We all value our freedom to live by our own measure. Do you think we should have the freedom to die that way as well?
I keep promising myself and my family that I'm done writing about death and dying. But then something happens -- like the How To Die In Oregon movie or Jack Kevorkian's death -- and there I am again, wanting to challenge your thinking on what it means to die in the 21st century. Sometimes it seems there's a genuine movement going on here. Every time I turn around, someone is pushing our comfort zone on end-of-life decisions.
In my blog posts and my novel, I've tried to present all sides of the death with dignity argument. I've encouraged choice but have not taken a stand on what that choice ought to be. I've talked about end-of-life planning, letting parents live their own lives and make their own decisions, and even bioethics. But there's something about what one proponent called "The Holy Grail" of the dying argument -- assisted dying -- that still makes a lot of people squirm. With Dr. Kevorkian's death, I think it's time for us to take that bogeyman out of the closet, too.
Call it "medicide" like Kevorkian did, or the value-neutral "aid in death" like the folks at Compassion & Choices do. You can even pull out the old Greek term, "euthanasia," meaning good death, like author Robert Orfali, who watched his wife and soulmate die of an incurable disease. But it all comes down to the same question:
When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient's life by some painless means if the patient and his or her family request it?
A 2007 Gallup poll showed that 71 percent of Americans think they should.
But depending on the circumstances there are still a lot of people, including the jury that put Dr. Kevorkian in jail for nearly a decade, that believe that assisted dying is murder. Kevorkian had found a way around all that by building a "suicide machine" that would enable terminally ill patients to give themselves a lethal dose of medication. No one arrested him for that. He ended up in prison because he personally administered the medication to Thomas Youk, an ALS patient, who could not use his hands to take the medication himself.
I've spoken with palliative care experts and learned that palliative sedation is already legal in every state. That means, after exhausting other alternatives, physicians can provide sufficient pain medication to make the terminally ill patient unconscious and unaware of extreme pain while the disease progresses to death. The patient usually succumbs to dehydration, which takes about a week.
It's also legal for a terminally-ill patient to consciously refuse hydration or other life-sustaining interventions. Many states allow or regulate the rights of family members to request cessation of life-sustaining treatment for a terminally ill family member who cannot speak for themselves.
Does this all seem hypocritical to you? If a physician can write an order to sedate a patient until they die, why shouldn't they be able to give an injection to do it immediately? In the same vein (no pun intended), if a terminally-ill patient does not want to continue life-sustaining treatment and elects to die of dehydration, why can't they elect to end their life in one shot?
Now, I admit there are a lot of fine points to the argument, such as:
- When is a person considered to be dying?
- Is it our job to keep them alive or to help them die?
- Who should make the decision as to when a life ends? Why?
- Is quality of life an issue?
The U.S. Supreme Court made assisted dying a state issue in 1997. It's now legal in Oregon, Washington and Montana. Author Robert Orfali wants it to be legal in Hawaii, too. I asked Orfali, whose books include "Death With Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia" and "Grieving a Soulmate," what he hoped Dr. Kevorkian's death would mean to people. He said:
"Kevorkian's contribution was to bring the practice of underground euthanasia out in the open. In the U.S., up to 24 percent of primary care physicians and 57 percent of oncologists report having been asked to hasten a patient's death, and about one-quarter say they complied. The underground practice is crude, unruly, and totally unregulated. The alternative is to legalize the practice with proper safeguards and make it another palliative-care option. Jack taught us that prohibition does not work."
I found the reaction by L. Brooks Patterson, a former prosecutor and executive in Oakland County, CA, where Kevorkian was convicted, ironically similar:
"I don't think he was the right ambassador to represent the issue. It was the law be damned with him. The issue would have been better debated in a more serious arena than in the back of Jack's van. It was a sideshow. Helping people commit suicide in the back of a van is not dying with dignity."
For my part, I hope that Jack Kevorkian's death will cause you to think, then take a personal stand on your end-of-life choice. That is the ultimate key to ensuring that you die with dignity, a dignity that's measured by your own belief system.
Janice M. Van Dyck is author of Finding Frances, a novel about a family dealing with end-of-life choices.