Boomers pushing for option of doctor assisted dying

[bondi688]

Boomers Push Doctor-Assisted Dying in End-of-Life Revolt - Bloomberg

"Claudia Burzichelli doesn’t want to die like her dad. Nine years ago, her father, already afflicted with Parkinson’s, killed himself with a gunshot to the head days after his release from a hospital where he had been treated for a heart attack. Burzichelli, 54, now suffering from kidney and lung cancer, is haunted by her father’s violent death, even more so as she contemplates her own mortality. She hopes to find a more peaceful way to end her life, if it comes to that.

"On those days when I’ve struggled to breathe, when I think about the stresses on my family, I would hope that I might have more options than starving myself or taking my life in a violent way,” she told a panel of New Jersey lawmakers during a hearing in February on a bill to legalize assisted dying. “It comforts me to think there could be a process, a way to offer options that would not hurt my family.”

To me, the control of the "when, where and how" of one's exit when faced with a terminal illness is critical. I know that choice is not what everyone would want, but it is important for the option to exist. I hope the country will soon come to the understanding and acceptance of that choice, instead of forcing people to take the very inhumane way of shooting or hanging oneself, or jumping out of the window. I am glad that there are efforts made to address and bring about the choice.

 

[ziggy29]

To me the only major ethical dilemma (in some potential cases) is making sure this is what the patient *really* wanted, made voluntarily of sound mind, and not unduly influenced by family members, doctors or the thought of medical bills.

Some physicians invoke the Hippocratic Oath -- "first do no harm" -- in opposing euthanasia, physician-assisted suicide or whatever you want to call it. But to me, a system that requires medical professionals to prolong a life of suffering *is*, in a very real way, doing harm to the patient.

 

[bondi688]

ziggy29
I agree with you that the choice has to be made by the person on his/her own volition, and not be pushed or influenced by anyone in anyway. But that civil option should be available. Gruesome and inhumane way of suicide is always available, but why should a person's exit be so undignified and shocking to the family members? Why not have a peaceful farewell and go gently into the night when the clear minded decision is made by the person, and maybe even surrounded by the love ones. I am looking at ways to participate in working with groups like Compassion and Choice to bring about that voluntary choice which is available now only in OR, WA, Switzerland, the Netherlands.

 

[Brat]

The Oregon law has a lot of safeguards. Several professionals must agree that the patient has less than 6 months to live, is of sound mind and not subject to pressure by others to end their life.

Oregon also has a Physician's Orders for Life Sustaining Treatment that can be prepared with the patient when the physician would not be surprised if they passed away in the next year.

The above is much better than a Health Care Directive because it is self executing.

 

[travelover]

....... self executing.

No pun intended, I'm sure.

 

[heeyy_joe]

It tugs at my heartstrings when I read artiles like this one. I do think that there are many doctors that assist today with a wink and a nod.

 

[Calico]

....I do think that there are many doctors that assist today with a wink and a nod.

During the last couple years of his life, my dad was in and out of the hospital with various ailments, including two severe occurrences of pneumonia. He was a physician, and he had made very clear (in writing, with all the appropriate directives) that he did not want "extreme measures" taken etc. to keep him alive. However, he never reached the point of being that sick, so on each trip to the hospital they fixed him up and eventually sent him home. He had been raising one of his granddaughters (child of my sibling - long story) for several years, and one September he saw her off to her first year of college, which had been a goal dear to his heart. He had said several times that if he lived long enough to see her off to college, he would feel he had achieved every goal he had left.

Three weeks later he entered his local hospital, under the care of his long-time, small-town doctor, for no discernible reason other than exhaustion. He died peacefully in his sleep in the hospital a few days later. We firmly believe that his doctor assisted him with his final wishes, and our family was grateful. I never directly asked the doctor, because I didn't want to put him on the spot. I hope when the time comes, I will have the legal choice to exit on my terms.

 

[Silver]

It tugs at my heartstrings when I read artiles like this one. I do think that there are many doctors that assist today with a wink and a nod.

Hospice nurses are often the advocate for the patient with their physician, working directly with the client and the family while communicating the current health status and their wishes for a dignified, pain-free ending.

 

[MichaelB]

I do think that there are many doctors that assist today with a wink and a nod.

I think so. At least that is what I have seen. Not so much a wink and nod as a kind heart and kindred spirit, which is undoubtedly what you meant. It really helps to have a family doctor, who, in situations like these, can be such a critical ally.

 

[heeyy_joe]

Hospice nurses are often the advocate for the patient with their physician, working directly with the client and the family while communicating the current health status and their wishes for a dignified, pain-free ending.

Hospice = my charity of choice.

 

[Midpack]

To me the only major ethical dilemma (in some potential cases) is making sure this is what the patient *really* wanted, made voluntarily of sound mind, and not unduly influenced by family members, doctors or the thought of medical bills.

