Here we go down the slippery slope. Are we going to get to the place where we euthanize an infant with spina bifida like in the Netherlands?. This scares me.
3
I’m a physician in Canada; for the past 3 years (since it became legal) i have been providing medical assistance in dying (MAiD). In Canada 99+% of such deaths are the result of IV medications administered by a physician or NP; all costs are covered by provincial health plans. About 1% of all deaths in Canada are now the result of MAiD, perhaps because it is more accessible then in the US. No physician is forced to provide MAiD if it is against their religious beliefs but they do have to refer patients to someone that can help them.
Contrary to some comments, the main cause of patient suffering is not pain but the loss of control and the loss of the ability to do things that make life meaningful. Also, I have yet to encounter a family that was pushing their loved one to have MAiD; to the contrary, families tend to go along reluctantly with their loved ones’ desire for MAiD; it is the patients themselves who desperately want MAiD and are delighted and relieved when found eligible.
The Canadian law is not perfect but it has enabled thousands of Canadians, who might otherwise have died lingering and even agonizing deaths, peaceful and dignified deaths instead and an end to suffering they find intolerable.
296
@Rachelle Sender
retired AMA attorney F/70
Thank you, Dr. Sender, for this excellent report on how you individually and your MAiD physicians+NPs from sea-to-sea are ending the suffering of Canadians. I'm guessing that medical and allied health care professionals are as relieved as those you serve to see this finally arrive in a workable pathway for all?
Regretably, the Supreme Court decision that brought this change for Canadians extends only to citizens. This service is not something that U.S. residents can cross the border to buy, like cheaper prescription drugs.
The U.S. will not any time soon, even among those states that have some lawful assisted-dying, get to the level of cohesion and acceptance you report. Especially your inclusion of negative Quality of Life and Activities of Daily Living/QOL + ADL considerations. The fear of "lingering" is gone for your colleagues and your patients, providing peace for families in so many ways.
76
We accelerate and delay death every single day in virtually every hospital in this pathetic country. What difference does it make if we accelerate a death by hours, minutes or days. We can keep a shell of a human alive for a long time for no other reason than emotional ignorance and technological advances. Go visit a nursing home or a long term acute care facility. Bed sores the size of Texas, feeding tubes, tracheostomy’s, colostomies, indwelling Foley catheters, fecal management systems, boy what fun. Me, I’m prepared, I just hope I don’t lose the ability to execute myself. If you want to suffer, you should have to pay for it in Trumps country.
43
Let me address readers from my perch in my ninth decade. My right to die a dignified death is no one else’s business. I claim I have a right to make a dignified exit from this life in the manner and at the time of my choosing.
I applaud Oregon State Rep. Mitch Greenlick’s effort to extend access to Oregon’s aid-in-dying law to dementia patients. May he be successful.
However, I don’t think that Mr. Greenlick’s effort goes far enough. Advanced age in and of itself is a period of inexorable deterioration, even absent the horrible ravages of dementia. This deterioration means nothing less than the deterioration of the quality of life. Vision dims. Hearing fades. Balance is impaired. Mobility becomes restricted, a serious blow to independence and self-reliance. Chronic disease may suddenly manifest as acute disease. Infectious diseases can become serious – even lethal – threats. Our social circles become smaller and smaller as death takes our spouses and friends. Bones become brittle, fractures too common, and recovery slow, if it occurs at all. Surgeries – even some diagnostic procedures – come with elevated risk. The list goes on. For many, though minds may remain sharp, the enemy is the body.
As our population ages, questions about the end of life journey will only increase in number and urgency. I feel indebted to the good people of Compassion & Choices and Death With Dignity for their advocacy on my – and others’ – behalf.
370
retired AMA attorney F/70
At FedGod New York replies here is the complete format and one-page text of my crosses-state-lines Physician & EMS Orders for Treatment. Anchored in our constitutionally-protected right to refuse treatment. Works better than state laws in those states that have enacted way-too-limited assisted-dying rules.
Don't need an attorney to write this advance directive for yourself. Take it to family, neighbors, friends for each to read out loud to you what it says. Carry a copy in a wallet or purse with a driver's license. Applies to trauma where the body is completely wrecked and prognosis grim. Ditto for big strokes. And always all ways for end-of-life suffering from ALS or Parkinson's or Alzheimer's.
Do remember that a bracelet from The Medic Alert Foundation is what EMS and ER docs are trained to look for, e.g., messages about allergies or drug reactions. So enter your adapted Physician and EMS Orders into the Foundation's POLST database -- making your orders accessible 24/7 to interdict standing orders that you choose to block. And get a bracelet that says "POLST" with the Foundation's contact information by phone and online.
Last, for those choosing a tattoo, remember that there is little likelihood EMS or ER docs will find it OR it could be covered in blood? Get a bracelet too?!
13
There is no greater expression of personal freedom than to be able to control the end of one's own life. It just seems un-American to force people to suffer or die without dignity.
34
I just don't understand it.
A patient who is suffering from pain and has a terminal illness is not allowed to end his/her life when a pet who is suffering from an incurable illness is "put down."
Why must a human being suffer because someone says they must. Religious fanatics say it's a sin. But I would bet that, if Jesus were consulted, he/she would say relieve the person of the suffering and send him/her to the great beyond.
Let the person who is suffering and has no hope of surviving, make the choice. I surely wouldn't want to be bedridden suffering pain that can't be alleviated. Let me die.
38
Please, please, I hope that more options will be available for those facing dementia. My mother would have hated to see what she turned into for the last eight years of her life.
There should be a way to say in advance, for example, if I don't know my name, am incontinent, can't feed myself, you may give me my prescription to end my life.
Modern medicine is keeping us alive far past when we are meant to be--when we become only a burden to our families, who then forget the vital humans we once were.
Religious groups, stay out of this and mind your own business.
78
When you get right down to it, these statutes are an unjustifiable intrusion into our private lives. Neither the State, a religious group or some other entity has the right to tell me how, when, and under what circumstances I can choose to end my life. Leaping off a tall building would certainly do it, but such a violent and painful end should not be necessary. The choice to end my life is mine and mine alone and it should be carried out with dignity.
32
My husband and I wrote in our will that we wanted a dignified death: when it’s time, it’s time. My husband, the love of my entire life, from 1958 to the day of his death in 2016, died with dignity after knowing his GBM spread to his entire system. My daughter and I, regretfully, had to “fight” a doctor who didn’t want to comply with his testament and decisions made when he was fully conscious.
37
The complexity and the waiting periods are a definite drawback for an individual wishing to have access to the aid-in-dying procedure. Having had the opportunity to review these laws for a local bar association publication, these statutes provide that once the drug is received by the patient it must be self-administered. What is a quadriplegic to do who may be unable to self-administer the drug? If someone else feeds the drug to a quadriplegic, it might be considered euthanasia which is illegal and could subject that person to criminal prosecution.
10
@Marvin
retired AMA attorney F/70
Yep! Especially in Southern states where evangelicals elect evangelicals to enforce their version of state law.
Only lawful way out in this country right now, including those with ALS or Parkinson's or paralysis that are not the easy terminal cancer diagnoses, is by inpatient hospice IV that contains both morphine & methadone.
I've included in my Replies here, a one-page plain-English adapted POLST that I title Physician & EMS Orders for Treatment. This crosses-state-lines advance directive is anchored in our constitutionally-protected right to refuse treatment. Sadly, a clear decision written by Justice O'Connor that her POA holders are now deploying to benefit with her Alzheimer's.
For yourself and family and clients, find and use my adapted POLST? When the suffering becomes dominant, assisted-death can only be accessed in this country by inpatient hospice Medical Director order for IV morphine&methadone. Quiet death in hours.
That too is covered in Replies here, mostly to NYT Picks.
I go to Switzerland 2023, qualified under Swiss law and medical requirements to drink the juice in a beautiful quiet apartment. My choice to fly and fini alone. My traveling music is Ernesto Cortazar's You are my Destiny. The CD will be my contribution to the Zurich space and place that provides assisted-death services for anyone from anywhere.
For those with fewer resources, many Swiss assisted-death organizations waive fees.
13
Everyone should have the right to die with dignity and surrounded by those they love.
13
After watching both my parents die, especially the up close and personal passing of my mother, I'll never inflict that on my daughter. After her SIL's gruesome cancer death, my mother hounded me for forty-three years not to let her pass certain points -- but when those points came and I tried to discuss matters with her, she angrily cut off the conversation. She passed every single marker well before she died and turned her passing into a weapon against my daughter and me. After months of changing her diapers and caring for her without any assistance -- she never qualified for hospice -- I was utterly relieved to find her dead very early one morning. I'd already resolved not to drag out my death, but dealing with my mother solidified my resolve to control my own death. If worst comes to worst, I'll go outside and shoot myself before I burden my daughter, the only family I have left.
