End-of-Life Choice, Palliative Care and Counseling

Posts TaggedWashington State

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.

Everyday Elder Abuse

Tomorrow is World Elder Abuse Prevention Day. It’s a day to appreciate that elders in our society endure abusive behavior every day and to consider how we might remedy this deplorable situation.

We hear of instances in which families, caregivers or others physically assault or verbally abuse elders in their care. Whether these instances arise from criminal pathology, frustration or plain meanness, we should all be on the lookout for such abusers, report them to authorities and encourage punishment.

Compassion & Choices focuses on other forms of abuse — the ones most commonly and even routinely — inflicted on elders. These forms are rarely recognized as abuse and are never punished. I’m talking about the pain, torture and invasion of bodily integrity from “heroic” and futile medical procedures associated with end-of-life care.

Most elders in this nation die in acute medical facilities. Even those whose deaths are anticipated following a long battle with cancer, heart failure or lung dysfunction do not die in the peace of their homes. Even they, the long-time dying, must endure the cold mechanical interventions of intensive care. Often in violation of express wishes stated in an Advance Directive for Healthcare, our elders must bear insertion of tubes to measure arcane pressures, tubes to breathe, to siphon throats, to empty urine, to drain fluids, to administer food and fluids. They must submit to the constant clicking, humming, droning and ringing of the machines and alarms at their bedside.

Add to this scene severe and unnecessary suffering from inadequate treatment of pain. Add to this a rampant failure to acknowledge and palliate agonizing symptoms like breathlessness, itching, hiccoughs, nausea, dizziness, bedsores and draining wounds of surgery .

What emerges is a picture of widespread, systematic, Medicare-supported torture of our elderly, dying citizens. Shame, shame on us for using taxpayer’s money in this indefensible manner.

When an 85-year old man like William Bergman, dying of mesothelioma, moans in pain with every breath, as his daughter pleads with doctors to prescribe more effective pain medication, that is elder abuse. Compassion & Choices won a court judgment to that effect, the first of its kind, in 2001.

When an 82-year old woman like Margaret Furlong receives full cardio-pulmonary resuscitation in violation of her Advance Directive, and endures ten days of intensive care despite squeezing her son’s hand to communicate her desire to have her hands untied and machines discontinued, that is elder abuse. Yet when Compassion & Choices helped bring this case as elder abuse and failure to honor an advance directive, it was thrown out of court.

When medical providers encourage irrational hope in endless rounds of chemotherapy for advanced, end-stage cancer, that research indicates are unlikely to extend life but sure to degrade its quality, that’s elder abuse.

When institutions withhold vital information about medical practices like terminal sedation or aid in dying, which they deem immoral, and hold patients hostage to their own beliefs in the redemptive power of suffering, that is elder abuse, and abrogation of informed consent principles. Catholic facilities that enforce gag rules and bar conversations about legal aid in dying, even when a patient inquires, are doing just that in Oregon and Washington.

Compassion & Choices is not alone in naming such examples “abuse” and “torture” and citing them as human rights violations. International conventions, treaties and courts demonstrate an understanding of the veracity and gravity of such charges. Numerous internationally recognized principles address patient care and the right to bodily integrity.

The European Charter of Patients’ Rights for example sets out, “Each individual has the right to avoid as much suffering and pain as possible, in each phase of his or her illness. The health services must commit themselves to taking all measures useful to this end, like providing palliative care treatment and simplifying patients’ access to them.” Policies restricting opioid availability and causing patients to suffer unnecessary pain abridge the human right to be free of torture.

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, has stated, “[E]very competent patient…should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should be based upon law and only relate to clearly and strictly defined exceptional circumstances.”

This year, let’s acknowledge our national habit of over-treatment at the end of life for what it is: elder abuse, torture and a violation of human rights. Let’s stop withholding information, ignoring wishes and inflicting elders with futile, painful treatment and unnecessary pain and suffering. And certainly, let’s stop using Medicare taxes to pay for this national scandal.

Dignified death in the wings

Why Washington’s Catholic health care institutions won’t block physician-assisted death
By Floyd McKay

Initiative 1000 becomes Washington’s Death With Dignity Act (DWDA) on March 4, giving physicians the right to assist terminally ill patients to end their lives with a lethal prescription. As the deadline nears for putting the controversial law into effect, much of the uncertainty centers on whether medical institutions opposed to it can prevent associated health providers from participating.

Read the rest of “Dignified death in the wings“.

Washington DWD will work for patients

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.