Oregon

Sep 21, 2012Oregon End-of-Life Care Program Spreads, Report Finds

By Nick Budnick
The Oregonian
September 20, 2012

An Oregon effort to ensure people near the end of life receive the care they want continues to spread across the country, according to a new report.

The Oregon Physicians Orders for Life Sustaining Treatment (POLST) program, created two decades ago and put into state law by the Legislature in 2009, has been adopted by 15 states and is under consideration in 28 others, according to the report, prepared by the Retirement Research Foundation and the Archstone Foundation.

That’s an increase just over last year. Then, the program, which includes an electronic registry of detailed end-of-life care instructions, had been adopted in only 12 states.

The report, which advises other states on lessons learned, will formally be released Monday, Oct. 1, but a draft copy has already been released by Oregon Health & Science University, which houses the POLST program.

It recaps the accomplishments of the program, which has been used by 88,000 Oregonians. On average, the registry receives 3,500 to 4,000 new medical-instruction forms each month. More

Sep 21, 2012A Graceful Exit: Taking Charge at the End of Life

by Claudia Rowe
YES! Magazine

September 19, 2012

I was standing in my cubicle, a 24-year-old fact-checker envisioning a publishing career of glamor and greatness, suddenly shaking as I read the document my mother had mailed. It detailed her wish that I promise never to keep her or my father alive with artificial respirators, IV-drip nourishment, or anything else she deemed “extreme.”

I was horrified, and slightly angry. My mom was a 54-year-old literature professor who’d spent the 1970s eating whole grains and downing vitamins. She was healthier than anyone I knew. Why get so dramatic now? It seemed ghoulish, not to mention premature. But I scrawled my signature at the bottom of the page and shoved it into an envelope, my mother’s voice in my head, prodding me along.

As with the whole wheat and vitamins, my mother—back in 1990—was onto something long before it became conventional wisdom. But these days, Americans’ approach to aging and death is rapidly evolving, pushed both by the numbers and the grim reality behind them: In 40 years, there will be 19 million Americans over 85, all at high risk of losing the ability to care for themselves or dwindling away due to organ failure, dementia, or chronic illness. (The days of a sudden fatal heart attack are fading; by 2008, the death rate from coronary heart disease was down 72 percent from what it was in 1950.)

So while many seniors now live vigorous lives well into their 80s, no one gets a free pass. Eating right and exercising may merely forestall an inevitable and ruinously expensive decline. By 2050, the cost of dementia care alone is projected to total more than $1 trillion.

My mom’s decision to face her end came not from any of these facts, but from the nightmare of watching her own mother’s angry decline in a New York nursing home. “You’re all a bunch of rotten apples,” Grandma growled at visitors, the words erupting from her otherwise mute lips. And there she sat for three years, waiting to die. “Why can’t you just get me some pills so I can go?” she would sometimes wail.

The slide toward death was only slightly less awful for my father’s mother. Grandma Ada would greet me with a dazed smile—though it was impossible to know if she recognized the person standing in front of her wheelchair—before thrashing with involuntary spasms. An aide would come to restrain her, and then my dad and I would leave.

This cannot be right. This cannot be what we want for our parents—or ourselves. More

Sep 18, 2012Going Gently Into That Good Night

By Daniel Krieger
Narratively
September 18, 2012

If you’re dying and don’t care to wait around for death, you can always book your own appointment. One simple way to do this would be to stop eating and drinking; another would be to stop life-sustaining medicine or devices. Assuming you can decide on your own, both of these methods are good and kosher as far as the law goes. A third approach, however, ventures into a grayer area of legal and ethical terrain—quaffing a lethal cocktail. In the business of ending your life, the means matter a lot more than the final result.

These were three things my mother, Ann Krieger, was pondering when she reached the final leg of her terminal illness last year, a month before Mother’s Day. After several years of fighting colon cancer, her doctor broke the news that the cancer had spread and the treatment was no longer working. There was no more they could do.

“You’ve got months, not weeks,” he said.

“What should I do?” she asked. “Should I end it now?”

“No,” he said. “You don’t want to do that.”