Some physicians invoke the Hippocratic Oath -- "first do no harm" -- in opposing euthanasia, physician-assisted suicide or whatever you want to call it. But to me, a system that requires medical professionals to prolong a life of suffering *is*, in a very real way, doing harm to the patient.

+1. IOW, unfortunately there are some folks who are kept alive against their own wishes now, though I'm not suggesting doctors or family members are doing so without the best intentions.

 

[DeborahB]

In my health care directive I firmly state that I want no unnecessary measures taken to prolong life. I mean it. My parents also had similar directives in place.

My seemingly healthy 85 year old mother had a massive stroke a few years ago. While in the hospital, they found cancer all over her body. We were told the options: she could either die of the stroke peacefully with the help of morphine, or linger for a few painful weeks and die of the cancer. She had made her wishes clear and the doctors and hospital had no issue with taking her off telemetry and giving her morphine. She died about 12 hours after we started the morphine (they thought it wouldn't be that long).

I did find it interesting that no one at the hospital resisted the plan - her physician ordered morphine and there was total agreement among the staff. And while she was still somewhat lucid, she was partly paralyzed and couldn't write... there was no way to involve her in the process, really, at that point.

You never know when something will happen to you and you will be unprepared to make your choices known. At least with a health directive your wishes are clear.

 

[donheff]

I don't think we need to worry too much about people being pushed into offing themselves. Pretty easy to set requirements that demand a double check on that. What we see a lot of is various parties (medical and family) pushing in the other direction against earlier wishes expressed by the patient. Once you lose the capacity to continue to insist on death you are at the mercy of your family and medical professionals.

 

[travelover]

I don't think we need to worry too much about people being pushed into offing themselves. Pretty easy to set requirements that demand a double check on that. What we see a lot of is various parties (medical and family) pushing in the other direction against earlier wishes expressed by the patient. Once you lose the capacity to continue to insist on death you are at the mercy of your family and medical professionals.

Exactly right - we went through this with DW's dad. He had asked for no extraordinary intervention, but when it came down to it, his oldest daughter insisted that he couldn't have really meant it as it is "different" when you are actually facing real death as opposed to contemplating how you would might feel in the future. Of course, by then he was in no condition to communicate his wishes.

 

[haha]

During the last couple years of his life, my dad was in and out of the hospital with various ailments, including two severe occurrences of pneumonia. He was a physician, and he had made very clear (in writing, with all the appropriate directives) that he did not want "extreme measures" taken etc. to keep him alive. However, he never reached the point of being that sick, so on each trip to the hospital they fixed him up and eventually sent him home. He had been raising one of his granddaughters (child of my sibling - long story) for several years, and one September he saw her off to her first year of college, which had been a goal dear to his heart. He had said several times that if he lived long enough to see her off to college, he would feel he had achieved every goal he had left.

Three weeks later he entered his local hospital, under the care of his long-time, small-town doctor, for no discernible reason other than exhaustion. He died peacefully in his sleep in the hospital a few days later. We firmly believe that his doctor assisted him with his final wishes, and our family was grateful. I never directly asked the doctor, because I didn't want to put him on the spot. I hope when the time comes, I will have the legal choice to exit on my terms.

Calico, your Dad sounds like a very good man. I am glad he got his graceful exit.

Ha

 

[ocdokie]

Once you lose the capacity to continue to insist on death you are at the mercy of your family and medical professionals.

I, too, have seen this happen and it concerns me greatly. If I can't trust my doctor to abide by the terms of my written advance directive once I'm mentally incapacitated, what's the point in having one? Such directives are ostensibly meant to come into force when one is no longer able to express one's wishes on receiving medical care, yet they're ignored in favor of what the handiest (or most vocal) relative wants. Maybe one way to ensure that my wishes are followed would be to add provisions to my advance directive and my will, absolving my doctor(s) of liability if they follow my written wishes, and appointing a guardian who is empowered to use my assets to sue anyone who disregards them.

This leads to another issue for which I have no answer. The current physician-assisted suicide laws in the U.S. apply only to those with terminal illnesses who are expected to die within a relatively short time. I know of no provision in those laws that operate when one's illness is mental, rather than physical.

If I lose my legal capacity to choose what medical care I receive due to dementia, I would like to take advantage of assisted suicide, but it appears this is currently not possible anywhere in the U.S. The thought of lingering for perhaps years, or even decades, in such a state horrifies me. I have no wish to burden my family or drain my assets in prolonging a life in which I have lost the essence of what I think of as "me."

Perhaps I need a provision added to my advance directive to address this circumstance that appoints a guardian who will accompany me to Switzerland or the Netherlands and arrange for my death. I have no idea whether such a thing is possible, but I plan to look into it. If any of you have other ideas for an exit plan, I'd like to hear them.

