls indicate that 60 percent of whites (38 percent of blacks) favor allowing physicians to assist the terminally ill to die.
By all accounts, Oregon's pioneering "Death With Dignity" law has been doing what was intended. The 1998 law (which has been copied in Washington state) has survived legal challenges -- including protests by members of Congress -- because of its safeguards. A physician must determine that the patient has less than six months to live and a second opinion is required. The patient must make repeated requests, waiting at least 15 days between requests. If these procedures are followed, an Oregon physician can prescribe the life-ending drugs, which may be taken with or without a doctor present. About 30 persons a year have gone through this process and died, usually with close family members present. Most of the patients were suffering from advanced cancer or ALS (Lou Gehrig's Disease).
Leading medical institutions, Harvard Medical School, and organizations such as the American Medical Women's Association, the American Medical Student Association and the American Public Health Association support legislation permitting physicians to assist terminally ill patients to take their lives with drugs. The American Medical Association stands opposed. The American Academy of Hospice and Palliative Medicine is neutral, possibly because proper hospice care (in which I am now a participant) can avoid the need to take one's life and even put off death. But in the end, hospice provides for pain-free and comfortable last days, with the help of a hospice nurse to tend to the patient and a hospice social worker to work with the family.
Much of the opposition to assisted death also comes from the severely disabled and persons with serious chronic diseases. They fear, with some justice, that they and people like them will be vulnerable if, for example their insurance companies balk at the cost of their care. The insurance industry is based on making a profit, not saving the lives of the costly and frail elderly or the very ill. Former Colorado governor Richard Lamm, who previously said that the elderly should "get out of the way" because they were costing Medicare too much money and have a "duty to die" is again calling for forms of rationing in health care. Talk about "death panels," several respected health professions agree with Lamm that health care needs ought to be rationed. It already is, as I saw recently.
The emergency room at the county hospital in Ventura, CA, as in many other public hospitals, more than 100 poor people, mostly Hispanics waited for hours for the single triage nurse on duty. Across the road the private hospital's emergency room was empty? Rationing, triage for the insured are facts. What does that mean for the frail elderly, if Medicaid or Medicare funds were cut?
Other opposition to the legalization of the right to die comes from religious institutions and right-to-life organizations who also oppose elective abortions. I disagree, but I believe that just as the state should stay out of a woman's right to choose, so the state should not need to come between a dying patient and his/her right to choose the manner and time of his/her death.
Oregon's statute, I admit, is a model of regulation for the safety of the patient's rights and to guard against abuse, say by relatives who can no longer care for the patient. But the choice of hospice seems to be minimized. That's why I'm uncomfortable with such organizations like "Compassion and Choices," which seems to advocate an end-to-life, as if it were a walk in the park. They may encourage people to seek the alleged comfort of death for no good reason. A woman I know whose medical problems are serious but not life threatening seems to have given up on life because she's despondent over the death of her husband.
End-of-life advocates seem to provide little encouragement to fight a disease, as I am grappling with my cancer, and the reasons for their despondency or depression, the better to hang onto life and "rage against the dying of the light." Try hospice to deal with pain and depression.
As another, more gentle poet, Robert Frost has written, "The woods are lovely, dark and deep. But I have promises to keep and miles to go before I sleep. Miles to go before I sleep."
Write saulfriedman@comcast.net Friedman also writes for www.timegoesby.net
Follow Saul Friedman on Twitter: www.twitter.com/saulfriedman
Hillary St. Pierre: Why I Considered Assisted Suicide
Rev. Amy Ziettlow: Finding God in the ICU
Nancy Cronk: My Father's Final Journey in Hospice
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The problem is not the right-to-d
Sad but true.
Judging by the overwhelmi
America's unhealthy obsession with living as looooooong as possible, no matter what, and doing every conceivabl
Compassion & Choices has a dual mission: We work both to improve care at the end of life and to expand choices. Those two goals complement each other. It would be difficult to improve care, to be as good as care can be, without also expanding choices. And it would not be appropriat
We ignore neither prong of our mission. We improve care and we expand choice.
According to Oregon’s Department of Health and Human Services, 91.5% of persons who used the Oregon Death with Dignity Act (ODDA) in 2009 were enrolled in hospice.
http://www
Oregon’s hospital death rate is among the lowest; its home death rate among the highest. In 2002, nearly 80% of dying Oregonians had an advance directive, and the likelihood that an advance directive would be respected was high. Oregon’s end-of-lif
http://www
We believe that hospice is an integral part of the compassion
Learn more about us at compassion
Carla Axtman
Online Community Builder
Compassion & Choices
People who are against allowing patients to choose are, quite frankly, going to make people suffer when they should not. When you get to these situations
It was sad to have him die but he was happy for his last days in a comfortabl
Living on the planet for nearly all of us is an exercise in subtractio
Though I realize this comment is somewhat tangential to the subject at hand, maybe it's time to begin thinking as individual
I can't help but wonder how their "moral" arguments would be effected by removing their monetary incentives
This is useless! Every time I read an article with this type of ubiquitous obfuscatio
The malignant attitude this statement foments toward health care reform had the requiremen
Let me be clear about context. Former Governor Lamm made is heartless statement about the elderly back in 1984. He also has a history of working hard towards the progressiv
If you find this kind of writing expresses your opinion, I ask you to read more.
for the frail elderly, who doesn't eat enough to live, won't drink hardly anything, the family and the personal physician decides whether to do extraordin
Carla Axtman
Online Community Builder
Compassion & Choices
compassion
With physician-
And yet, those who call themselves pro-choice and scream "My body, my choice!" the loudest continue to systematic
They are hypocrites
I find that hard to believe.
If the principle is that women should be able to make their own medical decisions and have control over their bodies without government interferen
Instead, we get silence. Or we get some lukewarm support for physician-
By claiming to be pro-choice
I am an abortion rights supporter. I am not "pro-choic