Actually, my mother kind of did, but the doctor referred her to hospice and gave her information about palliative care, a mode of treatment that relieves the pain of patients with serious illnesses. But in my mother’s case, the physical distress was less acute than the existential. Coming to terms with the fact that you’re going to die is elusive. For some people, like her, an attempt to manage the logistics could make it seem more doable. She and my father had given this some thought and had very specific ideas about how they wanted their end-of-life matters handled.

Six years earlier, horrified by what was taking place with Terri Schiavo in Florida, they sat my sister and me down to give us instructions. Should it ever come down to it, my parents told us, they wanted no artificial resuscitation, experimental procedures, machines or IVs—none of that stuff. They just wanted us to make sure they would be allowed to die naturally. “The idea,” my father explained to me recently, “is to be pain-free, comfortable and not go through a lot of unnecessary, costly and painful treatments which won’t help anyway.”

My mother had first-hand experience with this 21 years ago when her mom, my grandma Trixie, who was in perfect health at 85, was struck by a hit-and-run driver near her home in Queens. The doctors at New York Hospital said she had severe trauma in her brainstem and wouldn’t wake up. She was hooked up to a ventilator. More

Sep 14, 2012Ashland Hospital Forum Dominated by Questions on End-of-Life, Abortion

By Sam Wheeler

Mail Tribune
September 14, 2012

Some of Ashland Community Hospital’s policies will change if a partnership is formed with Dignity Health, representatives from the hospital system said Thursday night.

Physicians at an ACH run by Dignity Health would not be able to prescribe patients who qualify under the Oregon Death with Dignity Act medication that induces death upon ingesting, system officials told about 45 people at the first of two forums on the possible merger.

“If the physician is on our dime “… the thing that the physician cannot do is write the prescription and hand it to the patient,” said Carol Bayley, Dignity Health’s Vice President for Ethics and Justice Education.

Currently, ACH has “no policies that dictate the issue one way or another,” said Mark Marchetti, ACH chief executive officer.

Marchetti had said Wednesday that the end-of-life care its patients receive will not change if a partnership is formed with Dignity Health; but, according to Bayley, it will. More

Aug 21, 2012Northampton woman, plagued with terminal illness, supports ‘Death with Dignity’ option on the Massachusetts ballot

By Dan Ring
The Republican
August 20, 2012

Myra P. Berzoff said she doesn’t know if she would take life-ending medications, but said she would like the choice.

Berzoff, a Northampton resident for about 12 years, has been receiving home-based hospice services through Cooley Dickinson Hospital. At 91, she needs oxygen virtually 100 percent of the time, or else she would suffocate. She said she was diagnosed with emphysema three years ago and lives with the fear she could die from breathlessness.

Berzoff said she is a strong supporter of a ballot question on Nov. 6 that if approved by voters would allow adults to self-administer lethal drugs after requesting a prescription. The proposed Death with Dignity Act is modeled after similar laws in Oregon and Washington, also passed by voters. To be eligible, people would need to be diagnosed with a terminal illness and given six months or less to live by a primary doctor with verification by a consulting doctor.

Berzoff, who ran programs and performed other duties at the Helen Keller Services for the Blind in New York for about 20 years, said she wants to live long enough to vote for the ballot question. “I think everybody has a right in making that decision if they are of sound mind,” she said. “I don’t see any point in forcing people to live on and on. I don’t see a reason.”

Opponents call the ballot initiative “physician-assisted suicide.” Critics say that hospice and palliative care are better choices. A new group, called the Committee Against Physician Assisted Suicide, has started a web site at www.stopassistedsuicide.org.

Berzoff said she is losing weight, requires oxygen around the clock and must use a walker to get from room to room in her home.

“I don’t know how much palliative care will do for me in the final analysis,’’ she says. “I don’t know how sick I will get in the final analysis.”

She said she used to smoke about a half pack of cigarettes a day, but quit decades ago when her grand-daughter, Sarah, then 4, told her she didn’t want her to die from smoking. She doesn’t know if smoking caused her emphysema.

Berzoff , who has Medicare, received hospice because she said her doctor has twice certified she had less than six months to live. But she said she has refused to die and that she doesn’t consider herself terminally ill as long as she has oxygen.

