End-of-Life Choice, Palliative Care and Counseling

Washington DWD will work for patientsby Sonja

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Last week’s Seattle Weekly story entitled “Terminal Uncertainty,” took on the problems of medical prognoses for terminal patients. But the story missed some important elements.

Estimating the course of a terminal illness is fraught with uncertainty. Responses to treatment differ, sometimes dramatically, between patients, based on on a multitude of variables.

No physician knows with certainty the course of a disease with or without therapy. The Death with Dignity statute in Washington stipulates that an illness must be “incurable and irreversible,” before qualifying it as “terminal.”

Waiting periods and hospice counseling provide patients the time and support needed to make a decision that reflects the patient’s own values and beliefs. This is why regulation to guarantee patients themselves remain in control, like Washington’s Death With Dignity Act, is so critical. The patient alone, not the physician, decides when the dying process has become unbearable.

The Oregon Hospice Association documents how the law operates in the real world: “Oregon ‘s hospices often describe as typical an individual who asks for a prescription on day 1, becomes qualified on day 15, and, because he or she has a plan to alleviate his or her worst fears, is then able to get on with life. That the Oregon law is available at all offers great comfort.” (Oregon Hospice Association, 2006–link)

Key results of the Oregon Death with Dignity Act are improved communication between doctors and patients, wider education about end-of-life treatments and better end-of-life care for all Oregonians.

Ten years of Oregon data demonstrate that the Death With Dignity law works for patients. About 40% of Oregonians who receive the medication never use it. Patients almost never take life-ending medication the day they receive a prescription. Significant percentages who request medication die during the 15-day waiting period. Studies show some patients live longer than anticipated precisely because of the comfort they receive from obtaining the medication and having a measure of control over their illness’ final stages.

We expect similar results in Washington.