End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Archive for September, 2009

News, Opinion and Cartoons Debunk Myths and Support End-of-Life Choice

What’s Wrong With the Finance Bill?
An Interview With Sen. Jay Rockefeller, The Washington Post, September 18, 2009

 “To be fair, it’s not all cost control. To give you an example, everyone is afraid of discussing end-of-life because they think you’ll kill granny. It’s nonsense. We train geriatrics in our medical schools. After a few years of practicing geriatrics, however, they go into other specialties that make more money. You could raise how you reimburse geriatricians so they stay in geriatrics. And since end-of-life care is so expensive, it would be good to have more doctors working on that. It’s not all about cutting. Some of it will be about increasing.”
To read the full article, click here.

Last Rights
Shouldn’t we be able to end our lives however and whenever we want?

by Gary Cartwright, Texas Monthly, October 2009
One night recently, during a dinner table conversation, an attractive, cultured, well-educated friend in her late sixties declared with surprising finality, “If I had stage-four pancreatic cancer, I’d put a revolver in my mouth and go night-night.” She was reacting to a newspaper article we had all read about a 66-year-old woman in Sequim, Washington, who, in the final stages of a terminal illness, chose to die by way of doctorassisted suicide, now legal thanks to the passage of a new state law. We all agreed that the Death With Dignity Act sounded better than a revolver in the mouth. The law passed last November with 58 percent of the vote, making Washington the second state, after Oregon, to legalize assisted suicide, which is a crime elsewhere in the United States and many parts of the world.

To read the full article, click here.

By Gary Trudeau

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Stop Abandoning Dying Patients to Unbearable Suffering, Illegal Acts & Violent Deaths

Death with Dignity laws prevent violent deaths

Compassion & Choices, the nation’s oldest and largest nonprofit working to expand end-of-life care and choice, responded to the violent death of a Laguna Woods woman with cancer and the arrest of her 90-year-old husband for manslaughter:

“Violent deaths of terminal patients are one hundred percent preventable. Loving spouses resort to extreme, violent and desperate acts when support and legal options are inadequate,” said Barbara Coombs Lee, president of Compassion and Choices. “Violence at the end of life is a symptom of a national crisis-the unbearable suffering and frightful options many loving families face when enduring a painful and prolonged dying process. This week’s developments illustrate the desperation patients and their caregivers feel, and the need for rational public policy on end-of-life choices. Only Oregon, Washington and Montana currently have rational policies with strict guidelines in place. The time has come to close the door on covert behavior and violent actions by suffering patients and their families.”

Oregon physician Dr. Nick Gideonse has commented on other cases in the past, “Instead of being forced into considering options like guns or other violent methods, patients should be able to talk with their physicians about a range of legal, safe, peaceful options for easing a painful dying process. The only way to protect patients, families and doctors, and enforce safeguards around aid in dying, is through laws such as Oregon’s Death with Dignity Act.”

While Compassion & Choices (C&C) is not aware of all the facts in this particular case, C&C is available to provide mentally competent terminally ill adults, their families and caregivers, with end-of-life consultation, referrals for appropriate care, and, if needed, personal support at the time of death.

Since 1993, Compassion & Choices’ End-of-Life Consultation program has served thousands of clients and helped them find a way to humane and peaceful dying. C&C applies guidelines and safeguards similar to those practiced safely under Oregon’s Death with Dignity Act for 11 years. Our client relationships are confidential and our average length of contact with a client is 180 days-we know our clients well.

“California leaders have drastically cut support for Caregiver Resource Centers, leaving little support for those who care for family members, and opening the door to desperate acts like these. Lawmakers and organized medicine are also guilty of dereliction of duty for not setting clear, regulated guidelines for aid in dying,” said Coombs Lee. “Without such public policies, patients and families are isolated, suffer in legal limbo, and are not able to make informed, open end-of-life decisions. This legal paralysis does nothing to prevent unnecessary suffering and tragic, violent deaths that traumatize families.”

