End-of-Life Choice, Palliative Care and Counseling

Posts Taggedphysician assisted suicide

For Palm Springs man, grief and anger over an end-of-life decision

By Steve Lopez
Los Angeles Times
July 21, 2012

On the evening of July 2, Bill Bentinck, 87, was led from his Palm Springs home in handcuffs, in mourning and in shock.

The body of his wife of 25 years, Lynda, was still in the house, but there was no time to grieve. After telling police that his terminally ill wife had chosen to disconnect her oxygen supply and put an end to her suffering from emphysema, he was arrested on suspicion of murder.

Bentinck, a straight-talking man in the Jimmy Stewart mold, felt that he had made a difficult but compassionate choice in honoring his wife’s last wish and not reconnecting the oxygen. But police saw it differently, and Bentinck, a retired entomologist and medical equipment designer, was about to endure a nightmarish three-day ordeal. More

The Evolving State of Physician-Assisted Suicide

By Jaime Joyce
The Atlantic
July 16, 2012

Should terminally ill patients have the right to kill themselves? Voters in Massachusetts will soon decide. Last Wednesday, the Secretary of the Commonwealth announced that on November 6, 2012, when Bay State voters go to the polls to pick the next President, they will also have their say on a ballot measure called the Death with Dignity Act. If passed, the law would make Massachusetts the third state to give adults diagnosed with six months or less to live the option to end their lives using a lethal dose of doctor-prescribed medication.

Last year, volunteers from across the state began a petition drive to collect the 68,911 signatures needed to introduce the act for consideration by the state legislature; by the time they were done, they’d gotten more than 86,000 voters to sign on to show their support. Lawmakers had until the beginning of May to address the issue, but they declined to do so. In response, volunteers fanned out for a second wave of signature gathering. An additional 21,000 people from the state’s 14 counties signed on to support the Act. That’s nearly double the number needed to bypass the statehouse and bring the issue directly to voters via ballot measure.

Oregon and Washington were the first states to enact Death with Dignity laws. (In Montana, the state’s Supreme Court ruled in 2009 that physician-assisted suicide was legal, but Montana has no guidelines in place to regulate and monitor the practice.) Since 1997, when Oregon’s Death with Dignity Act went into effect, more than 900 people have received prescriptions to their end their lives. Not all have used the drugs. The Oregon Public Heath Division reports that more than 600 individuals have taken the dose, while the remainder either decided against using the prescription, or succumbed to their diagnosed illness.

In Oregon and Washington, patients must first make two requests of their doctor for medication, fifteen days apart. The patient then has to make the request in writing. In order to prevent potential abuses, patients are required to sign consent forms in the presence of two witnesses to whom they are not related. Once approved, patients must self-administer the drugs. Typically, it’s a deadly dose of Seconal, a barbiturate often prescribed by doctors to treat insomnia or to calm patients before surgery. The contents of the capsules are stirred into a glass of water or a serving of applesauce, to dull the taste. Statistics compiled and released annually by the Oregon Department of Health show that in the majority of cases, people lose consciousness within five minutes of swallowing the drugs. It can take anywhere between one minute and four days to die, but for most people death comes in just 25 minutes.

Ninety-eight percent of people who have made use of the law in Oregon are white. Eighty-one percent had cancer. Fifty-two percent were men. The median age of those who died using the law was 71. Most patients were enrolled in hospice and privately insured. They cited loss of autonomy, loss of dignity and the fact that they were “less able to engage in activities making life enjoyable” as the top three end-of-life concerns. In Washington State, where a Death with Dignity Act was approved by ballot initiative in 2008, and went into effect the following year, patients fit a similar profile. According to the latest figures released by the state, 135 people have died from the lethal prescription. The Death with Dignity Act that will go before Massachusetts’s voters this fall is modeled after laws in place in Oregon and Washington.

A survey conducted in May by Western New England Polling Institute showed that 60 percent of Massachusetts’s voters supported the rights of terminally ill patients to legally obtain and ingest life-ending drugs. Still, the measure faces tough challenges from powerful factions within and beyond the state. The Massachusetts Medical Society opposes the Act. The American Medical Association does too. “Physician-assisted suicide is fundamentally incompatible with the physician’s role as a healer,” the AMA states in its Code of Medical Ethics. “Patients should not be abandoned once it is determined that cure is impossible.”

Disability-rights activists have also spoken out against physician-assisted suicide. So has the Catholic Church. Noting a resurgence of interest in the topic and a renewed push by advocates of physician-assisted suicide to extend the practice beyond Oregon and Washington, the United States Conference of Catholic Bishops last year issued an impassioned statement against the practice. In Massachusetts, the Roman Catholic Archdiocese of Boston, anticipating the ballot measure, created a website, suicideisalwaysatragedy.org. “Our society will be judged by how we treat those who are ill and infirm,” Archbishop of Boston, Cardinal Sean O’Malley, says in a video address that appears on the site. “They need our care and protection, not lethal drugs.”