47
When I was around 15 or 16 I got into an an argument with my father over what I can't remember , but I do remember saying to him , “ I didn't ask to come here.” Obviously , meaning I didn't ask to be born. His rejoinder was , “neither did I.” Brilliant. That was the the one , and only time my father and I agreed on anything, except for when this veteran of Patton's Third Army finally admitted that the Russians were instrumental in deafening defeated Nazi Germany .
So I reach back to my father/son confrontation for my perspective on the acrimonious debate on aid in dying laws. As sophomoric as my argument is, it viscerally resonates with this apostate Catholic. When you eliminate all the Western religious prohibitions about suicide whether by”eating” your gun and going to Jesus , or by getting a bunch of drugs from a sympathetic pharmacist/ doctor so you can l leave this mortal coil with dignity, it comes down to not only the hubris that brought all of us into this potential for misery, but hubris on the part of our elected officials who think they have the right to dictate to us how we can go back to the oblivion we never asked to leave. Shame on them, and us , for tolerating this situation. Even where aid in dying is legal, the law has so many hoops for the poor soul to jump over when all it wants to do is merge into the restful darkness and leave this world with more dignity than it had when brought kicking and screaming into the light .
18
Why can't the do gooders, the religious objectors, the philosophically opposed butt out? This should be a personal decision, with few if any obstacles, including waiting periods that seem as draconian as the several weeks long dictum in Missouri that women seeking an abortion needed to have a medically unnecessary pelvic exam three days before the abortion in addition to the needed one required on the day of the abortion . I support aid in dying. I want it there for me, if I need it. I do not want to be in pain, or hooked up to machines, or be bankrupted. I need to be able to make the decision when the time is right. Here in Hawaii we have obstacles to getting the medication, unnecessarily long waiting periods, etc., but at least the option is viable. Those who object don't have to avail themselves of the option, but they should not be controlling the lives of those who want it. That is bullying.
28
The missing part of this dialogue is the endlessly amounts of money, time and care that go into extending life as long as possible. Is this our best way of honoring the legacy of the sick? Or is it an unwillingness to say good-bye by the well? We extended the life of my mother in law, just long enough for all to say good bye. When the priest finished her last rites, the nurse asked us if we had said our good byes. When we said "yes," she turned down the dials of the machines, one by one, and we watched her vitals fall to zero. Her case was brief, but I cannot imagine telling the hospital to keep her going indefinitely, when her body had already expired. When my father in law's cancer recurred, six months later, he begged me to take him to Oregon. Sadly, he passed, while in considerable pain, before his required residency there would have been completed. Dying is fraught and complicated. We make it easier for the animals we love than humans we do too. Why is that?
30
Aid in dying is also available in North Carolina, where it is practiced subject to standard of care, rather than pursuant to a heavily regulatory statute. For those interested in the NC landscape: https://www.northcarolinalawreview.org/single-post/2019/01/16/Aid-in-Dying-in-North-Carolina
KATHRYN L. TUCKER, JD
Executive Director
End of Life Liberty Project
206-595-0097
[email protected]
https://www.cascadianow.org/end-of-life-liberty-project/
10
Simply having the right to die will ease the anxiety of many who are ill and may never use the option, but know they have it should suffering grow unbearable.
28
Many people on this site have provided beloved animal companions an exit from pain and suffering. That we refuse human beings the same gentle grace is an ugly reflection on our values and ethics.
47
@hotGumption
Amen to that.
11
I want the Aldous Huxley way, but not yet.
Look it up!
4
My mother will have been unable to control her life, half paralyzed and angry, hurting herself and others, for 10 years on August 4. She is so miserable, and given a choice would not hesitate. In the first year, she grabbed a mushroom from my hand when we were joking it was poisonous.
She was a vital creative woman, much loved, and now all she can do is endure and excrete. She is stoic, but there has never been a question (including discussions beforehand; her stroke prevented her taking the measures she had planned) that she would not choose this.
Families who are not as able to afford the expense, not that this won't make people reactive to consider it, are bankrupted. Enduring the mostly well meaning maze of the health care system has kidnapped our lives as well.
A choice would be more than welcome.
215
@Susan Anderson
retired AMA attorney F/70
Your mother qualifies for inpatient hospice where she does not have to do lift a finger to get help with ending her life: 1) The person who has her Power of Attorney to decide when she cannot communicate should meet with hospice inpatient Medical Director(s) to find the one that will agree to IV morphine&methadone after she is transferred into his/her facility. Build trust and speak in medical terms that include pain and nightmares with morphine alone (thus needs methadone to quiet the brain storm).
2) Set a date for a transfer for your mother into this inpatient hospice bed. Bring your POA document and stay with her while the Medical Director reviews his order for morphine&methadone by IV and you provide the requisite consent (probably in addition to hers). Make sure the inpatient physician sets a dose that will lead to her quiet death, no struggling or gasping for breath, in a few hours to a few days.
The most important part of your task is to interview hospice Medical Directors who are the sole decision makers for the inpatient facilities (not home-based care/services MDs). You will find a hospice Medical Director who will order what you need.
I was lucky. First call got to a young MD who agreed to my request for M&M for my Alzheimer's father. We build a record to support the prescriber, the dose and combination of drugs needed to meet each patient's individual needs.
Go for this choice and teach others?
70
End of life care and dementia care long-term provide many, many jobs for the young and perhaps otherwise unemployable or unemployed.
1
@Auntie Mame
Are you suggesting that, in order to provide this employment to others, we somehow have a responsibility to stick around and suffer the horrors that accompany years of a dementing disease? That's one hell of a social ask. I've seen what happens when people develop various dementias and I think I'll pass on that, jobs or no jobs. There are other areas of employment for people.
31
The big guns of religion and conservatism step up to tell you how to LIVE your life and that you CAN'T end it on your terms.
Seems that choice belongs to ---well, I've personally never seem him, but it's definitely a GUY.
Just buy a gun, get in the tub, put a plastic bag over your head and let somebody else deal with the mess.
I will always have the freedom to stop the music.
5
@AWENSHOK
Doesn't help stroke patients or those with Parkinson's or ALS or a vast array of other conditions that render them unable to do anything. zip nada nunc No self-help in dying.
Do read Susan Anderson, Boston, story here about her post-stroke mother's decade of suffering and my reply should you or someone you love need a viable alternative to a gun? Every state option via inpatient hospice.
3
Although many voices are heard in this public debate, we don't hear directly from those undergoing the dying process. Many voices speak about them, for them; many make moral judgments about them based on high principles. Until more voices of the dying are permitted into the public domain, this debate will be incomplete and unbalanced.
8
Steve (New York),
Studies in states where Physician Aid in Dying is legal have shown that physical pain is not a primary reason for the request. PAD has been legal in Oregon since 1997 and the Oregon Health Authority produces a yearly report on PAS. The reasons patients gave when requesting PAS in Oregon have been consistent in reports for 20 years:
90 percent reported a decreasing ability to participate in activities that made life enjoyable
90 percent reported loss of autonomy
65 percent reported loss of dignity.
Loss of control over one's end day has consistently been shown to be the main request for Physician Aid in Dying. This could be referred to as existential pain but it is not physical pain that motivates people to hasten their death.
8
While I understand that it is important to make sure the patient and not the relatives make decisions about a premature demise, I am not sure where religious groups should have any influence in these decisions.
If we have separations of church and state in our schools, we should certainly have it in our lives. I am not religious and I resent that some Catholic or other group should have an influence in my decision making process were I to choose for a health reason to terminate my life. I would be my decision.
I also don't understand why there is such a big deal about it. This decision is mostly taken by people who are terminally ill, anyway. Why not let them go a little early and have some sense of power left. What's the big deal between a few months earlier or later when a person's right to choose could give people a little sense of relief?
20
@Manuela
retired AMA attorney F/70
The battle is over those not near death with easy diagnoses - like cancer. The suffering comes and the blocked assisted-dying arises with a vast array of acute situations like a stroke or evolving disabling conditions like Parkinson's and ALS.
For these people, inpatient hospice morphine&methadone by IV is the only viable option and, as many have reported here, many Southern states where evangelicals dictate standard of care may not offer this in any setting.
That leaves DIGNITAS and other Swiss organizations that have welcomed those suffering from all over the world for many years.
7
Must we each surrender our personal autonomy to the medical industries? Count the steps that must be taken to "safeguard" the person trying to make this choice for herself, and then tot up the fees she will have to pay to get there.