The purpose of Compassion & Choices End-of-Life Consultation program is to ensure excellent end-of-life care and, if unbearable suffering persists, provide information and support to achieve a peaceful, dignified death.

Compassion & Choices is a national organization serving patients and their families, advocating for expanding legal end-of-life choices, and educating the public. Our experts are available for interviews. Individuals seeking information about end-of-life decisions can access our End of Life Consultation service by calling 1-800-247-7421.


The Way We Die Now

Timothy Egan
The New York Times

PORTLAND, Ore. —– In the last days of her life, Annabel Kitzhaber had a decision to make: she could be the tissue-skinned woman in the hospital with the tubes and the needles, the meds and smells and the squawk of television. Or she could go home and finish the love story with the man she’d been married to for 65 years.

Her husband was a soldier who had fought through Europe with Patton’s army. And as he aged, his son would call him on D-Day and thank him – for saving the world from the Nazis, for bequeathing his generation with a relatively easy time.

That son, John Kitzhaber, knew exactly what his mother’s decision meant. He was not only a governor, a Democrat who served two terms in Oregon as it tried to show the world that a state could give health care to most of its citizens, but a doctor himself.

At age 88, with a weak heart, and tests that showed she most likely had cancer, Annabel chose to go home, walking away from the medical-industrial complex.

“The whole focus had been centered on her illness and her aging,” said Kitzhaber. “But both she and my father let go that part of their lives that they could not control and instead began to focus on what they could control: the joys and blessings of their marriage.”

She died at home, four months after the decision, surrounded by those she loved. Her husband died eight months later.

The story of Annabel and Albert Kitzhaber is no more remarkable than a grove of ancient maple trees blushing gold in the early autumn, a moment in a life cycle. But for reasons both cynical and clinical, the American political debate on health care treats end-of-life care like a contagion — an unspeakable one at that.

Nobody was more frustrated than John Kitzhaber as the health care debate got hijacked over the summer by shouters and misinformation specialists. And no politician is more battle-scarred on this issue. He looks, at 62, still the Western man, with his jeans, his shag of gray hair, the face weathered by days spent trying to lure steelhead to the surface in the Rogue River. It has been his life work to see if at least one part of the country could join the family of nations that offers universal coverage.

With his mother’s death in 2005, Kitzhaber lived the absurdities of the present system. Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel’s home and help her through her final days.

“The fundamental problem is that one percent of the population accounts for 35 percent of health care spending,” he said. “So the big question is not how we pay for health care, but what are we buying.”

He is not, he says, in favor of pulling the plug on granny. The culture of life should be paramount, he says, following the oath he took as a doctor. But Oregon, years ahead of the rest of the country, has talked and talked and talked about this taboo topic, and they’ve voted on it as well, in several forms. They found — in line with national studies — that most people want to die at home.

In addition, Oregon was the first state to allow terminally ill patients to take medications to end their lives. The fear was, Oregon would become a death magnet, drawing suicide tourists and put itself on a slope to euthanasia. But it has not worked out that way. Since the change in the law in 1997, only about 33 people a year with terminal illnesses have ended their lives by their own hand with a doctor’s prescription.

In last year’s presidential campaign, Kitzhaber tried to make health care the top domestic issue. After the campaign, he was on the short list to become President Obama’s secretary of health and Human Services. Now he’s running, next year, for a third term for governor.

He was appalled when Sarah Palin and Senator Charles Grassley of Iowa started stoking fears of nonexistent death panels. At last, public officials were talking about death — but only to scare the elderly and win political points.

More sensible voices have since joined the debate, asking how we reform a system that lavishes most of its benefits on a cure for the “disease” of aging. President Obama has talked about squeezing billions of waste, fraud and abuse from Medicare. But he has yet to admit the obvious: those savings can only come from changing the way the system treats dying people.

About $67 billion — nearly a third of the money spent by Medicare — goes to patients in the last two years of life. The need to spend less money at the end of life “is the elephant in the room,” Evan Thomas wrote in “The Case for Killing Granny,” the cover story in last week’s Newsweek. “Everyone sees it but no one wants to talk about it.”

