assisted suicide

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Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking

Lee J. Haywood/flickr

Lee J. Haywood/flickr

By Nell Lake
Guest contributor

One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home…Go.”

Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated.

Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally.

Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer.

So Wilton needed another option for ending her life. Soon Klein heard a radio interview about “the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.”

Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and see if she wanted to continue.”

Wilton began the “dry run” on April 28, 2012.

No Food, No Drink

Most often referred to as VSED — voluntary stopping of eating and drinking — the practice of giving up food and drink in order to hasten one’s death is being increasingly publicized by aid-in-dying advocates as a legal alternative to physician-assisted suicide.

VSED is legal everywhere, even in states without aid-in-dying laws, and in cases in which a person, like Wilton, would not qualify for assistance with dying even in those states.  Compassion and Choices, a leading “death with dignity” organization, is beginning to more actively promote VSED as an option because “it’s something that patients can openly pursue, in open dialogue with their physicians, with the support of hospice,” says Barbara Coombs Lee, the group’s director. “We do want to make it more public. We want to make it more visible because it upholds the truth that ultimately patients should be and are in charge. That’s kind of a consciousness-raising task. Continue reading

How Vermont Passed Assisted Suicide (And Can We Go There To Die?)

The Vermont State House in Montpelier (Wikimedia Commons/jonathanking)

The Vermont State House in Montpelier (Wikimedia Commons/jonathanking)

Remember the physician-assisted-suicide referendum that came ever so close to passing last year in Massachusetts, failing in a 51-to-49 percent squeaker?

Well, where Massachusetts feared to tread, neighboring Vermont has now trodden, and the state is about to become the fourth to legalize physician-assisted suicide for terminally ill people, after Oregon, Washington and Montana. It is the first to do so through its lawmakers rather than a popular referendum or court.

The “end-of-life choices” bill rode a wild political roller-coaster before it was finally passed this Monday evening, and it’s now on its way to a supportive Gov. Peter Shumlin and expected to be signed soon.

Vermont Public Radio’s John Dillon has covered the bill all along the way, and I asked him for his insights into the political dynamics behind the action. But first, a brief note for us flatlanders: What will our neighbor to the north’s decision mean for us? Will we be able to drive with our doctors up to Brattleboro or Burlington if we’re fatally ill and want help taking control of our final days?

I sent a query to Patient Choices Vermont, the group that spearheaded the state’s “end-of-life choices” bill, and heard back from Jessica Oski of Sirotkin & Necrason, a government relations firm that has represented Patient Choices Vermont for a decade. She writes:

1. To be qualified to use the assistance of the Vermont Patient Choice at End of Life Bill, a person must be “18 years of age or older, a resident of Vermont, and under the care of a physician.” There is no specific guidance under the law as to who qualifies as a Vermont resident.

2. In order for a physician to benefit from the immunity under the law the physician must be “licensed to practice medicine under 26 V.S.A chapter 23 or 33.” In other words, licensed in Vermont.

Now for the politics. The tale I heard from VPR’s John Dillon suggests three possible lessons for the backers of physician-assisted suicide in Massachusetts: Stick with it. Compromise quickly when the right moment strikes. And you may fare better in a legislature than in a popular referendum.

The Vermont House had considered a “death with dignity” bill in 2007, John said, but it didn’t pass. Last year, a similar measure failed to pass in the state Senate. This year was different.  Continue reading

How Death With Dignity Failed In Mass.

Sometimes it takes an outsider’s perspective to see what’s going on in your own back yard. Here, Paula Span decodes the downfall of the Death With Dignity Act in Massachusetts. Writing in The New York Times today she boils the loss down to a few basics that undermined support for the measure, which was defeated by voters 51 to 49 percent in November.

The winning strategy, Span writes, included exploiting certain language in the measure, and running fear-based ads attacking the act. Span writes:

…early research showed that Massachusetts residents believed in individual choice, and respect for others’ choices, about death and dying, Mr. Baerlein said. So the anti-Question 2 forces didn’t attack on direct moral or ethical grounds; instead, its ads took aim at certain provisions and how they were worded.