For myself, I have Medicare but won't use it unless I need to have a broken bone set or stitches. I don't see doctors because too often I have accompanied friends and loved ones through the process of diagnosis to death, and the successive disempowerment each step entails. I personally believe a fundamental misstep of modern medicine was the reliance on animal testing, and so I will not be a beneficiary of medicines developed from it. I see the medical industry determined to secure each human being as a lifelong consumer of its products and "services" - whether they wish to be, or not. From conception through death. Even before, and maybe, if the various AI hybrid "longevity" promoters have their way, after.
You can opt out. I'm lucky that now I have a life that is both meaningful to me and useful. But when I know that it is coming to its end, I will revisit a little book on my shelf titled "Final Exit," and I will say my goodbyes and depart in such a way that my body will not concentrate poisons nor pass them on to the living, but will be a fit source of nutrients for other beings still needing them. It's the least I can do.
8
As a nurse who volunteered for years for an excellent hospice program, the adoption of the measures described in this article are long overdue. As with so many things, this country needs to look to other countries who have had assisted suicide for years as to how it is carried out legally and ethically. To Steve the doctor, I have seen patients come to hospice with a diagnosis of terminal illnesses only to be discharged and alive 15 or more years later. The hospice I was associated with had their doctor (who was trained in hospice care) determine the terminal status of the patient after review of patients chart and conversations with the patients physicians. Pain management physicians have no authority to decide a patients destiny based on pain and one gets into dangerous territory by claiming to.
4
A study cited by Dr. Atul Gawande in "What Matters in the End" indicates that dying patients with a prescription available for ending life actually live longer than those without. As the article points out, these prescriptions are seldom used. But patients who have the option of ending their lives retain a sense of autonomy, which is one of the most important things left to us as our bodies fail.
The other barrier to use of these prescriptions is cost. I'm a physician and I went on line to price the cost of the barbiturates needed to end life. It was $3000! One can literally not afford to die.
13
@Frank Baudino
Street fentanyl from China costs a whole lot less and works when a plan is set to do the drug alone and not call anyone with a Narcan needle.
For those with the means to do so, there are Swiss organizations like DIGNITAS that waive fees for those who cannot pay. Friends and neighbors, including me, cover plane fare one way. I go 2023.
8
These laws are progress, but no law removes the responsibility to plan for end of life.
My mother is in a nursing facility. She does not recognize her husband or her children. She barely eats. She cannot read or watch TV. She never leaves her bed. She has no dignity, no life.
We signed "hospice" documents to prevent intervention other than pain relief. But this may go on for months. And our father will not "abandon her." He lives in the facility in a single room with a bed. He has grown depressed and is deteriorating rapidly.
My siblings and I discussed options. We have none. Because my mother did not provide written instructions. She never took us aside and said anything other than, "don't let me die in a nursing home."
We failed at that. But what choice do we have? It takes two people to care for our mother 24-hours a day.
I have three children. I sat them down and told them that I would rather die than live as my mother does.
I said plainly that I don't want my money wasted keeping me alive when I have no life. I'd rather the children use it, spend it their own children, build a business, enjoy the life I gave them.
"Take me to Switzerland or Oregon," says my living will. "Have a party with me as guest of honor. Tell stories. Celebrate my life as your father. It's been my great priviledge. Remember me well. And end my life at the end of the party."
I hope that's enough.
25
@Joe
retired AMA attorney F/70
Find and read one of many Replies here on how to get your mother to inpatient hospice IV morphine&methadone to end her suffering.
7
If I am dying of an incurable disease or illness, and I am in constant pain and dealing with poor quality of life, I want the ability to die with dignity. I don’t think someone I’ve never met should have a say in that decision. If we can provide this for our pets, there’s no reason we can’t be just as humane to ourselves. No one should have to suffer a long drawn out “natural” death.
25
When assisted suicide becomes legal, some people who don't want it will receive assistance.
2
Nonsense. People who want control over their dying will have written, signed directives which your hypothetical greedy relatives will not be able to change.
Just as often, relatives who are religious quacks keep brain-dead family alive on respirators when all hope is lost -- because they're waiting for God to terminate life.
Life ain't going to get terminated by God or anyone else when machines do the breathing and imbecile family won't allow physicians to turn them off. Besides, Medicaid will pay.
A nightmare scenario.
30
Total nonsense. All of my family lives in The Netherlands, where assisted suicide has been allowed for many years, and in my large extended family only one person has chosen it, even though several had cancer and went through hell before they died.
There are enough controls in place to avoid it.
28
Canada has had this law allowing physical assisted end of life on books for several years now. I know two instances of it being used. There are well designed processes to ensure it is not abused or used indiscriminately, including a cool off period in case the patient changes his/her mind.
As do all Scandinavian countries.
But then, Americans cannot or don’t want to emulate anything from these “socialist” societies!
15
It is time we offer this option—-legally. To be certain, there will be miscues and follow-on stories of abuse, misuse, etc.; there is no perfect solution set because humans are involved. We have extraordinary medical capabilities now to prolong life and those capabilities will continue to improve. Not everyone wants to merely exchange CO2 for O2 without the corresponding quality-of-life experiences. It’s not too much to ask to depart in a peaceful, dignified manner that mitigates the agony of one’s final days, hours, minutes and seconds as well as those who are tortured witnessing their loved one’s exodus. This is not a choice for all, but the choice should be available.
6
One glaring example of a barrier not mentioned in the article is that the V.A. (Veterans Affairs) is not allowed to use any aid in dying as it is a federal agency. There are currently Viet Nam Veterans who meet the state criteria for assistance, but are forced to pay out of pocket to go doctor shopping for physicians who are willing to write the prescription.
A second barrier in the Colorado law, is that the drug must be self-administered, not assisted by a family member or doctor. Many people who want to use the method of dying, cannot move their hands due to neurological conditions. The process is not a mess as it is developed and implemented in a fractured state-by-state process, it is fractured with the mess in health care plans that have no federal access for those with V.A. health care, much less the myriad of other 'choices' in the private insurance arena. May be easier to go to the Netherlands than go through the stuck process in the U.S.
12
@Lazlo Toth
Correct: No federal dollars can be used for aid in dying. Thus, Medicare will not cover physician or drug costs, nor will the VA. But some states -- Oregon, California and Hawaii to date -- will cover it through Medicaid programs.
All these state laws require self-ingestion, another barrier for some conditions. Rep. Greenlick's proposed law in Oregon would instead permit "self-administration," which could include infusion pumps for those who cannot swallow medication.
15
Think about "death with dignity" from the perspective of the Insurance Companies. End-of-life care is among the most costly; so it will be (and is) cheaper if a patient dies than if they go on living, consuming costly medical care. So the incentives of the Insurance Companies will be to push euthanasia as a cost-saving mechanism. To ignore the incentives is to be naive. This is how capitalism works and will work in this "market" as well, no matter how fervently government attempts to regulate it. Take a look at the opioid crisis if you think government regulation will stop this process.
2
As a pain management physician who has cared for many terminally ill patients, I would be happy to support this except for two things:
1. One of the major reasons for request for physician assisted suicide is pain (when Jerry Brown signed the California law, he cited this as the reason for his doing so). Yet studies have shown that while over 95% of terminally ill people can have their pain successfully treated, only about 60% actually have this. Most physicians receive little training in pain management.
2. Although all the state laws admonish against assisting people with a mental illness that might be making them suicidal, none have in place any requirement that patients be evaluated by a mental health professional before providing the means for assisted suicide. As most physicians have little training in the evaluation of mental illness beyond what they learned during a few weeks rotation in medical school, this doesn't exactly inspire confidence that they are able to make much of an evaluation.
Yes, I know having a pain specialist and a psychiatrist involved in the patient's care may be an added burden, but remember we are talking about people's lives. How would you feel if you had a relative with cancer who requested and received assisted suicide without ever seeing an oncologist and then found out it was a treatable form.
31
@Steve Excellent letter. As a retired nurse I sit with friends and family who are dieing. I just sit with them, keeping them company. But as a nurse I know when a patient is in pain. And some suffer greatly, to the point I want to cry. I do not ever tell the family, but I DO talk with the physician about this. And sometimes dosages are increased. We DO know what drugs are avaliable and how to use them and use them specifically for a particular patient. You can be made pain free. This then presents the question of : palliative sedation. I am a firm believer in this. Sedation to the point of loss of life. I do not view this as assisted anything. But aid in comfort to the dieing. But it is a grey area for many.
56
@Steve After having surgery for breast explant, I found pain and burning pain to be an interesting journey, the Percocet did not agree with me, but 4,000 milligrams a day of Tylenol worked for 4 days as I tapered off it, I would love to hear what drugs can provide less pain with the least side effects, but I am one person who will not hesitate to drink the drink of dignity to end life with gratitude and release from suffering.
19
@Juliana James
Obviously never having examined you I can't give a specific medical opinion. However, that being said, the burning pain you describe is suggestive of neuropathic pain which doesn't respond that well to opioids or Tylenol or NSAIDS.