She said she has reached no conclusions about whether she would self-administer drugs to instantly take her life.

“I think I should have the right if tomorrow I decide I want to do myself in,” she says bluntly. “I’m using up resources. I feel very strongly about that.”

Basically the same law was enacted in Washington in 2009 and Oregon in 1997. Relatively low numbers of people have used the law, including 114 people who received the lethal medications prescribed by a doctor in Oregon last year and 103 in Washington, according to reports by public health authorities in those states. Roughly a third of those in each state did not use the drugs, however.

Among the opponents of the ballot question in Massachusetts are the four Roman Catholic bishops including Bishop Timothy McDonnell in Springfield.

In the September issue of the Catholic Mirror, due to be released the end of this month, McDonnell writes that the ballot question seeks to authorize physicians “to give death-dealing drugs so that people with serious illness can commit suicide,” according to an excerpt of his column provided by the Diocese of Springfield.

James F. Driscoll, executive director of the Massachusetts Catholic Conference, the public policy arm for the Roman Catholic bishops in Massachusetts, said the church values life from conception to death. He said the church is a big supporter of hospice and palliative care. McDonnell also emphasizes hospice and palliative care in his upcoming column.

Driscoll said the ballot question would set a dangerous precedent. “The church is against this initiative and thinks it is a dangerous path to take a human life before natural death,” Driscoll said.

About 2.6 million Catholics live in Massachusetts, or about 40 to 45 percent of the population, according to Driscoll.

The new coalition, named the Committee Against Physician Assisted Suicide, said it plans to recruit citizens, healthcare leaders, and religious organizations to defeat “this poorly written, confusing, and flawed ballot question,” according to its web site.

Under the ballot question, which qualified with the signatures of about 125,000 registered voters, terminally ill patients would need to make three requests for the medications including two oral and one written, with two different waiting periods between the final request and the prescription.

Stephen Crawford, a spokesman for Dignity 2012, said two former editors of The New England Journal of Medicine and other key doctors were among the original signers of a petition for the law.

The Massachusetts Medical Society, however, opposes the ballot question, keeping in line with the Society’s longstanding policy against physician-assisted suicide, said spokesman Richard P. Gulla.

Dr. John S. Howland, a family physician in Southbridge, said the ballot question is not good for physicians because it would violate the Hippocratic Oath. “It’s very detrimental to the doctor-patient relationship,” he said.

Crawford said the ballot question does not call for suicide in the traditional sense, which involves depression and despair. He also said the initiative should not be labeled “physician-assisted suicide,” which conjures up images of the late Dr. Jack Kevorkian and his “suicide machine” made of scrap parts.

“This is about patients who are suffering,” Crawford said. “This isn’t about the doctors.”

Berzoff, born in New Haven, grew up in a different era.

Her father, a Yale University graduate, contracted tuberculosis, an infectious disease mostly of the lungs. The family moved to western North Carolina , along with thousands of others with the then-incurable disease, seeking fresh air and sunshine.

Born of Jewish parents, she attended for 11 years and graduated from St. Genevieve-of-the-Pines, an all-girls Catholic school, considered one of the state’s best private schools. She obtained her bachelor’s at the University of North Carolina at Chapel Hill and her master’s at The Teachers College at Columbia University.

Her husband, Sydney, a longtime director of development for Brandeis University, would not have agreed, she concedes. He would have taken any treatment to stay alive, she said. He suffered for many months from lymphoma before dying at 49, leaving her a widow for the last 45 years. A daughter, Barbara Shapiro, 49, died of breast cancer after a prolonged period.

Another daughter, Joan Berzoff, is a professor at the School of Social Work at Smith College in Northampton, and a third daughter, Emily Enteress, is businesswoman.

Taught by nuns at Catholic school, Myra Berzoff scoffs at the argument that the ballot question is dangerous because it advocates taking a human life before natural death. She said she should have the option offered by the ballot question.

“That’s absurd,” she said. “If you’re suffering, it’s your life. It isn’t the life of the Catholic church. It’s mine.”

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