But it’s the people of Massachusetts who will ultimately decide the law’s fate, not religious leaders, lawmakers or medical professionals. Dr. Marcia Angell, former editor of Massachusetts Medical Society’s New England Journal of Medicine, and one of the Act’s lead sponsors, puts little stock in what physicians have to say about the matter.

“I am less concerned with what doctors want than with what patients want,” Angell said in an interview that aired on WGBH, in Boston. She continued, “I think doctors sometimes have a too-narrow idea of what their own obligations are. They feel they have an obligation to extend life even when it can’t be extended significantly. And even if you have that situation, then it seems to me they have two obligations. One is to support the autonomy, the self-determination of their patients. And the other is to relieve suffering. If you can’t extend life significantly, then you must relieve suffering.”

A study released by the Health Research and Education Trust shows that Americans are living longer lives than ever before. As a result, more individuals and families will face difficult questions about end-of-life care. In 2011, the oldest Baby Boomers turned 65. By 2030, the number of Boomers between 66 and 84 years old will climb to 61 million, and six out of 10 will be managing chronic health conditions. For the elderly and others facing terminal illness, doctors have numerous ways to prolong life. Palliative and hospice care are available to help patients find peace and comfort in their final days. But there are some people who want another option, which is the right to end suffering by taking their own life at a time and place of their choosing.

Where’s our right to die?

By Santiago Wills
Salon
July 3, 2012

Just a couple of weeks ago, the British Columbia Supreme Court fired the latest volley in North America’s long and dramatic debate about physician-assisted suicide. In a 395-page ruling, Justice Lynn Smith claimed that the Canadian constitution didn’t prevent doctors from aiding suffering patients who wished to end their lives — a position that kicked up attention south of the border as well.

During the past two decades, similar contested rulings have opened the way for physician-assisted death in the United States. Despite strong opposition from religious organizations and groups representing handicapped and disabled people, Oregon and Washington state legalized physician-assisted suicide in 1997 and 2008, respectively. In fact, since 1997, more than 900 people in Oregon have received a prescription to commit suicide, while in Washington, nearly 300 people have requested a similar death in the last four years.

Assisted suicide, to put it mildly, is a controversial subject — and one that continues to be fought over vociferously by both right-to-die activists and religious groups. But according to Howard Ball, a professor emeritus of political science at the University of Vermont, the legalization of physician-assisted death is a gesture of human compassion. As he details in his new book, “At Liberty to Die: The Battle for Death With Dignity in America,” the issue goes to the heart of bigger questions about the American soul — from the meaning of personal liberty to the importance of constitutional law.

Salon spoke to Ball over the phone about the evolution of death, Jack Kevorkian and the right-to-die movement’s legal hopes.

A License to Do Whatever a “Health Care” Worker Feels Like Doing Act

A bill mislabeled the “Health Care Freedom of Conscience Act” began its journey through the Montana legislature January 23rd. This is a bad bill, with the same malevolent repercussions as the so-called “Conscience” regulations put into effect at a federal level in the waning days of the Bush administration .

If  House Bill 351  introduced by Wendy Warburton of Havre, is enacted it won’t matter to Montanans if the federal regulation is eventually reversed, we’ll have our own law “protecting” health care workers and facilities from any legal or disciplinary action if they refuse to perform a procedure or administer drugs based on their conscience. “Conscience” is defined in the bill “as the religious, moral, or ethical principles held by a health care provider or health care institution.”

 

We all know what this bill is really aimed at: limiting and complicating access to health care services of the most private and personal kinds. Section 2, Number 3 states, “The purpose is to protect as a basic civil right the right of all health care providers and health care institutions to decline to counsel, advise, prescribe, provide, perform, or assist in counseling, advising, prescribing, providing, or performing a health care service that violates their consciences. Health care services may include but are not limited to abortion, abortifacients, artificial birth control, artificial insemination, assisted reproduction, human cloning, euthanasia, human embryonic stem-cell research, fetal experimentation, physician-assisted suicide, and sterilization.”

 

The possibility for mayhem this bill opens up is endless. Is a health care worker a vegetarian for ethical reasons? If this bill passes he can refuse to serve patients meals that include meat. The worker is completely within his “rights.”  Rushed to an emergency room needing an immediate blood transfusion? Oops! The doctor on duty is a Jehovah’s Witness. This bill would protect her “right” to refuse to order a life-saving transfusion based on her religious beliefs. Want a job at Planned Parenthood but don’t believe minors should have access to birth control? Planned Parenthood can’t use that “excuse” not to hire you. Discrimination in hiring based on “conscience” would be specifically prohibited.

 

HB 351 is nonsense. The fact that an elected official dreamed it up and it’s getting a hearing is scary. The highest calling for health care workers and facilities is to provide the best care legally possible. If a worker does not wish to be involved in contraceptive or end of life issues then they have no business working for a facility that does. End of story….I wish.