The most efficacious medications for any forms of neuropathic pain are the serotonin-norepinephrine reuptake inhibitors such as venlafaxine, duloxetine, and the tricyclic antidepressants and the anticonvulsants like pregabalin and gabapentin.
As to side-effects, unfortunately there hasn't been a single medication since the beginning of time that hasn't had side-effects.
11
When it comes down to it, most people want to live as long as they can. When you are far from death, it is easy to predict that you won't want to suffer, etc., etc. So many people seem sure that their relatives will elect to die, and I think they are mostly mistaken.
And when their time comes, they too will hang on as long as possible, maybe complaining and bewailing their own suffering, but alive nevertheless. You would think devout Christians at least would be lining up to storm the gates of heaven, but a bird in the hand mostly wins out.
23
@Mary
My experience has been quite different in recent years. My late partner, when given a diagnosis of widespread cancer, simply responded to the doctor: "I am 90 years old, I have had a wonderful life, and I am ready to go." We welcomed Hospice into our lives, friends and family visited and reminisced and medical staff managed his pain levels. He died as he lived, quoting the song: "I did it my way."
I plan to question all of my doctors in the weeks ahead re their support of aide in dying.
37
My late wife had brain cancer and elected to hasten her death, as allowed by the Washington Death with Dignity Act. The skilled staff and volunteers at Compassion and Choices Washington helped speed the paperwork along, and a dedicated and skilled volunteer counseled us and aided in the preparation of the medication.
Meg died quietly, quickly and peacefully, in the presence of her family, as she had wanted and had planned.
Two of my fellow brain cancer caregiver support group members, each caring for a sibling, contacted me, having watched their sibling die, and each had the same message:
“Meg made the right choice”.
248
@Andrew This is the choice my son has made if (when?) his brain cancer returns. He's a unicorn--a ten year survivor of glioblastoma. My condolences on the death of your wife.
38
@Karen K Thank you. May your son continue to be one of those few _very_ long term survivors who give hope to all other glioblastoma patients. Here's hoping medical science can figure out what's special about them. (My bet is on a great immune response).
20
@Andrew
As a Hospice Volunteer for many years, I second your wife's choice. Dying "peacefully" is not common especially with cancer. What the patient wants should govern all procedures and not what the family thinks or the religious beliefs of the doctor.
42
At age 83 I have had some time to think about my passing. I have had the usual problems of aging, stroke, heart attack, but nothing that killed me. But the idea of waiting for some person, or machine, to give me permission to die is insane. Actually if you are caught trying to kill yourself in some communities you could be put in prison. So there you are in prison hoping to die, but then you are being watched every 15 minutes. So why not take examples like Socrates and his hemlock and Cleopatra and her Asp to leave this veil of tears when we choose. We all die here anyway on this spacial ball of rock, dirt, mud, water and air that is spinning through space at 73,000 miles per hour. And there isn't a damn thing we can do about it. Let's at least give ourselves the choice of choosing when or how we go.
14
@Jim Dwyer Refuse antibitoics. Direct your HCPOA to refuse antibiotics for you if you can’t say for yourself.
6
My life. My death.
With or without state approval.
17
I'm dying. I can pretend it isn't happening, but it is. From this vantage point, I can see the worst is yet to come. I have tried killing myself but it's harder than most people think. The culture wants people like me to stay around and linger and be in agony and pain. What I fear is the humiliation. Society cannot accept that a social construct that has been self-invented is not worth living for. That our relationships are just not enough to bear inordinate suffering. I want society to know -- I want to throw it in their smug faces -- that we are going to leave this mortal coil no matter what, and they cannot stop it or us -- when we want out. We are going to go. And so are they.
18
We seem to forget that dying is as natural of a process as is being born. Before we begin declining so much that we are 'incapacitated' is the time to reflect on and make decisions about how we want to spend our final days.
Do we want to use extra-ordinary means to stay alive at all costs or do we accept a simple route, where we die naturally, aside from palliative care pain medicine?
There are many types of medicines that can significantly reduce even some of the worst pain.
We deserve the right to make informed choices and to share our preferences with family, friends, our primary doctor and from this create an advanced directive for how we want to spend our final days.
I
7
My Dad is in his nineties and recently suffered a terrible accident that has left him bedridden and dependent on others to use the bedpan. His desire to be able to bring about his own death has moved from a low thrum to a pressing daily topic of conversation. I wish I could offer him a peaceful legal way "out" when he is ready.
10
Morphine. Steady doses every 2 hours.
2
@Elise Make sure he isn’t given antibiotics for the pneumonia or UTI he may and probably will develop at some time.
7
My poor aunt could have had a peaceful death several times had she not been taken to hospital and treated for pneumonia. Unable to care for herself or to remember anything, including the names of the two aides who had been living with her for almost a dozen years, or me for that matter, she died a bad death (albeit, at least, in her own home).
The image of her contorted dead face will haunt me forever, I think.
In a just world, we could have helped her out of this world a long time ago.
8
Geez, its almost as if some people want to have some control over their lives! Don't they and the "Right to choose" women realize that other people's nosy religious beliefs should control their most important intimate decisions?
4
As a friend of mine said, if she ever finds out she has terminal cancer, she'll go out and score some street-level fentanyl.
Short of that, people with the means should save up for that last trip to Europe.
5
Being over 80 and diagnosed with fatal lung disease, that is untreatable, I would much prefer to have an early outlet to suffocating! At this point I pray for a fatal heart attack or other drop dead attacks. Yes, I am a chicken and know we all die and pray there is an after life which I am not afraid of. It’s the thought of slowly suffocating and my children being burdened with my care!
7
@Delta Dawn
Call a local hospice and get on their service. There are medications to keep you from feeling like you are suffocating and hospice nurses and doctors are trained to help in exactly your situation.
5
@Mari
retired AMA attorney F/70
Find and read here in Replies my detailed pathway to a quiet death in hours with lawful inpatient hospice morphine&methadone by IV. ONLY viable with hospice inpatient IV and Medical Director communication that builds trust and gets to an agreement on drugs/dose/IV route.
1
It's high time this issue was recognized at the national as well as state levels, as in some European countries, and we all were given the choice and empowerment to obtain a simple prescription to die with dignity, if so desired.
14
Suicide rates among the elderly are up sharply, showing that the slow progress in "right to die" laws isn't stopping people from taking their own lives. It's horrid that so many have to use violent or insecure methods to evade the often tortuous death by inches so often prescribed by medical providers.
18
I guess if suicide is up in the population of older people, it is because modern medicine allows them to live longer and so prey to ever more pain.
It's always funny to me when the physicians caring for my elderly friends say, in response to my queries regarding pain medication, "It's highly addictive." Good heavens, at that age, so what, say I.
I've seen too many of my family and friends suffer. A lucky few were able to get their morphine upped.
But life is sweet. If at the end, I could be dragged to some mountaintop in order to throw myself off, I'm afraid the beautiful view would stop me.
12
A person in assisted living or a nursing home, who is not capable of leaving, may not be able to get out to get the medications needed to end life and medications in the facility are heavily restricted. Said person probably doesn't have access to a knife or gun. A relative of mine in a death with dignity state is now in the 15-day waiting period. The process has not been difficult. A quick google search found the right organization and they seem to take care of most everything. The staff we've talked to got into it because of the cruelty of keeping the elderly alive at all costs. These angels are proud of their work and find it to be very satisfying. My relative's complaint is the length of the waiting period.
14
For reasons that are transparently paternalistic and quasi-religious, the American College of Physicians opposes aid in dying. The arguments used against it (by the ACP and others) are nearly identical to those used against abortion, mutatis mutandis. I am deeply grateful that it is legal my state (Oregon) and in an ever-increasing number of others. I strongly support Mitch Greenlick's bills that would eliminate the discrimination against those who know they will be unable to make the decision for themselves once they have only 6 months left to live. The next step would be to make it legal for those who could make the decision but could not carry it out, namely some patients with ALS.
22
I have a disease called iBM and will choose euthanasia in the Netherlands once I feel that I can no longer live with parálisis, this will only happen 10 years from now, but I am more than ready for that time, I pity my American friends where their dogs have more rights than them
8
This seems to be much ado about nothing other than wrangling about morality, which in turn derives from the Judaeo-Christian ethic. I believe Islam also regards suicide as a sin. In other cultures such as Japan, this is not the case. If an individual is not totally paralyzed it's not particularly difficult to kill yourself if you really want to. The issue is when you want someone else to do it for you.
2
@Mike
It may not be particularly difficult to do it without medical assistance, but the DIY methods typically leave a mess for someone else to clean up. Much kinder to everyone involved if medical assistance, via a known lethal drug dose, is available.