For instance, the proposed law — which included multiple safeguards and waiting periods to prevent impulsive requests, coercion or abuse — required a physician to “recommend” that a terminally ill patient notify his next of kin of his intent.

But it didn’t “require” family notification. “How would you feel if you came home and your mother had decided to take her life?” Mr. Baerlein said. “Voters couldn’t get their arms around that.” Continue reading

Marcia Angell: What Went Wrong, What’s Next For Death With Dignity

(stevegarfield/flickr)

Here Dr. Marcia Angell, former editor of The New England Journal of Medicine and lead backer of the doctor-assisted suicide measure that failed this week, talks with WBUR’s Sacha Pfeiffer about what went wrong and how to move forward.

Here’s the full interview:

Marcia Angell: Well, it’s not clear what will happen now. I think we have to regroup and think about that. The bad news is that we lost, but the good news is that the margin was razor-thin. And what this tells us is that people know that we’re ready for this, that this is the decent thing to do. So I don’t think that this is going to go away. But, by law, we can’t do another ballot initiative for another five years, I think.

What I’m looking for is what’s happening nearby. I would suspect that we would see a ballot initiative like this in perhaps Maine, maybe New Jersey, maybe Vermont. And we also can look north to Canada and see what’s happening there. The supreme court of British Columbia overturned a Canadian law against assisted dying, and that’s pending appeal. If the decision in British Columbia stands up to the appeal, then all of Canada will permit assisted dying.

Sacha Pfeiffer: You make me think of a gay marriage parallel here: that the more time passes, the more we see other states approving same-sex marriage. So are you hoping there’s a strategy of acceptance, and if you come back in a few years the state will be more accepting?

MA: Oh yes. I have no doubt about that. Continue reading

What Brought Down Assisted Suicide? Flaws? Money? And Now What?

The fight over Question 2, the assisted suicide measure on the Massachusetts ballot, officially ended early this morning when its backers conceded defeat in a narrow squeak of a vote. What happened? How did the measure lose its early lead in the polls?

A statement from the main opposition group, the Committee Against Assisted Suicide, says the question, which would have allowed terminally ill patients to request life-ending prescriptions from their doctors, was simply flawed.

From its chairperson, Rosanne Bacon Meade:

“While some votes remain uncounted on this question, we believe the question’s defeat is now assured.  We believe Question 2 was defeated because the voters came to see this as a flawed approach to end of life care, lacking in the most basic safeguards. A broad coalition of medical professionals, religious leaders, elected officials and, voters from across the political spectrum made clear that these flaws were too troubling for a question of such consequence. We hope these results mark the beginning of a deliberate and thorough conversation about ways to improve end-of-life care in Massachusetts, which, as the nation’s health care capital, is well positioned to take the lead on this issue.”

The measure’s proponents, however, cite a flood of money to the opposition, which ended up outspending them by about 5 to 1, about $5 million to $1 million. That money went in part to pay for ads like the one above, which proponents say is misleading. In a message to supporters, they wrote: “Death with Dignity has been law for a combined 19 years in other states. Not once has the law been abused or misused. Of course, no patient has ever been told to swallow 100 pills, as opponents claim in their TV ads.”

Steve Crawford, a spokesman for the measure’s backers, the Death With Dignity Act campaign, said the initiative was “a grassroots effort financed by individuals, many of whom have experienced the death of a loved one that has been painful and prolonged.” Continue reading

Breaking: Mass. Backers Of Assisted Suicide Concede Defeat

This just in from the WBUR newsroom:

The supporters of Question 2, the Massachusetts ballot measure that would allow doctors to prescribe life-ending medication to terminally ill patients who request it, just conceded defeat in the narrowly split vote:

Following is a statement from the Question 2, Death with Dignity Act campaign:

For the past year, the people of Massachusetts participated in an open and honest conversation about allowing terminally-ill patients the choice to end their suffering. The Death with Dignity Act offered the terminally-ill the right to make that decision for themselves, but regrettably, we fell short. Our grassroots campaign was fueled by thousands of people from across this state, but outspent five to one by groups opposed to individual choice.

