Accompanying death
The best part of the life of a good person, his small acts of kindness and love without name or memory. –Woodsworth
Death, like birth, is not an emergency but an emergency. Death is akin to the opening of a flower.–Stephen Levine
He was a bit surprised that, as a Christian, I agreed so strongly with him on assisted suicide; I think life is kind of Earth school so even though assisted suicide meant you’d be out early, before your term was over you’d be out anyway, so who said it wasn’t cool to take a incomplete in the course? ?–Anne Lamott
One of my students was suffering terribly from bone cancer and two strokes. He was a terminal patient in the hospital. Often in his agony he would say, “Can’t you help me die now?” My instinctive feeling of empathy mixed with my personal ethical ideas. Just listening, being with him, even in awkward moments, was my response and I wasn’t asking for anything more.
It said, “I wish I lived in Oregon.” In moments of lucidity, he lamented what he called “paternalistic” medical practice. He found some solace in having drawn up a living will with the help of his family.
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In 1976, a court order had the comatose Karen Ann Quinlan taken off a ventilator, and in 1990, Nancy Cruzan’s parents went all the way to the Supreme Court to remove their daughter from life support. Now, going through directives, there is more flexibility to accommodate the wishes of patients. Of course, doctors and patients should not and should not go against their personal beliefs.
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In the Los Angeles Times magazine on July 18, 2004, Fred Dickey published an article about an 85-year-old Oregonian, Howard Wildfang, who was dying a prolonged death from lung cancer.
“She sits in her retirement home apartment…her papery skin is mottled. Her body is shrunken…words come with great effort…”
He says that he has decided to legally end his own life. In Oregon, the “Death with Dignity” Act (passed in 1994, in force since 1998) provides that with guarantees, any person professionally diagnosed with a terminal illness (within a probable period of six months) has the right to hasten death. In the first eight years of the Oregon law, 240 people ate lethal prescriptions.
Howard feels that he not only wants to alleviate their suffering, but also be a part of social progress in our American culture. In California, much to the protest of the Catholic Church and others, a similar bill is being considered that would free doctors from the responsibility of prescribing lethal doses of drugs. “Through his death, he sees another way he can serve that populist spirit by showing others that they can control their lives to the end.”
Howard feels it’s time for him to go, for technology not to force him to live longer than he thinks is natural. In Oregon, assisted dying law requires two verbal requests (separated fifteen days) and one written request signed by two witnesses. Two physicians must confirm the terminal diagnosis before issuing the prescription. The person should be judged “capable” and informed of alternatives, including pain control. The terminally ill person must take the drugs themselves, in Howard’s case it would be 10 grams of pentobarbital in a drinkable solution, about triple the amount needed to kill an average adult.
Howard died seven days before the date he had planned to take the final medication.
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In Oregon, in cases of physician-assisted suicide, the cause of death is listed as the person’s illness, not suicide. The New York City Medical Examiner’s Office listed the cause of death of those who jumped from the World Trade Center towers on 9/11 as “homicides,” not suicides.
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I visit a fellow Catholic, terminally ill, who is wrestling with his conscience about how he would die. We discussed how Catholic teaching does not require one to take extraordinary measures to prolong life. The doctor says he has no reasonable chance of getting better, so he doesn’t want to be put on machines just to keep going. He seems comfortable with his decision not to have artificial procedures applied.
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Doctors may not agree with physician-assisted suicide, but there are other ways to hasten death. Some doctors may offer strong sedatives for severe pain. These sedatives hasten death, deeply relaxing the person into a sleep from which they are unlikely to wake.
Some people may choose to refuse food as a way to die. Doctors report that dehydration and starvation in the terminally ill are relatively painless, part of a protective mechanism in the body. Patients die of dehydration rather than starvation, if they don’t die of their disease first. The brain produces compounds that create a euphoria. The lungs breathe harder while the heartbeat slows and blood pressure drops. The kidneys release toxins that anesthetize the body; muscles shrink and limbs cool.
Others have left instructions with family or friends on when to remove life support technology. Physicians, with advance directives/family support, can remove the feeding tube in the stomach and stop intravenous feeding.
Living Wills/Advance Guidelines
“Advance directive” is a term that covers living wills and powers of attorney for health care (durable power of attorney for health care). Some of our patients have a living will or “advance directive” that prohibits the artificial prolongation of life if the person is in a terminal medical condition from which there is no reasonable expectation of recovery. It is put into words like these: “I don’t want to just be alive at all costs. If my death is imminent and unavoidable, and I have lost my ability to meaningfully interact with others, I don’t want surgeries or resuscitation.” , no life support from ventilators, life-prolonging procedures like feeding tubes, intensive care services…I want to be sedated before I come off a ventilator.”
The living will defines the medical conditions covered, for example, a terminal illness; a permanent unconscious condition; a minimally conscious condition where there is an inability to express one’s desires. Indicates if and when to suspend or withdraw life support treatments, CPR, resuscitation, artificial administration of fluids and nutrition. You can ask for enough comfort care (palliative care) with painkillers and sedatives, after which you are not given food or water.
Some, on the other hand, want to strongly assert their desire for aggressive life-sustaining care. They don’t want, for example, to have a feeding tube removed when their condition is apparently “hopeless.” They assert their “Right to Live”. In England, the activist Leslie Burke went to court (2004) to oppose the guidelines of the General Medical Council which oversees medical practices in Great Britain. The advice allows doctors, even against a patient’s wishes, to withhold or withdraw life-prolonging treatment if they believe the patient’s condition is so serious and the prognosis so poor that artificial feeding would cause more suffering than benefit. A judge sided with Burke saying that a patient, as long as she is mentally competent, should decide.
Some of our patients want to avoid being appointed a conservator and have set up a “revocable trust” (living trust) that appoints someone to eat assets outside of the court’s jurisdiction, avoiding the costs of probate. Some, through a durable power of attorney, put a person in charge of finances. This does not have to be drawn up by a lawyer, but it must be notarized.
So let us make our own wishes known in advance. Ideally, we should write our living will and review it with our attorney so that we are on the same page about our wishes.