15
I believe terminally ill patients should have the right to seek aid in dying --- but whenever I see stories likes this, here is my question. I am assuming that the drugs that are prescribed in those states where this is legal are drugs that will cause death, but that the death they cause will be relatively painless, just as I am assuming, but do not know for a fact, that when dogs and cats are euthanized, their deaths are peaceful. So here is my question, are they using a different set of drugs when they execute convicted prisoners? I hear all the time about botched executions. So I just want to know, are the drugs used to hasten a peaceful death in the states where such is allowed the same drugs used in carrying out capital punishment?
3
@Barbara Clark
At first I thought, well, that's not really what Dr. Span is talking about -- but it's really a good question. An Atlantic article [https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/] might be a place to start. It notes that a major difference is that - for animals - the death is quick, and done with an injection. Humans in right to die states must ingest drugs - a totally different situation - and it takes much longer. I've held several pets when they were euthanized. They went very quickly; and there was no sign of any struggle or discomfort. Physicians in our states which allow them to participate may not administer such injections to humans.
7
In Holland you can choose an injection
5
I know many an elderly person who would be either subtly pressured or overtly pressured to do this by their own children. They consider their parents a burden and a bother, and worry that there will be no inheritance for them (even a small one), since such parents often have no long-term care insurance.
Anyone that thinks this won't become a major issues is kidding themselves. Or perhaps they actually want it this way?
16
@India
And I have known many an older adult who dreads the thought of dying slowly, congnitive bit by cognitive bit, as progressive dementing diseases for which there are no effective treatments set in. There are issues with most medical choices, but they are still choices. This should also be a choice. I certainly want the choice if and when I am diagnosed with a dementing or painful illness for which there is no realistic hope of recovery.
92
@India FYI , Unless the elderly person has a great amount of money ; then your statement is a bit untruthful . A sick elderly person usually goes thru what ever assets (money) they have ; and then Medicaid covers their care so it should not put a burden on their children . Perhaps their children are not well informed or truly have a cold heart . Not everyone can afford long-term care insurance so I'm assuming they fall in the don't have any assets . So if there is an inheritance , why don't they have long term care insurance ? Who's kidding who ?
30
@India. I'm sure there are some who would pressure the elderly relative for whatever reason, but there are many, many more of us who ARE older and simply want the ability to NOT SUFFER even more than our heirs may want to get rid of us. Long term care insurance just insures you suffer with a roof over your head. People should have every right to choose a more comfortable end, and the current laws are so very restrictive it would be tough for a relative to pressure an elderly person into anything. They are so restrictive that older people like me are talking to each other about how to take the choice into our own hands if it comes to that.
80
It never ceases to amaze me that we treat dying pets more humanely and compassionately than we treat dying relatives. My cat died with more dignity than I likely will.
110
Choice. Period. The. End.
24
I still do not understand the religious objections to someone managing the time and nature of their own death. Why is wrong to manage one's own dying but not wrong to interfere in the progress of the illness that brought you to that place? If aid in dying is wrong, then so are chemotherapy, transplants, and antibiotics.
37
Quebec and later Canada have passed laws on the subject. Right now in Quebec, you can register your decision not to have any help in staying alive like reanimation or transfusions. The problem with dementia persists, you can’t decide to end your life when you won’t be able to make the decision. The government has formed a committee to study the problem but I don’t have high expectations since it’s almost impossible to find a consensus.
4
We show our dogs and cats more compassion that we do our elders.
I should be able to die on my own terms .. even if I dont have terminal illness. I am not religious and I wish to be free of religion ( let's face it -- our current laws are informed by religious morals or at least the religious voting block) when the moment comes for me to choose.
All the methods that are available to me are physically painful.
28
@FedGod
retired AMA attorney F/70
Not true if you have access to hospice services, which is included in all Medicare plans.
The pathway to set well in advance in a written directive? Hospice inpatient IV administration of morphine and methadone (to block nightmares caused by morphine alone). One needlestick and three hours to three days of a quiet pain free death.
Those who can get away from the rhetoric of "death with dignity at home" and set this hospice inpatient IV alternative really can get to a pain-free quiet death.
7
@n.c.fl How does anyone figure out how to set this up in advance?
3
@K.
First, don't use any of state forms or organizations' content for advance directives.
IF there is a specific person/patient with a clear medical pathway identified, do a Power of Attorney that can be the usual formats. Includes medical decisions to be made when the patient no longer able to communicate. Attach the modified POLST below and reference it by name-BOLDED-in the POA h.c. provision.
We all have a constitutionally-protected right to refuse treatment that crosses state lines. Write one-page plain-English titled: Physician & EMS Orders for Treatment:
Right to refuse treatment [bold]. Acting under established law, I direct that all caregivers for me set a care plan that maximizes comfort. 1) EMS [bold]. I refuse all ports or interventions by EMS. 2) Comfort care only [bold]. I refuse all diagnostic/imaging tests beyond a physician's personal clinical evaluation. With a pulse or breathing, relieve pain and suffering with IV morphine and methadone, preferably in a hospice bed in-hospital or an inpatient hospice bed.
Personal medical history that warrants this directive [bold]. STAY ON MEDICAL and off touchy-feely like "death with dignity." Mine says four auto wrecks that fractured 10 disks, chronic pain, and Alzheimer's DNA from father.
Signed this __ day of ___. 2019.
WITNESSES: [two--not family] AND
NOTARY PUBLIC per State format.
All states! $15/2 years to get in The Medic-Alert Foundation info + wear a bracelet. SHOW cc: your attorney!
8
And how is this not suicide? Because now we have created a fiction of treatment choices.
Medical ethicists tell us that treatment choices don’t need to be rational, merely not capricious.
In other words it doesn’t matter that everyone knows the breathing tube will help you rest and fight the infection, if you don’t want that tube then you don’t have to accept it.
I lost a parent and a sibling too early to irrational “treatment decisions” based on subjective thoughts and ideas that the doctors didn’t agree with, knew were not necessarily true, yet said was acceptable.
3
My brother in law in the Netherlands has been on chemo for colon cancer, for 3 years, and has decided to stop treatment. He is wasting away very quickly, going from a strong, robust, strapping guy at 50, to a skin and bones, wheelchair bound 54 year old guy that is nearing the point where he cannot eat, use the restroom on his own, or even go outside any more. He has the option of physician assisted euthanasia, and he is getting close. People in the US has their church telling them that they should not do it, but I wouldn't let an organisation that protects priests over hundreds of thousands of victimized children, tell me what is right or what is wrong. It is a very personal decision, only the person that is considering doing it, has any business commenting on what they should do. Good luck, my brother in law.
65
@BorisRoberts, I am in the same exact condition as your brother in law, with the enormous, major difference of not having a humane option available. It's terrible.
32
@cf I'm so sorry CF! My friend and I are very old. We have saved medication that can end our lives when we are ready. We fortunately found out that we might get nauseated and vomit it up, so we got prescription anti nausea meds to keep on hand to take first. Maybe you can do the same. Good luck to you.
28
@cf Perhaps you do have an option. Find out if hospice will keep you comfortable with voluntary stoppage of eating and drinking. That can be done here in Oregon and probably in every other state, since it does not involve providing a chemical with the stated purpose of ending life. The question is, would a hospice be willing to provide comfort care in that scenario.
15
Just days ago, we had to watch my father in law die, painfully and after hours of gasping for breath (the morphine didn't help), from a 2 year battle with brain cancer. In his final weeks, he lost his ability to speak, move, or eat, and had long since lost the dignity and strength of the man he once was. Among the last things he said, when he still had the ability, was, "I'm ready to die, I wish I could die, but my body won't let me", and he feared exactly the kind of death that he had. He should have had the choice, and the ability, to die when and how he wanted to. It's a crime against humanity that we prevent people from doing so.
504
@Bryan
retired AMA attorney F/70
Add methadone to morphine to nuke the nightmares frequently caused by morphine alone. Or atavan in Catholic facilities. Hospice inpatient Medical Directors using IV delivery are the only reliable way to set this plan and get it implemented.
My Alzheimer's father's very young hospice MD understood immediately when I made that request for my father, months before he arrived. The night he was transferred from assisted-living to hospice assisted-dying, I got a phone call recorded that said: "Given your father's pain history and open cancer sores, I recommend morphine and methadone by IV. He will have a good and quiet death in three hours to three days." I said "Yes!" He died four days later with no painful thrashing or gasping.
122
@Bryan
I had a similar experience with my mom who died from pancreatic cancer at age 65 and was otherwise in excellent health. She fought hard for 2 years, constantly telling her docs and any medical professional she encountered that she ultimately wanted to have control over how she died. She thought she was making the official request. Over and over again. But no one explained the process until she entered in-home hospice just two months before she ultimately died. We started too late. After one now official in-person request, she was too weak to travel to the hospital again. She too had the kind of death she feared and it was terrible to watch. It was terrible to be at a loss, administering the morphine that didn't help, watching alone as she whimpered in pain. It still haunts me nearly 3 years later. I hope for your father-in-law, my mom, and others like them we can make changes so others won't have to suffer like they did.