 

[bondi688]

ocdokie
While I understand what you say about dementia and quality of life when one is no longer a functional or thinking being, I do not think a choice to end life for that reason will ever come about. That is so full of danger for abuse by way of defining of what is an acceptable mental capability to qualify for life. I will be satisfied with having a choice for gentle passage in case of a terminal illness with a horrible and protracted painful ending.

 

[Calico]

Calico, your Dad sounds like a very good man. I am glad he got his graceful exit.

Ha

Thank you. He was a stand up guy.

I think his graceful exit was made possible because of who his doctor was. Years before he died, my dad alluded to the fact that he and his doctor had an "understanding" about end of life. His own father, my grandfather, was a GP in NY for decades, back in the days when doctors made regular house calls. Apparently my grandfather quietly honored a few of his elderly patients' wishes in the same way, when they asked for that final gift. I hope this option becomes legal in my lifetime, with all appropriate safeguards in place to prevent abuse, of course.

 

[Tadpole]

I live in WA and, when I moved here, I thought - good, they have a euthanasia law and honor directives. Once I got here I discovered that the "safeguards" are too restrictive to be useful for many situations. Cancer is the only thing I can think of that leaves one wanting to avoid prolonging the pain and fits within the euthanasia safeguards. The way I read it, Terri Schiavo would not have been able to leave a legal directive for euthanasia and have her desires executed because she would have been too brain dead to reconfirm her wishes as required by law. My major fear would be a situation like my husband's grandmother who had a stroke at 90 and died at 97 having never awakened from that stroke but just kept alive in a fetal position on a bed for 7 years. (probably at government expense; my guess but the family didn't have money.)

Now, having moved near my husbands family, I discover that the Catholic church owns most of the facilities including the hospitals and hospices around me. According to my relatives they pretend that they honor directives but really do not honor them in reality. (my husband and I have been careful to outline that we want to empower each other to make decisions without consultation with a doctor unless we choose to do so.)

I am seriously considering selling the house we bought two years ago and moving down the road and hoping the one religion that does not believe in self determination does not buy the facilities up in my new location.

 

[Brat]

There is one option to institutional hospice care, bring the failing person home and have hospice come to you. It is a lot of work, admittedly, and some intuitions will fight that decision aggressively if the family is paying the bill 100%.

Another option is a care home, but again you are involving another person in the care and you can't control what they do or guarantee that pain medication prescribed is actually received by the patient.

 

[donheff]

ocdokie
While I understand what you say about dementia and quality of life when one is no longer a functional or thinking being, I do not think a choice to end life for that reason will ever come about. That is so full of danger for abuse by way of defining of what is an acceptable mental capability to qualify for life. I will be satisfied with having a choice for gentle passage in case of a terminal illness with a horrible and protracted painful ending.

I agree that it will not soon become an option but I don't see the potential for abuse as a real danger. Any law authorizing such a practice need only demand that advance directives specify an objective test that would be applied to determine whether the dementia patient was far enough gone to qualify. The law could specify what tests could be elected. We do that now where assisted suicide is OK - the test is that the patient must be medically determined to be terminal within specified constraints. To avoid abuse the law need only specify that assisted suicide will not be available absent an advance directive.

 

[samclem]

This is obviously an emotional topic.
With euthanasia there is so much potential for abuse, both overt and subtle. Choosing to end one's life, especially while still lucid, needs to be the ultimate personal decision--made by the person involved and only that person. And, since it's obviously a permanent decision, it's fitting that there be a mechanism to assure you are totally committed to the decision. It may seem barbaric, but having the person take the tangible, physical steps to accomplish the deed is the gold-standard way to know it's what they wanted to do, at least at that moment. It shouldn't be easy.

"Claudia Burzichelli doesn’t want to die like her dad. Nine years ago, her father, already afflicted with Parkinson’s, killed himself with a gunshot to the head days after his release from a hospital where he had been treated for a heart attack. Burzichelli, 54, now suffering from kidney and lung cancer, is haunted by her father’s violent death, even more so as she contemplates her own mortality. She hopes to find a more peaceful way to end her life, if it comes to that.

It sounds like Claudia's dad's exit was peaceful, at least as he experienced it.
I know there are people who want to die and cannot physically accomplish the act. I don't have an answer for that, except better enforcement of the already existing written directives. But for those who are physically capable of acting but unable to muster the courage, who want support (which is encouragement), well, I think we need to give a lot of thought to the ramifications, for everyone, of lowering the bar and increasing expectations that people should just seek out another specialist--someone who performs the final medical procedure. No fuss, they'll be listed in the phone book.
I can appreciate the opposing view on this, but I think maintaining the present prohibitions are overall better for all of us, though individual cases may seem more tragic as a result.