Even in defeat, the voters of Massachusetts have delivered a call to action that will continue and grow until the terminally-ill have the right to end their suffering, because today dying people needlessly endure in our Commonwealth and do not have the right to control their most personal medical decision.

Our full piece on the debate over assisted suicide and the dynamic of the political battle is here.

As Assisted Suicide Goes To Wire, Some Comfort From A Pain Specialist

(Photo illustration by Alex Kingsbury/WBUR)

According to the latest Massachusetts poll, just out from Western New England University Polling Institute, the assisted suicide question on tomorrow’s ballot is too close to call. Among 535 likely voters surveyed several days ago, the institute reports, “44 percent support allowing terminally ill patients to legally obtain medication to use to end their lives, while 42 percent are opposed. Fourteen percent of likely voters said they did not know or declined to answer the question.”

Question 2, also known as “Death With Dignity,” has surely spurred a valuable discussion about how we die; the most recent opinion in major local media came from the Boston Globe columnist Yvonne Abraham, whose mother’s recently diagnosed Alzheimer’s disease influenced her. But I have also found the conversation deeply disturbing, because so many commenters have shared horrifying stories about bad deaths. One comment on a recent CommonHealth post began: “I served until recently as a hospice chaplain. In my six years in this work, I was often surprised by family members bursting out with their true feelings and saying, “You wouldn’t let a dog suffer like this.”

I have my fair share of existential terror, and stories like these don’t help. It’s bad enough that I have to die; do I have to die painfully? The debate around Question 2 has further confused me. Opponents of the measure argue that pain can be controlled so well that fear of suffering — or suffering itself — is no reason for suicide. But if so, how to explain all the harrowing personal stories of bad ends?

Dan Carr

Dr. Daniel B. Carr of Tufts University School of Medicine (Alonso Nichols, Tufts University)

I turned for guidance to Dr. Daniel B. Carr, director of the Tufts Program on Pain Research, Education and Policy (which has not taken a position on Question 2) and a professor at Tufts University School of Medicine. What, I asked him, is the truth about dying and pain? Is it really as bad as some stories suggest — or can it really be as good as the opponents say?

Let me begin with the good news because it’s so nice to hear some. Massachusetts, he said, is extraordinarily rich in top-flight medical care for the end of life. It’s a pity, he said, that the political debate around Question 2 may distract people from awareness that we have “a wonderful series of support systems in Massachusetts for hospice and palliative care.” He particularly recommended the Hospice and Palliative Care Federation of Massachusetts.

Now to my question. Like any good academic, Dr. Carr had to back up first:

“First of all, the totality of suffering at the end of life often involves pain, but it often reflects other reasons as well. For instance, air hunger in someone who has pulmonary disease, or sleeplessness in someone with so-called Lou Gehrig’s disease. So pain control is a major part of palliative care, but palliative care is broader than just pain control. The concept of “total pain” has been in the literature for years. “Total pain” includes physical pain but also involves spiritual or existential pain and psychological burdens. So there’s more to palliative care than pain control, and there’s more to pain than just its intensity.

You can control about 90% of the pain in people with cancer.

In the clear majority — in most cases of, say, cancer-related pain — the figure that people quote is from studies applying a very simple three-step ladder that was developed by the World Health Organization: You can control about 90% of the pain in people with cancer. Now, i’m blending together different cancers, different stages and resting pain versus movement pain. But if you were to say: ‘Can you control most people’s pain with simple, non-invasive measures,’ the answer is yes. That’s been studied.

As for people who have more difficult pain problems despite moving up the medication ladder, by providing a suitable nerve block or infusion, you can probably control the majority of the remainder. Continue reading

How A Veterinarian’s Experience Influenced Her View On Assisted Suicide

shelley fitzgerald

Veterinarian Shelley Fitzgerald with her friends, Eddie and Jackie Parlee.

One of the most fascinating aspects of the debate over Question 2, the Massachusetts “Death With Dignity” ballot measure on assisted suicide, is the outpouring of personal stories about our encounters with death and dying that it has brought. We don’t like to talk about dying. But suddenly, we’re doing a lot more of it than usual.