111
@Tamar
retired AMA attorney F/70
One way in this country avoid this horror: inpatient hospice only by IV BOTH morphine and methadone (blocks nightmares caused by morphine alone).
Hard to remember the established pathways like hospice inpatient IV when terribly implemented new law holds the promise of "the kind of death she wanted."
ONLY inpatient hospice by IV to get to a good quiet death within three hours to three days, my Alzheimer's father's inpatient hospice Medical Director's words. And it was.
Thank you for choosing to share this story that some day you need to put the blame where it belongs--on our law makers and not on caregivers or family.
44
I was able to gently put my cat out of her pain when she was past all healing. But my mother spent 5 years in a nursing home, unable to walk or chew food or let people know what she needed. Come nightfall, she was agitated because she thought her son was being tortured in a room down the hall.
Which would you prefer to experience? Even if you'd like the five-years-of-horror scenario, why would you deny the alternative to someone else?
418
@Kathleen S.
Kathleen, reading this made me so sad for you and for your mother. Everyone should read your comment amd ask "Why do we humans (medical community and/or religion) persist in allowing suffering when there are alternatives?'
My personal view is that people who preach about the sanctity of life in the face of unbearable pain and terror are ones who have never experienced it for themeselves or for those close to them. We are a barbaric society still.
Arms around you, Kathleen.
38
Might it be that Catholic institutions that refuse to provide this patient/human right to die with dignity and comfort are simply making too much money off the cash cows aging baby boomers represent? We all know the most expensive/profitable healthcare is end-of-life healthcare. To fund it, there are billions of dollars wrapped up in the mortgage-free homes and old time pensions of those born before 1960. Wouldn't the healthcare industry love to get their grubby hands on all of it?
And since when are the Catholics the harbingers of what is right, moral, justified, and ethical anyway?
I will not hand over to the healthcare industrial complex any of what I've worked a lifetime to secure for my children. It's not my duty to suffer the ungodly treatment of the aged for a few extra weeks or months of "life." I demand a say in when and how I go.
42
Praise the NRA and pass the Glock. Messy, but quick.
5
In WA state on average about 350 patients a year qualify and receive this medication but only a third use it. The ones who don’t use it say that just having it gave them a sense of control over their illness and suffering. We should all be so lucky.
56
@Anita Larson I wholeheartedly agree with your statement around the sense of control. In a phase of life during which you often lose much of your personal agency, having the ability to make that decision means a lot, even if you don't use it.
25
@Anita Larson In Washington State about a third of those who receive prescriptions (there were 212 in 2017, the most recent year for which the state has published statistics) opt NOT to use the drugs. The percentage is similar in other states; for some patients, just having the option is sufficient.
27
@Paula Span @Tuscangal
Uh, I believe your statistics are exactly what @AnitaLarson said in her original comment. What is your point?
4
The process is far too complicated and reliant upon finding amenable Drs, a pharmacy and other support staff. While Eli Lilly made Seconal as a generic, it was about $1 a pill. Now it's over $30 and owned by Valeant. The end-of-life prescription is 100 capsules (emptied and in solution), so do the math. It's placed this humane option out of reach of anyone poor, another cruel price they pay, and of course, no insurance coverage. There's a compounded formula in WA that's similar, but it's still $850, and finding the right combo of a Dr willing to prescribe that and then HAND DELIVER (a requirement) it to the formulary is another unreasonable hoop to jump through.
And "6 months" is ridiculous- as if anyone knows? Besides the horrid timeline of mental decline, very old age SUCKS, and I sure as hell don't want to wait till every system fails one by one before I have this option. We were very, very lucky my Dad was able to end his life (at 94, in steep decline), but it took a lot of research and proactive planning for him to have this choice. Incidentally, we were told by several adult family homes and nursing facilities that they would not allow it on their premises- so we were supposed to take him to the car do to it? In the end, he did it in his retirement home, and we did not tell the medical staff in advance that he was going to. We were afraid they'd try to stop him. It was peaceful and private and a blessing of the highest, deepest order for all of us.
81
Had a grand-aunt die of Alzheimer's. Took her 30 (!) years to go, kept "alive" artificially for over a decade, which took a financial and emotional toll on her immediate family. Pro-choice on death should be taken seriously and we need to let go of our hang ups and fears so we can discuss how to implement it well nation-wide.
49
Over this past half year or so, I have been suffering terribly through Stage 4 stomach/lung cancer. These bills can't be changed quickly enough. "Who'' exactly is preventing me from doing this and why? It is inhumane. We should always be the one who makes this decision. Not Gov. Charlie Baker or the state of MA, AG Healy.
55
@cf
DIGNITAS Zurich and all costs waived for those who cannot pay them. Friends and neighbors can help you get this to fini.
20
The title of the article should read, "Aid in Dying will be Available Soon..." The way it reads is that people want death soon (the sooner the better?).
2
Lie lie lie . “And the patient is in charge of the process from start to finish: the patient must make the request, and ultimately ingest the medication.” Kim Callinan.
The patient actually loses all control once the script is written. Not a single Oregon model death laws provides the oversight to honor the so called “self administration “.
What else did Kim not reveal? Oh that it remains a homicide in Montana where no one has instant immunity from prosecution like in the states with the Oregon model death laws.
Consider that Yes 60% favor the concept but 95% reject legalizing euthanasia after they learn the extent of wrongful deaths allowed.
Potential for abuse abounds with laws allowing euthanasia.
There are many documented cases of abuses in the Oregon model death laws. The problem cases only come to light through media and medical or legal journals, but many are in documents on the DREDF org.
There is no oversight or assurance provided by the Oregon model death policy that can prevent wrongful deaths due to:
9. When there is a killing after changing their mind or while resisting. This is likely in 20 percent of assisted suicides, according to an extrapolation from Oregon statistics.
And finally Kim, your marketing claim of a peaceful death does not stand up to scrutiny and you know it which is why you make the fraudulent claim.
11. When the death is not a rapid or peaceful death (likely 25-72 percent of the the time according to a study by Bill Gallerizzo).
2
@Bradley Williams
Whenever I read studies(or sort-on studies, nonscientific by any measure) such as the one you cite I always look at who has authored or sponsored the study.
Bill Gallerizzo is a deacon in the Catholic church, so of course he will oppose assistance in dying and of course he will frame any questions and intepretations of data according to his beliefs. Biased research is not reliable research.
Furthermore, if a capable physicial is providing the drugs with which a person may end his or her life, those drugs should (and generally do) include anti-emetics, which prevent the body from regurgitating the drugs.
You have an agenda, and it's evidently a religious agenda, and you seek to impose your interpretation of what is moral and ethical on others who might prefer to have the final say over when and how they die. When and how I myself die is none of your business, and I believe many of your fellow Americans will tell you the same thing. Just because you and your church oppose aid in dying does not mean it should be denied to those who want it.
30
Of course, that's the point of church: everyone in it is holier than thou.
7
@Bradley Williams Your post is simply fear mongering.
5
I note that there have been problems with the drugs used in executions, but why do we never hear of similar problems in euthanasia cases?
Why don't condemned criminals get a lethal dose of barbiturates?
On the ethical issue, America says it's the home of the free. Why should freedom not extend to euthanasia.
18
@Ambrose
retired medical attorney F/70
In the U.S. and worldwide, including Canada, this is a law issue and not an ethical issue. Terminology used is assisted-dying and not euthanasia.
Since Canada's Supreme Court decided years ago that Canadians do have assisted-dying rights within limits set out by each province, you can start your home-base research with your provincial government?
3
@Ambrose There is a specific procedure, including an anti-emetic drug to prevent throwing up the fatal dose. This is one reason why people may need assistance.
2
Quite frankly, as it becomes more and more difficult and stigmatized to get effective pain medication, I myself have spent more and more time contemplating and preparing for suicide. When the tipping point is reached I believe I will be ready.
Anyone in power or oversight who doesn’t understand what people like me are facing has not been paying attention. This is not hyperbole, it is dire and it is real.
64
@John Ramey
You perpetuate a myth that is easily disproven.
The only meds that it seems people like you think are becoming "stigmatized" and more difficult to get are the opioids and that is why pain is poorly managed.
If this is so, perhaps you can explain to me why pain conditions like fibromyalgia or diabetic neuropathic pain which are much better managed with non-opioids than with opioids are just as poorly managed as those conditions that respond better to the opioids.
