March 11, 2014

A Simple, Quiet End for Dying People: Too Much to Ask?

Consider the case of Robert Minton, 58.

When he was a teenager, rheumatic fever damaged his heart. Fifteen years ago, in complicated open-heart surgery, doctors replaced his failing aortic valve with pig tissue. His recovery from that procedure was brutal.

Now, the replacement valve is failing, and his heart pumps blood less and less efficiently. He could choose to undergo another complex, risky procedure, but he knows in his gut he would not survive it this time.

He wants to die -- on his own terms, in his own time, while he is still capable of making a clear, rational decision.

Minton lives in Denver, Colorado. If only he lived in one of the five states where “assisted suicide” -- or as advocates prefer to call it these days, “aid in dying” – is legal.

Growing Acceptance
In 1997, Oregon’s “Death with Dignity Act” took effect. That legislation authorized prescriptions for lethal doses when two doctors concur that their patient will die within six months and is freely making this choice.

Critics called “assisted suicide” immoral, and it took a while before other states passed similar laws. In 2008, Washington legalized aid in dying. Last May, so did Vermont. Both Montana and New Mexico have made “aid in dying” legal, and distinguish it from the crime of “assisted suicide.” 

It’s no surprise that semantics matter greatly in this emotional issue. In a May 2013 Gallup Poll, 70% of responders agreed that doctors should be allowed to “end the patient’s life by some painless means” when it’s what patients and their families want. By contrast, only 51% of those responders supported letting doctors help a dying patient “commit suicide.”

Still, public acceptance of “aid in dying” is growing. That 70% agreement last year about allowing doctors to painlessly end a dying patient’s life when patient and family agree was only 37% in 1948. The trend toward increasing acceptance shows every indication of continuing, especially with the graying of Baby Boomers.

Who to Call?
About 3,000 people contact the advocacy group Compassion & Choices (C&C) every year for legal advice to reduce end-of-life suffering and even hasten death.

Here again is the issue of language. Providing a dying person the chance to have a peaceful and dignified death is not suicide, which the advocacy group defines as an “act by people with severe depression or other mental problem.”

C&C president Barbara Coombs Lee said her group counsels callers and describes options, but does not provide help or encourage people to end their lives. C&C directs callers who seem suicidal or mentally disturbed to suicide hotlines. 

The group first recommends palliate or hospice care to callers facing suffering and death who seek some measure of control over their situations. Ms. Lee said, ”Callers should get the best care, but also have a choice to accelerate the time of death if the very best care cannot make their remaining days acceptable.”

It makes a huge difference, according to Lee, if patients live where the law allows aid in dying. Just having the choice gives people a greater sense of control over their own lives.

Back to Robert Minton
So, what options are available to Mr. Minton? He doesn’t live in a state where the assistance he wants is legal. He can’t just travel to a state where it is legal, either. According to law and medical standards, only genuine residents – who have relationships with local doctors – can qualify to receive such lethal prescriptions.

Some dying patients who live where assisted dying isn’t allowed create their own solutions: refusing life-extending procedures, turning off a pacemaker, accumulating medications that – when taken in large quantity – would bring a peaceful end. 

Some dying patients choose another technique: refusing all food and water. Others – in secrecy – make furtive trips overseas for lethal drugs, or simply kill themselves with guns, a violent, horrible conclusion for them and for their loved ones.

Mr. Minton can’t afford to enter hospice, and doesn’t want to. He’s checking out the international underground market for pentobarbital, used in executions and animal euthanasia. He has considered mixing household chemicals and overdosing on heroin.

He said, “I think it’s best if I’m by myself. That way, nobody could get into trouble.”

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  • The New York Times article -- "Aid in Dying Movement Takes Hold in Some States" -- that told Robert Minton's story.
  • An earlier post on this blog about Dudley Clendinen and suicide.
  • "Aid in dying" advocacy group Compassion & Choices.

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