End-of-Life Choice, Palliative Care and Counseling

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Hobsons Choice

Today family, friends and neighbors who loved Joan and Thomas Vanacore are grieving their tragic deaths and wondering how it might have been different. The Vanacores, known by the community of North Haven, Connecticut as decent and loving people, died violently — because our society is dysfunctional around death. Our laws are cruel. Connecticut law denied them the peaceful, humane choices they deserved as their exemplary lives drew to a close. Compassion & Choices is working hard to change that and the sadness of this case only increases our determination to succeed.

Both the Vanacores had terminal illnesses. Thomas, 73, had advanced cancer and Joan, 70, was dying of Alzheimers. We can’t know for certain what Thomas was thinking when he shot his beloved wife of 38 years in the head and turned the gun on himself in the sunroom of their home. But as their story unfolds, it repeats a pattern and illuminates truths all too familiar to those who fight for dignity and choices at the end of life.

Here is that truth in a nutshell: Many people with terminal illness want desperately to meet death on their own terms. Facing imminent disintegration of body and mind, they wish their passing to reflect the values and beliefs of a lifetime and avoid prolonged, needless suffering. The laws of most states prevent them from planning a peaceful, intended death, so they resort to violent means. Some jump from balconies and some drive into highway abutments. But most turn to America’s icon — the gun.

Shame, shame on a society that forces such a Hobson’s choice. These are our elders, the generation that fought the war for democracy and freedom and they deserve better. Their actions reflect values that form the very backbone of America. Among these are a deep sense of responsibility for themselves and others, courage to face the hard facts of a tough situation, and the practical ability to take charge of their fate. Many also act from extreme altruism and desire to spare their families the burden of a long and difficult demise. Courage, altruism, responsibility — those who would condemn the Vanacores don’t appreciate the force of these bedrock American values.

The Vanacores join a line of decent, distinguished couples whose character led them to similar actions at the end of their lives. World War II Admiral Chester Nimitz, Jr. and his wife planned their death together and left loving notes for their family. In 1975 world famous theological scholar Henry van Dusen and his wife faced declining health and took overdoses of sleeping pills to end their lives. A letter for their three sons and said they had led happy lives, and were not afraid to die. Van Dusen’s successor as President of Union Theological Seminary commented that “He had a very strong belief in immortality. His attitude was that, when your time is up, when you have lived out the possibilities, it is all right to stop, and to go on to the next life.”

Why doesn’t society allow people who share Van Dusen’s conviction to pursue it openly and die in peace with medication prescribed by their doctor? Forcing people to plan in secret and act alone prevents a careful medical evaluation and the opportunity for palliation and probably shortens their lives even further. As Nobel laureate Percy Williams Bridgman, dying of cancer, wrote about his own self-inflicted gunshot, “It isn’t decent for society to make a man do this thing himself. Probably this is the last day I will be able to do it myself.”

When I think of the character of such people I always recall the story told by a woman from the little town of Sedro Woolley in Washington State. She described her husband as a person who “took care” of whatever needed doing. He took care of their rural home, and he took care of her. Dying of cancer and suffering excruciating pain, he still looked out for her needs. The day he died he spent the morning sharpening all her kitchen knives. Then he embraced her tenderly, went out to the yard and shot himself there, so it wouldn’t make a mess in the house.

The people who take pride in “taking care” deserve better from us. They deserve real choices and permission to die in peace and comfort, with the same honor and decency with which they lived their lives.

Aid in dying, the opportunity for the terminally ill and mentally competent to have the choice of life-ending medication prescribed by their doctors, is legal only in Oregon, Washington and Montana. Connecticut should turn the tragedy of the Vanacore case into hope and comfort for those who follow. The case in litigation, Blick v. Connecticut, takes the first step toward that hope.

Doctor’s role with terminal patients argued in court

New Haven Register
By Ed Stannard, Register Metro Editor
March 9, 2010

HARTFORD — The question of whether a doctor can be charged with manslaughter for helping a patient end his life came before a Superior Court judge Monday.

The state, represented by Associate Attorney General Perry Zinn-Rowthorn, sought to persuade Judge Julia Aurigemma that a suit by a right-to-life group should be dismissed.