1
Speaking as someone dealing with long-term severe chronic pain and an ever-increasing difficuty obtaining pain meds, I forsee a time when ending my life becomes a worthy choice. My state (NC) has no Dignity laws, nor is likely to get them. In any event, from what I read of such laws they largely serve to ease the stigma of suicide. It's OK if Bob did himself under a doctor's care; not so if he did it himself. I can handle that.
39
My mother, when in her 90's, shot herself in the head because she did NOT want to return to the hospital when her congestive heart disease continued to progress. Living in a state without a Death with Dignity law, she used to joke about moving to Oregon so she could "go" when ready. What I would have given if she had the option to die more peacefully...I'm still haunted.
Since this occurred, I have learned that elder suicide is not that uncommon, but we don't hear about it because relatives don't want this information public. I'm sworn to secrecy by my siblings who aren't ready for the grandchildren to know about her violent, self-inflicted death.
After I retire, I hope to give volunteer time to the Death with Dignity cause.
389
@name withheld, my condolences and support.
18
My heart goes out to you.
12
As a retired nurse I have seen this myself. I had a patient who was a diabetic who had stored up many bottles of insulin. She was insulin dependent. She ended her suffering with about 8 bottles of insulin. A quiet peaceful way to pass on. Elderly suicide happens.
33
The "six months to live" stipulation is the cruelest of all. l have a relative with a horrible set of conditions that make her life unbearable and painful. She'll probably be here for another 10 years or more. Why should she have to suffer so, just because of some stupid rule. Ironically, her husband who has been caring for her will probably die first. He used to be strong and healthy, but the past two years have really taken a toll on his health.
313
@mary
retired AMA attorney F/70
State laws are a cruel facade of assisted-dying for those who have made very clear their choice in advance directives.
U.S. states will not enact useful assisted-dying laws in time to help Boomers. My law partner has implemented a plan for a hemlock society recipe. Both parents were mentally OK, horribly sick and disabled for the last 15 years of their 90+ year life. She will be able to drink the juice when she chooses and where she chooses.
Dementia is the single most challenging diagnosis for assisted-death law makers worldwide. Remains to be seen whether Invitae's genetic profile(s) will be accepted by U.S. lawmakers for purposes of meeting medical requirements before the 14-year arc of Alzheimer's kicks the brain to non compos mentis.
My choice is DIGNITAS Zurich 2023, already qualified for pain attributable to car wrecks that each fractured different parts of my spine. I have my father's DNA except for gender and drunk Irish addiction genes. That includes his Alzheimer's.
DIGNITAS is a membership organization that often waives its charges for those unable to pay. It has simple medical forms to complete that do NOT require any physician sign-off. Getting to Swiss facilities while still mentally and physically able to complete the tasks is last check-off.
Your suffering relative can choose to die in Zurich and you can help her get that done.
Always all ways: "Death is not the enemy. Suffering is."
70
@mary, I'm sorry your family is having to deal with this. Thank you for reminding us people endure tremendous suffering
10
I have heard of terminal patients who refused food and water to end their lives ; they should have the choice to choose to die with dignity assisted by the drugs prescribed . All the discussion of refusing them that choice because of religious beliefs is abhorrent ; yet we are willing to go to war and kill others without thought . It smacks of thou shall not kill by preference .
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@sm That's how my mother did it. It was her wish to shoot herself, but with dementia, she forgot where she hid the gun to keep the grandchildren from finding it. When she was in the facility, she was rational enough to say to me
"I have lived too long!" Then she refused food and water. The facility tried to get me to sign permission for her to be entubated for forced feeding. Of course, we refused. It was a much harder way for her to die than if she had been able to use her gun.
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@grmadragon I am so sorry she suffered ; it is a barbaric way to go . That is why a choice should be given ; my deepest sympathy for your loss .
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@sm Thank you.
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Self-determination is a fundamental human right. It is, after all, my life and I should have the final say in its course, including its end point. It has been a long struggle to get the states to recognize this fact, but it happening. Laws that used to dictate our sex lives, who we can marry, abortion rights, and now how we die are all of the same class - who is the final authority in how we choose to lead our lives, the individual or the state? I hope that eventually the state removes any restrictions on assisted suicide, much as has happened in some European countries.
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@Scott Werden
retired AMA attorney F/70
Aloha Scott - The terminology among physicians and attorneys is "assisted dying" and the laws with corresponding easy-to-access assisted dying in Europe will never be implemented in this country.
Red States anchoring laws in evangelical extremes are a definite never. One more reason to make sure their residents have unrestricted access to guns - for suicides. Rapidly rising death-by-gun among old white guys in these states in recent years.
Blue States and HI are welcoming to immigrants from many cultures, including those who will fight to the death to oppose assisted-dying. So their state laws will be easy-to-pass and not useful to most. Already proven by data included in this story.
Set your plan for DIGNITAS or other Swiss organizations that have welcomed guests from other countries for decades. Fees waived for those who cannot afford them. Easy to fulfill medical qualifications that do not require any U.S. physician sign-off.
I go 2023 for severe spinal pain that won't get better and to miss the 14-year arc of Alzheimer's hard-wired into my DNA. Until that date, I gift plane flights and help with submitting medical records for neighbors and friends. All good.
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It needs to be available for Alzheimer’s and dementia patients, either following diagnosis but while they are still able to think cognitively OR by prior directive. I would sign that directive yesterday if it were available.
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Medically assisted dying takes place amidst much human suffering. What's important to me is knowing with confidence one's state of mind at that future time despite having clear feeling about when they will want medical assistance in dying. The key difference will be the amount of suffering, both physically and emotionally.
Everyone should have the right to their definition of a good death. But sometimes the definition may be at odds with how they feel when they are actually at that point. I recommend investigating Buddhist philosophy.
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Every human being has a use-by mortality date.
Humans die when, where and how they are supposed to.
When we die we can't take any of our stuff with us and use it.
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Wow! Very thorough, very complicated subject in many instances. The whole general issue of dying is still a matter of high anxiety for the majority of our population. No wonder that aid in dying is so fraught. I wonder if aid in dying will ever reach the level of federal law/regulation instead of each of our 50 states flying alone. Not sure fed help would help; just a thought.
The article doesn't mention this, but all of us who have pets also must consider pet death. Interesting (horrifying?) that we can legally end the life of a terribly suffering pet, but we have no right to end our own life if we suffer horribly. In this instance, we treat pets better than humans.
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“Aid in dying” is a definitely a euphemism for “physician-assisted suicide.” To use the euphemism is to open the door to death panels, faceless and nameless people who decide whether a person’s life is worth living.
And note that there is now a federal medical insurance billing code that allows physicians to be paid for offering patients advice and counsel on committing suicide, which means this type of counseling is more likely to take place.
Physicians are generally considered authority figures by most people, so whenever a physician offers the option of suicide it is more than a simple statement of fact; it is at the very least a push in the direction of suicide.
Individuals may in fact want an option to commit suicide, but let’s not pretend there are not economic and other forces that will benefit when that option is chosen.
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@Mon Ray
What about the financial incentives to keep people alive long past the point where all hope is lost? There is absolutely no evidence that there is a slippery slope happening. And allowing physicians to spend time talking to patients about what the PATIENT wants and needs should be part of medicine. All of your opposition is nothing but scare tactics.
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@Mon Ray
"Death panel". Isn't that a far-right fallacy invented to mislead the public and defeat the Affordable Care Act, also incorrectly called "Obamacare"?
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“Death panels”? Do you actually believe that?
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Expect to see the medical industry fighting these options tooth and nail, to safeguard their huge profits from a dying person's last years. However, they'll probably work through the funding of religious and disability groups rather than openly displaying their greed.
Alzheimer's is, or should be, the most feared disease in the US and as it's incurable, the afflicted should be allowed the option of aid in dying at any time after diagnosis.
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@Cal Medical groups, including national professional associations and state medical associations, seem to be reacting in just the opposite way. A number have switched from actively opposing these laws to a neutral stance. That not only makes it easier for lawmakers and supporters to pass legislation, but probably makes it easier for physicians to participate when laws do pass.
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@Cal You seem to be missing the point that none of the various state laws legalize this process earlier than six months prior to expected death. Even if your analysis is correct, the medical industry will still have years of huge profits during the "dying person's last years".
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@Paula Span Not in the South!
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You said
“Public opinion polls consistently show broad support for aid in dying,”
It the US not a democracy? Why isn’t the majority’s views being considered.
If some people don’t like it, they don’t have to participate. And frankly you don’t even need a Dr. here. Just a few pills and a glass of water. A monkey could give those.
Here in Switzerland aid in dying has been practiced for many years, without evidence of abuse.
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@Thomas
I agree with you completely, and as someone who is 69 years old, I would like nothing more than to have the means to peacefully end my life when I think it's time. A few pills and a glass of water; God grant me those. Not currently easily accomplished here.
