End-of-Life Choice, Palliative Care and Counseling

Game Changerby Sonja


Dr. Eric Kress vividly remembers the two patients who changed his mind. Kress is a family physician in Missoula, Montana, and for many years medical director at Hospice of Missoula. He was the one patients looked to for advice at the end of life. Most of the time, quality hospice care would guide them through their dying process in a comfortable fashion. But hospice care is not the answer for every patient.

Shortly after the Montana Supreme Court’s Baxter decision clarified state public policy did not prohibit aid in dying, Kress got a visit from the first patient, a man terminally ill with advanced amyotrophic lateral sclerosis, or ALS. This patient — a “rugged individualist,” Kress says — asked for an aid-in-dying prescription, but the court decision was new, and Kress was hesitant. The memory of this man’s reaction haunted Kress.

“He scolded me and told me I was a coward. He couldn’t pound the table,” Kress says. “But emotionally, with his eyes, he was pounding the table.”

Kress remembers the sleepless nights he spent pondering the questions the man provoked: “What kind of man or doctor am I? Am I just going to sit idly by watching a proud man suffer and die, or am I going to be brave and do what it takes to help people at the end of life?”

Several weeks later that patient was able to stockpile enough of his pain medication to hasten his death by putting it in his feeding tube.

“I felt a sense of failure and cowardice that I had not acted in that patient’s best interests,” Kress says. “I was more worried about me than I was the patient when I made that decision. Emotionally, for me, I was ashamed of it, that I hadn’t written the prescription for him.”

Not long after, a patient with terminal esophageal cancer asked Kress for medication he could have available for when his suffering became severe. After several conversations and confirmation of his diagnosis, Kress agreed to write him a prescription. The patient filled it and immediately gained great peace of mind. As time passed, the man’s pain became unrelenting and he knew it would not be long before he was unable to swallow. He decided it was time, and he asked Kress to be there when he died.

“He prepared the medication. He then opened a bottle of Guinness and insisted we all join him in a toast. All of us present were amazed at how peaceful his death was.” His last words to Kress were a plea to do anything he could to “further the cause.”

Since then, nine other patients have asked Kress about aid in dying, and he’s written prescriptions for two more. For Kress, responding to their requests is simply part of his palliative care practice. “Somebody is going to die, and you’re alleviating their symptoms in the dying process. That’s palliative care.”

But this year, opponents of end-of-life choice introduced a bill in the Montana legislature to gut the Baxter decision, threatening prison and fines for doctors who provided aid in dying.

The last words of that second patient came back to him, and Kress decided to share his story “to further the cause.” Publicly testifying against the bill, Kress asked, “You may be wondering, what kind of doctor is it that you will be sending to jail? I stand before you and state that I am that kind of doctor, I have written an aid in dying prescription on three occasions.” He repeated the message in Compassion & Choices radio ads and to reporters in Montana and across the country.

The Montana Senate rejected that bill (HB505), and many think support for it collapsed when people realized it targeted physicians like Eric Kress. Compassion & Choices Montana campaign manager Emily Bentley says Kress’ story was a “game changer.”

“Before Dr. Kress came out, our opponents liked to say the Baxter decision made it a ‘gray area,’” Bentley says. “Now, with Dr. Kress coming out, we know it is legal and doctors are providing this. Something like HB505 isn’t just theoretically clarifying something. They’re actually stripping away a right that currently exists.”

Kress is pleased with the results, and plans to continue his activism. “The senators clearly listened to me and to the citizens of Montana and were open-minded, and I appreciate it.” Dr. Kress clearly listened to his patients, and forever changed end-of-life care in Montana, and the political landscape surrounding it.