On Their Own Terms

The NYTs today has a terrific article on people taking death into their own hands. Currently Oregon is the only state that allows doctors to assist their patients' suicide. Naturally, that arch-conservative, President George Bush, is challenging its legitimacy in the Supreme Court -- just one more instance of the GOP's libertarian streak being blunted by religious fundamentalism.

Which brings up the question I hear Bill Maher ask all the time: Why is it the most religious people that have the biggest problem meeting their maker?

Norma, an 85 yr. old lung cancer patient, isn't afraid to die. She has a tacit, unspoken agreement with her doctor that when the pain gets too bad, she has the dosage to administer the coup de grace herself.

The NYTs article makes this clear:

They have never discussed suicide, she said, but he has written her a prescription for powerful pain medication: a bottle of 90 pills with five refills. "That's 450," she said with a giggle.

I love that she giggles.

But there are some legitimate concerns that doctor assisted suicide will become mandatory rather than merely an act of volition.

Opponents say the risk to patients and to society of physician-assisted suicide is great. One of the most prominent, Dr. Kenneth Stevens, chairman of the department of radiation oncology at the Oregon Health and Science University in Portland, said many patients who initially desired suicide would change their minds with counseling. Greater acceptance of physician-assisted suicide, he said, would let financial considerations drive health care down a slippery slope toward mandatory euthanasia.

"We say we want this because of choice," he said. "My concern is, in the future, will this become the only choice?"

That would be scary indeed, but I'm not one who is convinced by slippery slope arguments. Generally they're unconvincing and ideologically driven. Anyway I find its ultimately demeaning, coercive, and paternalistic to say cousenling would change their minds. Here, read counseling, as we'll try to change your mind by inducing that age old coercive: guilt.

Kudos to anyone that looks that type of counseling in the face and says, "Bring on the nothingness."

But what the article does best is show the dichotomy between what can happen when someone feels forced to do it themself and what can happen when it's under the supervision of the medical establishment.

In the absence of a law, these proponents say, some patients take desperate measures that can leave families devastated. Edward Wellwood, a retired vice president of a title company who lived in Rancho Palos Verdes, Calif., received a diagnosis of amyotrophic lateral sclerosis, or Lou Gehrig's disease, in July 2003, and his sister, Paula Connolly, said the prospect of living in an inert body "was a much more fearful choice for him than the thought of dying."

Mr. Wellwood told his wife and sister he feared becoming a "head on a pillow," and was worried that a long illness would wipe out the family savings. Realizing that he was determined to end his life, Mrs. Connolly offered to be with him, but he was afraid she would be arrested as an accomplice to suicide. One day last May, he left a note for his wife - they had no children - and drove to a nearby motel to shoot himself in the heart. The family then had to conduct a frantic search to find his body.

"The hardest part for me," Ms. Connolly said, "was looking for him and not knowing whether he was alive and not knowing whether he was dead - but knowing that he was alone."

Ms. Connolly wishes California had a law like Oregon's, she said, adding, "If he knew he could have a safe, easy out, he could have had another year."

But here's how death can be a beautiful farewell when doctor assisted suicide is open and legal.

Mr. Turner, the man in Charlotte, studied the various ways of ending his life and settled on starvation, since the very sick often have little interest in food.

At the end, a dose of morphine prescribed by his physician eased the discomfort from the tumor in his bowel. His daughter Lise, who is a nurse, said that after getting the pain medication, he told her, "I think this is pretty much going to be the weekend that I die."

Having seen other patients slip toward death after receiving pain medication, Ms. Turner said she doubted the pain pills themselves caused life to end. "Maybe what we did was provide the pain relief that allowed them to finally be at peace so they could die," she said.

His breathing continued to slow over the next day, and toward the end, Ms. Turner recalled, "We all piled into the bed; we all held on to him and said goodbye."

"I think when you've done it right, whatever 'right' means," she said, "you feel good."