The stories that have arrived in the comments section of this recent post are moving, sometimes heartbreaking, always thought-provoking. One particular recent comment prompted me to ask the writer to expand. She had written:

The issues raised by this ballot question are faced by veterinarians every day. I can only speak for myself but I can say I have never enjoyed euthanising a client’s pet. However, I am glad the option is available. The word euthanasia means ‘good death.’ Perhaps veterinarians’ experiences could provide some clarification.

That rang so true that I asked for more. But first, an emphatic preface: This is a veterinarian sharing her thoughts and experiences, but that by no means implies that she is equating putting a pet to sleep with physician assisted suicide in humans. So please hold those objections. She is, rather, offering an insider’s valuable perspective on hundreds of experiences in which families choose to hasten the end of a beloved pet’s life. And facing head-on an issue that vets don’t talk about much, either. Deepest thanks to Westford veterinarian Shelley Fitzgerald for sharing this:

Roxie was a friendly and exuberant two-year-old Afghan hound cross who came into our clinic in 2003 for a small swelling on her cheek. The most likely causes were an insect bite, an infection or trauma. However, the swelling increased in size despite being treated with antibiotics, antihistamines and steroids. Roxie continued to be happy and eat well, but we and her owners were dismayed.

Ultimately the cause of the swelling was determined to be an aggressive form of cancer. We all knew Roxie and her family well, and everyone in our clinic cried when Roxie was euthanized because she could no longer eat.

I have performed hundreds of euthanasias myself and witnessed many more. After nine years, the details of Roxie’s case are still clear and painful. Yet I would not have wanted to see her live in her condition. I was grateful then and still am now that the option to end Roxie’s suffering in a peaceful and painless way was available. Continue reading

In Hot Debate Over Assisted Suicide, Globe Comes Out Against Ballot Question

(Photo illustration by Alex Kingsbury/WBUR)

The Boston Globe today officially came out against Question 2, the “Death with Dignity” measure on next week’s Massachusetts ballot that would allow terminally ill patients to request prescriptions for life-ending pills. Its masthead editorial argues:

Reasonable people can disagree passionately about Question 2, but a yes vote would not serve the larger interests of the state. Rather than bring Massachusetts closer to an agreed-upon set of procedures for approaching the end of life, it would be a flashpoint and distraction — the maximum amount of moral conflict for a very modest gain.
Instead, Massachusetts should commit itself to a rigorous exploration of end-of-life issues, with the goal of bringing the medical community, insurers, religious groups, and state policy makers into agreement on how best to help individuals handle terminal illnesses and die on their own terms.

The Globe’s opposition is the latest of several major media “against” votes, from The Washington Post columnist E.J. Dionne, Jr. to an op-ed piece by Ben Mattlin, a journalist with a disabling disease, in The New York Times. But voices are also being raised in favor, including uber-ethicist Art Caplan on NBC. He writes:

The proposed Massachusetts law is very restricted and contains important safeguards. Experience in other states shows little reason for worry about abuse or misuse. Instead the more people who are going to die know they can end their lives sooner if they choose, the more many of them fight harder to live. Making assisted suicide possible in Massachusetts rightly puts a choice in the hands of a very few who may not use it, but value having it.

The latest polls suggest that the measure will pass, though the margin in favor has slipped significantly from earlier polls. Continue reading

Latest Poll Suggests Margin Narrowing On Assisted Suicide Ballot Question

(Photo illustration by Alex Kingsbury/WBUR)

From the WBUR newsroom:

BOSTON (AP) – A new poll shows support for all three initiatives on the Massachusetts ballot next month, but approval for the so-called “death with dignity” question appears to be slipping.

The Suffolk University/WHDH-TV poll shows Question 2 supported by a 47 to 41 percent margin, compared with a 64-27 percent margin of backing in a similar poll taken six weeks earlier.

The proposal would allow doctors to prescribe life-ending medication at the request of certain terminally ill patients.

Nearly three-quarters of those surveyed backed Question 1, which would require automakers to share diagnostic and repair information with independent mechanics. Fifty-five percent backed Question 3, which would allow marijuana to be used for some medical purposes.

The survey of 600 likely voters, conducted Oct. 25-28, had a margin of error of plus or minus four points.