End-of-Life Choice, Palliative Care and Counseling

Right to Die: Comforting Control at the End of the Lineby Sonja

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by Ilene Kaplan
Hartford Courant
January 11, 2013

Personal freedom, a core value among all Americans, means control of our lives at all times. We cherish and protect personal choice. After a lifetime exercising this freedom, people should not be denied control when excruciating illness is poised to claim their body.

Terminally ill patients want control at the end of their life, just as they’ve always controlled their other health decisions. They want assurance that if suffering and indignity make living unbearable, they have the means to peacefully end it.

Legislation has been introduced in the General Assembly that would allow a physician to prescribe medication to a mentally competent, terminally ill patient who can self-administer the medication to bring about a peaceful death. I hope, after appropriate debate, such a bill will be passed. It is time we give grown-ups the freedom to choose and let physicians willing to provide this choice feel safe in doing so. Connecticut needs a rational public policy for every end-of-life option.

In states where it is legal, aid in dying provides great comfort not only for the very few who actually use it, but for many others in just knowing the choice exists. For patients staring an unbearable death in the face — and those close to them witnessing this anguished decline — the option to end their suffering in a peaceful way is an enormous comfort. It is not for the government or anyone else to say that is wrong.

An additional benefit to allowing terminally ill adults to control their end-of-life choices is to regulate a practice that has been occurring covertly for years. With limited options, some people desperately turn to anyone they think might help them end their agony.

In a series of highly publicized Connecticut cases over the last two decades, for example, suffering patients with terminal illnesses begged a family member or friend for assistance in ending their lives, resulting in criminal prosecution of the loved one who acquiesced.

I, too, have received such a call. Many years ago, a dying woman presented me with a horrifying image. She could not find a doctor to help her die. She said, “I don’t need my money anymore. There must be a doctor out there willing to help me for the right price.” Currently, doctors fear helping patients carry out their end-of-life choices, even if the physician acts in accordance with a patient’s wishes. Until, under law, terminally ill adults are allowed to control their dying and doctors are protected in supporting them, they’ll continue to seek other methods.

In states where aid in dying is legal, there is no evidence of abuse, and in fact, very few people even exercise this option. Oregon’s law only accounts for 0.2 percent of deaths. Out of 114 patients who went through the process of getting their end-of-life prescriptions last year, 37 percent (43 people) never used them. The misery, pain and loss of autonomy as death nears can be so excruciating that for some, just knowing the means to a quicker death is available helps them through the grimmest moments, whether or not it ever comes out of their nightstand drawer.

National polls show overwhelming support for patient choice even though it would only touch a tiny fraction of the population. Most of us will live as long as we’re able, through age and aches and distress, until our bodies finally just quit. The issue is whether everyone, whatever their agony and whatever their wishes, must be forced to die on the schedule their disease decides for them, or whether individuals control this crucial decision.

Critics raise concerns that such a law might be abused. But there is zero evidence of such abuse in other states that have approved such legislation.

Opposition is strongest among religious groups who believe only God should have the power to make life-and-death decisions. Yet medical science has advanced to the point that respirators, feeding tubes, dialysis and other torturous procedures can artificially keep a failing body going on and on, robbing it of its clear intent to die. Is that not battling God as well, and a capability fraught with its own forms of exploitation and abuse? People’s right to apply their religious values to their own decisions does not include the right to make decisions for others.