On the other side, Daniel Krisch, representing two doctors who sued the state, argued a doctor helping a terminally ill patient die with dignity should not be arrested under the state’s assisted-suicide law.

The law says helping someone commit suicide is second-degree manslaughter, a Class C felony. The plaintiffs claim a doctor prescribing medication to a terminally ill, mentally competent patient is providing end-of-life care, not aiding suicide.

Zinn-Rowthorn said the suit, seeking a declaratory judgment from Aurigemma, is improper because it is asking the judge to legislate. Ruling for the doctors, he said, would “risk serious harms to public health and it would intrude on the legislators’ prerogative” to decide public policy.

Among Zinn-Rowthorn’s reasons were that there is no patient who is in imminent need, so the medical state of anyone requesting this assistance is unknown.

He said the General Assembly has refused to change the law to make an exception for doctors, but a bill introduced last year had “14 pages of definitions, of restrictions, oversight, check that were built into the legislation.”

There would be no such protections if aid in dying was approved by a judge’s order rather than legislation, he said.

Krisch argued “there is a growing consensus” in the medical community differentiating suicide from aid in dying. “This is an appropriate medical treatment option for patients to be able to discuss with their doctors,” he said.

He said the doctors involved have had patients request medication to end their lives, people who are “suffering real, horrible diseases … facing very real, very hard choices.”

Watch the video of patient Sheldon Smith at the New Haven Register>>

Krisch said if doctors were allowed to prescribe lethal medications the legislature would create needed safeguards. “Doctors are not going to go around willy-nilly. Doctors are bound by medical ethics,” he said.

“It won’t be the Wild West of aid in dying.”

READ OUR PRESS RELEASE HERE>>

We Should All Have The Right To Die As We Choose

By Helen Ubiñas, Hartford Courant, October 8, 2009

John Welles loaded his old .38-caliber revolver, bent his tiring frame over a walker to make his way out to his garden and laid down.
His friend Hunt Williams, who’d just cleaned the gun, suggested where Welles should aim the revolver and then began walking the 100 or so yards up the driveway.

“God bless — ” Williams called out.

But before he could finish the sentence, Williams heard the shot.
It’s been about five years since Williams was charged, and later granted a special form of probation, for helping his 66-year-old friend end the excruciating pain from advanced prostate cancer that was eating away at his bones. And while Williams’ story has been told often in the years since, something struck me Wednesday as he recalled the chilling details again — this time at a press conference in Hartford announcing a lawsuit aimed at preventing physicians from being prosecuted for prescribing drugs to end a person’s life.

We’ve been here before, of course. Advocates trying to legislate a person’s right to die. There was a bill introduced last year, but it didn’t go very far.

And the opposition wasted no time making it clear that it will do whatever it can to ensure that this latest attempt won’t go very far, either. Michael Culhane, executive director of the Connecticut Catholic Conference, told reporters that the church opposes the lawsuit and will attempt to intervene.

“… Life is sacred from conception to natural death,” Culhane said.

Well, that’s one argument. Another is “do no harm,” the oath doctors take. And those who oppose assisted suicide echo that sentiment, arguing that it is not the right or responsibility of anyone to choose when someone else dies.

But listening to Williams, it was clear that harm is being done.

To people like Williams, brave enough to stand by his friend, compelled by love to do what the state won’t allow, what those who oppose say no one has the right to do.

And to people like Welles, forced in his darkest hour to inflict the kind of violence on himself that no one should have to resort to in a desperate attempt to end unfathomable pain.
Sheldon Smith, who also spoke Wednesday, has a plan. A living will and a bottle of sleeping pills for the moment the 86- year-old decides that the pain from his fourth-stage abdominal cancer becomes unbearable, that his terminal illness has robbed him of a life worth living.

“I want to leave this world with the same dignity with which I’ve lived my life,” he said.

Smith has already held a farewell party to celebrate his life — with a live band and lots of moving words from friends and family.

But again, Smith is on his own.

I understand the misgivings some might have; I have a few myself. As I spoke to Smith after the press conference, I wondered how this man who still seemed so full of life would know when the right time was, how he’d differentiate between a bad day and the day.

But that’s a decision for Smith to make, one that we should all be able to make for ourselves. And more important, that we should respect.