John Kitzhaber, M.D., politician, and son who watched both parents die in a dignified way, cannot stop talking about it. His parents’ generation won the war, built the interstate highway system, cured polio, eradicated smallpox and created the two greatest social programs of the 20th century — Social Security and Medicare.

Now the baton has been passed to the Baby Boomers. But the hour is late, Kitzhaber says, with no answer to a pressing generational question: “What is our legacy?”

Compassion & Choices praises intent of New Hampshire Death with Dignity Bill

Doubts Legislature will Approve Patient Choice

Compassion & Choicesapplauds the intent of a New Hampshire measure to legalize physician aid in dying, but expressed doubts that the Legislature will vote to support patients’ rights to make their own end-of-life decisions. “Too many Americans suffer needlessly and endure unrelenting pain,” said Barbara Coombs Lee, president of Compassion & Choices. “This measure contains good, proven public policy that is now the law in Oregon, Washington and Montana. It’s unfortunate that so many politicians fail to serve the people who want and need this choice.” Not all citizens have the opportunity to vote directly on Death with Dignity proposals, like those in Washington State, which passed it last November by a large margin.

Oregon’s 11-year experience teaches that end-of-life choice has benefited not only the patients who used the law, but all Oregonians facing the end of life. All dying patients in the state benefited from improved care from physicians and health care providers, increased use of medical morphine, increased referrals to hospice, the lowest rates of in-hospital deaths and the greatest opportunity to die at home among loved ones in the nation.

National surveys over twenty years have shown a large majority of Americans support making physician aid in dying a legal choice. “Americans want choices in all aspects of their lives. The right to choose how we die echoes the right to choose how we live,” said Coombs Lee. “Because such an overwhelming majority holds this view, one day everyone will know the comfort of choice and control. It is time for federal and state governments to honor the will of the people and legalize aid in dying.”



Compassion & Choices Responds To United Kingdom Guidelines Clarifying End-Of-Life Policy

Compassion & Choices, the nation’s oldest and largest nonprofit working to expand end-of-life care and choice, released the following statement today in response to action in the United Kingdom to clarify that nation’s end-of-life policies. 

“The United Kingdom’s director of public prosecutions has published guidance on when prosecution will be undertaken when a family member or friend assists another to ‘commit suicide.’  A similar lack of clarity and overbroad interpretation of ‘assisted suicide’ laws in the United States prevent physicians from providing medication a mentally competent, terminally ill individual might choose to take to end a prolonged and unbearable dying process. The guidelines were prompted when a court ruled that Debbie Purdy, who is suffering in the advanced stages of multiple sclerosis, had the right to know under what circumstances her husband would be prosecuted if he helped her travel abroad to die. 

“Compassion & Choices works to make the choice of aid in dying available to mentally competent terminally ill patients. Aid in dying refers to a physician-provided prescription for medication that a mentally competent terminally ill patient may self-administer, if they find their dying process unbearable, to bring about a peaceful death. A broad swath of the medical and health policy community in the U.S., including the American Public Health Association, supports this medical practice.

“This decision is best made in the context of the patient/physician relationship. Here, the patient can express their concerns, the physician can assure that the patient is in fact mentally competent and terminally ill, and can provide information about all options, including aggressive pain and symptom management, palliative sedation, and hospice care, as well as aid in dying. The choice for aid in dying is one that properly belongs among the options that should be available to a terminally ill patient.

“In the U.S. this choice has been made affirmatively legal by statute in two states, Oregon and Washington. It has been recognized as a right of Montana citizens under that state’s constitutional guarantees of privacy and dignity. In states where aid in dying is practiced openly, it has been demonstrated to improve end-of-life care for all terminally ill patients in that state, and is used relatively rarely, without complications. That is why Compassion & Choices advocates for legal aid in dying.

“Establishing clarity in these vague, antiquated laws is extremely important to patients and their loved ones. In the absence of such clarity, the laws should not be interpreted broadly to impact end-of-life planning.”

Read the press release here>>