As for the US being a democracy: Trump is president. He was not elected; he was "installed". HC received more than three million more votes, but we got this massively ugly catastrophe instead. America is a lie.
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@Thomas Unfortunately, "a few pills and a glass of water" presupposes that the person who desires that outcome knows exactly what pills to take, in what amounts to be effective, and is capable of acquiring, paying for them, holding them in their hand, and swallowing them. It also opens that person up to denial of certain benefits to survivors, like life insurance, which may not be payable if the death is found to be suicide.
A legal framework is required - and functions well in many of the states that have it - to not only allow a patient the advice and assistance of a doctor in procuring the medication, but to legally protect the doctor, the patient, and the patient's family from what would otherwise be legally a homicide.
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@meisnoone
All Swiss assisted-dying organizations serve people from all over the world.
Any U.S. citizen can go after completing simple medical submissions that require no U.S. physicians sign-off. Fees waived for those who cannot pay.
My date is 2023 qualified already under Swiss law for severe pain and leaving before Alzheimer's kicks in. All good.
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I am 66 years old. This third chapter of my life would be much more satisfying, more peaceful, if I knew that I could opt to end my life with dignity if and when I decided it was time.
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Re: '...I am 66 years old....ETC." {@Susan}
I'm of similar age; I KNOW I can end my life, should i develop cancer / whatever...anytime i choose to do so...
That being said...
Jumping off a building / in front of a train / swallowing a bullet, strychnine, takin' a bath with my phone, on it's charger, etc., are analogous to getting an abortion from 'Marty', (lead tool, 'N, die machine operator, at 'Transmissions-R-Us')...
INSTEAD, OF a pill or 'D., 'N, C., performed by an Ob.Gyn / nurse practitioner, etc., back in the time when there was NO legal abortion providers!!
I have nothing against 'Marty', the machinist, but...I want my healthcare from licensed professionals!
And I DON'T want any input from faiths I'm NOT involved, with!
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@Susan Fill out an Advanced Directive. Consider directing that no antibiotics be given after a certain point. For example, if I'm bedbound and have dementia I don't want any antibiotics. Hopefully, pneumonia or a UTI, will set me free. If I have a stroke and can't say otherwise, I don't want antibiotics. It's impossible to ask your family not to feed you or to put a pillow over your head etc. It's naive to just to hope to avoid ill health during old age. Health decline happens and we lose control of our destiny once an incident lands you in the hospital-rehab-hospital- nursing home loop. Everyone one of those healthcare facilities is obligated to keep your body alive and antibiotics will keep bringing you back round til the next setback hits and the slow spiral down continues.
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@Susan
retired AMA attorney F/70
Set a plan for DIGNITAS Switzerland where citizens from all countries are welcomed. Easy to qualify medically and no U.S. physician sign-off required. Fees waived for those who cannot pay.
My date is set for 2023. In the interim, I help others to get there and with their paperwork. And I write lots of Reply messages for Paula Span's periodic reports on wishful thinkers about what will happen in this country.
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Not discussed in this piece is a huge (perhaps the greatest) benefit to those that are able to obtain a prescription for aid in dying: the empowerment it gives those with a terminal illness.
At a time when there is very little control (of anything) left in your life, that bottle in the bedside table gives people a choice to participate in that day.
This empowerment is experienced by all who have such a prescription -- whether it is actually used or not.
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@Barry Statistics have shown that a substantial number of the patients who request and receive the prescription don't, in fact, use it. But they do have the comfort of knowing that it is there if they decide not to go on any longer.
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@Barry
retired AMA attorney F/70
Also sleeping well at night are those like me who accept that U.S. states will never get to accessible assisted-dying laws. We go to Switzerland, DIGNITAS and similar membership organizations that you can join now.
I go 2023. You can join now and be ready for when it is your time. And, in the interim, teach others about what you have learned about Swiss law and services?
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@Barry
My intent -even living in California- is to go to a real progressive nation in the right- to- die movement ( such as Switzerland) should the circumstances call for it
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Wait. Can’t we still just go to the doctor or local drug dealer to o.d on opioid if it’s check out time?
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@Justvisitingthisplanet
Of course! Many prescription meds ( ie opioids, benzodiazepines) will cause respiratory suppression and death if taken all at once, rather than as typically prescribed.
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@Justvisitingthisplanet
The great majority of those over Sixty already have a very effective, pain-free way to end suffering. Already in their homes, just waiting. Medication(s) for high blood pressure. Just saying. Works very well with anti-anxiety meds OR opioids.
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@Phyliss Dalmatian
My answer when asked, theoretically, is that warfarin saved up is highly effective and largely painless. Do remember that warfarin is what Europe used to kill the rats that carried the plague!
A FL neighbor who was very sick and had used up his reverse-mortgage money, chose Easter Sunday (not religious) several years ago. Told one friend when he dropped off his dog and house key. Took his stash of warfarin with juice, better than water, to keep it down and he was gone in an hour. Set that plan many years ago so had lots of peace on the days before he died.
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How slippery is the slope between "I want this" and "You should do this"....?
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There's no slippery slope.
Try being a dementia patient for 15 years, running out of all your money and unable to do anything at all.
It's very arrogant to decide for someone else when they should live and when they should die.
Especially if you don't take care of them, pay for their care or vote against any government help to care for dementia patients.
My mother never, never ever wanted to live with dementia for 15 years. She wanted to die with dignity. But that is not an available option.
There is no slippery slope.
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Considering the barriers described in this article, I have no doubt many
will still try to get barbiturates from other sources. If you search the NYT archives, you will find information about those who travel to Mexico just to get these drugs. Apparently they are intended for putting down animals, and do not require prescriptions. (I have often thought that our way of death treats our pets with much more mercy than we allow for humans.)
How tragic that so many of us must die secretly and alone.
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@Virginia Eskridge
It is not possible to get barbiturates in Mexico, or anywhere else. However, there are other methods that are easily available, such as overdosing on Tylenol. See Derek Humphrey's book Final Exit for info on other effective methods, including helium.
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We need a mandatory living will in this country, starting at age say 55 or 60? Like when you apply for medicare or social security, it can be updated whenever a person wants/changed depending on the need/situation. What extreme measures/treatments, likely outcomes, and cost. I especially feel bad for people with Alzheimer and their caregivers, unable to make an informed decision before it is too late.
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What was not mentioned is the high cost of obtaining appropriate drugs to use for ending one’s life. In some cases, less effective drugs have to be used because of inaccessibility of short-acting barbiturates, thanks to prisons surreptitiously buying them up from Europe to kill prisoners under the death penalty..
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@Karmadillo It's not prisons buying them up, it's the pharma company that charges exorbitant rates. While Eli Lilly made Seconal as a generic, it was about $1 a pill. Now it's over $30 after the patent was bought by others and now is owned by Valeant. The end-of-life prescription is 100, so do the math. It's placed this out of reach of anyone poor, another cruel price they pay. There's a compounded formula in WA that's similar, but it's still $850, and finding the right combo of a Dr willing to prescribe that formula and then HAND DELIVER (a requirement) it to the formulary is another unreasonable hoop to jump through. We were very, very lucky my Dad was able to do this, but it took a lot of research and proactive planning for him to have this choice. Incidentally, we were told by several adult family homes and nursing facilities that they would not allow it on their premises- so we were supposed to take him to the car do to it? In the end, he did it in his retirement home, and we did not tell the medical staff in advance that he was going to. We were afraid they'd try to stop him. It was peaceful and private and a blessing of the highest order for all of us.
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@Karmadillo - You have that backwards. Europe refuses to sell barbiturates to the US for the purpose of aiding our death penalty. The remaining US states that still execute people are the ones scrambling to find drugs strong enough to kill humanely. They are failing, and are mixing drugs that, even combined, don't produce death without prolonged agony.
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@Melinda Just do what Canada did. Here we refused to pay the high price and quietly brought in the ingredients for pentobarbital as compounding medicine. The compounding formula is from the Netherlands, called Mixtura Nontherapeutica Pentobarbital. 99% of people here choose the "needle" method though where the doctor basically "puts you down."
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As an Illinois resident, I am very interested in this article. We do not have this option yet. I am 68, with two parents who had dementia/Alzheimer’s. My siblings and I have often discussed the idea that a person with dementia can live a long life, but be incapable of making the decision to legally end their life.
Please have more articles on this subject! Baby boomers want to know.
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@Jane
retired AMA attorney F/70
U.S. laws will never get to where the Swiss have been for many years: DIGNITAS Zurich 2023 is my date and widely shared need-to-know access.
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Once again, it is a matter of "choice". Because we live in a democratic society it is imperative we legalize all aspects of choices concerning our individual lives. No authority has the right to demand control over individual choices.
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@Nancibel
After all, who's life is it? Certainly not the States
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