“It’s time for the courts to make it clear that John Welles deserved better, that I deserved better and that terminal patients and their families in our great state of Connecticut deserve better,” Williams said at the end of his speech.

He’s right. If we have a right to live as we choose, we should have the right to die as we choose as well.

READ MORE ABOUT BLICK v. CONNECTICUT HERE >>

Suicide Law Challenged

Doctors: Can We Be Prosecuted In State For Aiding Terminally Ill?

By Arielle Levin Becker, The Hartford Courant, October 7, 2009

State law prohibits a person from intentionally helping someone commit suicide. Now a group of doctors is asking if that same law prohibits doctors from agreeing to a terminally ill patient’s request to prescribe medication the patient could use to end his life.

In a lawsuit against the state, the doctors are asking the court to clarify whether the law allows physicians to be prosecuted for prescribing medication to mentally competent, terminally ill patients who could use it to end their lives. The lawsuit argues that they should not be prosecuted, said Kathryn Tucker, an attorney for the doctors and director of legal affairs for the national end-of-life-care advocacy group Compassion & Choices.

“In some sense, the underlying question is do we consider the choice of a dying patient for a peaceful death, do we consider that suicide, or is it something different,” Tucker said. “And our argument will be that it is very much different.”

If the suit succeeds, Tucker said, it could serve as a model for addressing end-of-life cases in other states with similarly worded laws.

A spokesman for the group said the suit was filed late Tuesday. A copy could not be obtained Tuesday night, and both the spokesman and Tucker said they would not release the suit or the names of the plaintiffs before a press conference this morning.

Only two states, Oregon and Washington, allow terminally ill patients to end their lives by taking lethal medications prescribed by a physician. Washington’s law was approved by voters last fall; Oregon’s law was enacted in 1997. In Oregon, 88 patients received prescriptions for lethal medications in 2008, according to a report published by the Oregon Department of Human Services. Of those, 54 took the medication, 22 died of underlying disease and 12 were still alive at the end of the year. In addition, six people with earlier prescriptions died from taking the medications in 2008.

In other states, Tucker said, doctors who treat patients with terminal illnesses face questions from patients who wish to end their lives, and some help them in covert ways. Sometimes, she said, patients turn to family members or friends for help.

“Right now in Connecticut, if you are a terminally ill patient and you are trapped in a dying process that you find unbearable, which does happen from time to time, you don’t currently have the freedom to turn to your physician and ask that physician to provide a prescription for medication that you could choose to consume to bring about a peaceful death and to end the suffering that you find unbearable,” Tucker said. “And the reason why is that physicians in Connecticut have assumed that an old, vague Connecticut law that allows criminal prosecution of a person who assists another to ‘commit suicide’” could be used to prosecute them.
Connecticut residents who have helped terminally ill friends or relatives end their lives have been prosecuted.

In 2005, Cornwall resident Huntington Williams was charged with second-degree manslaughter after allegedly helping his friend, John T. Welles, 66, kill himself the year before. Welles had advanced prostate cancer that had metastasized into his bones. Williams was at Welles’ home to care for him.

A warrant for Williams’ arrest described the two men’s actions before Welles died: Welles went into his bedroom to get his gun. Williams cleaned it. Welles loaded it. Williams carried it outside, and both men discussed where Welles should aim it. The men shook hands, and Williams headed down his friend’s driveway. Within minutes, Welles died of a self- inflicted gunshot wound to the head. Williams called police. Dozens of Cornwall residents showed up in court to support Williams. Eventually, he was granted a special form of probation allowing first-time offenders to avoid jail and a criminal record.

Williams said Tuesday that he supports the doctors’ lawsuit. He plans to attend and speak at today’s press conference because he feels strongly about helping others who might end up in the position he was in.

“As people get older and their health is bound to decline, then there could very readily be a fear of becoming incapacitated and not being able to control their own destiny,” he said. “I think that’s where a lot of the emphasis should be placed.”

Williams said he did not think any change in the law or policy would be widely used.

“I suspect if all goes well, in the future, when this is passed, that there’ll be a very small percentage of elderly people that do this,” he said. “But it’s that few that need it that’s important.”

READ MORE ABOUT BLICK v. CONNECTICUT HERE >>