watched my Mom and her Twin die of cancer about a year apart... made up my mind right then and there. i'll never go out that way.
Posted on 07/09/2007 3:54:06 PM PDT by SubGeniusX
Marcelle Jones has thought a lot about how her life might end. She has been treated for a serious medical problem for several years, and while it has not gotten worse, eventually "it's going to get me," said Jones, 82.
Long before she moved to Lakeland in 1990, Jones had joined the Hemlock Society - now known as Compassion and Choices - an organization that provides information about how terminally ill people can end their lives, either through passive means or, if they choose, by suicide.
Lacking family and wanting to spare her friends the burden of caring for her, Jones said she has made careful preparations. In a calm and measured voice, she said when her illness becomes terminal, she likely will simply stop eating and drinking water. Far from being a tortured end, she said, it would be painless.
"It does not have to be a matter of taking chemicals or being injected. It can be easy and peaceful," said Jones, who was a teacher and property manager before retiring.
Dr. Jack Kevorkian's release from prison on June 1 raised again the controversy of what role physicians should play in helping people end their lives. Kevorkian, a retired Detroit pathologist who has advocated for years that people should have the right to request that doctors administer life-ending drugs, spent eight years in a Michigan penitentiary for second-degree murder after he was convicted of injecting lethal drugs into a man who had amyotrophic lateral sclerosis, or Lou Gehrig's disease. (See related story, A10.)
Kevorkian complained in an interview in The New York Times after his release that nothing has changed during his prison term, but others dispute that, saying there has been movement in legal, medical and public opinion. Helping the gravely ill face the end of life is far broader than simply legalizing physician-assisted suicide or euthanasia, they say, and Kevorkian has framed the issue too narrowly.
"A tremendous amount has changed," said Susan M. Wolf, professor of law and medicine at the University of Minnesota.
Wolf enumerated the following points on which law and medical practice have advanced in the past several years:
The U.S. Supreme Court decided last year that an Oregon statute permitting physician-assisted suicide does not violate federal law, thus allowing it to remain on the books.
Data on physician-assisted suicide and euthanasia have been collected in Oregon, revealing that not very many people are availing themselves of the option to have physicians prescribe lethal drugs. According to The Associated Press, between 1997, when the statute was enacted, and 2006, 292 people - mostly cancer patients - have died under the law's provisions. However, data from Oregon and the Netherlands - where physician-assisted suicide is also legal - indicate doctors are not reporting all cases, perhaps for fear of landing in trouble with peers or authorities, Wolf said.
There has been progress in the alleviation of pain - known as palliative care - for the dying and in the maturing of the hospice movement.
"We've seen tremendous progress in the past decade in palliative care. That wasn't true before," Wolf said. "People don't feel like they're a trapped animal in a corner anymore."
Dr. Stephen Leedy has seen that level of suffering. Leedy is the medical director of Good Shepherd Hospice, a not-for-profit organization that serves Polk, Highlands and Hardee counties, providing medical, psychological and spiritual care to clients who have been given six months or less to live. He said he has been asked by patients to end their lives, but not frequently.
"Usually, it's because of uncontrolled symptoms, like intractable pain. Or, they don't want to be a burden to their families. Or they say all hope is lost," he said.
Leedy agreed with Wolf that the situation has changed during Kevorkian's time in prison. There has been a "huge jump" in the number of people in hospice care, he said.
In 2006, there were 4,100 hospice organizations nationwide serving 1.2 million patients. Good Shepherd is the largest independent not-for-profit hospice in the country, serving about 2,500 patients currently, Leedy said, compared to the nationwide average of 40 patients.
When doctors are asked to help a patient die, they should ask what lies behind the request, Leedy said. It is a matter of helping those at the end of life find purpose.
"For some, it's physical pain, for some it's psychosocial suffering. What hospice organizations do well is address all these needs," he said. "I've never had a patient, after we've done everything we could for them, still ask to help them die. If I did, I would have to say, 'I can't help you.'<0x200A>"
the right to hasten one's death
Jones praises hospice for its work in easing the dying process, but she said all people should have the right to "hasten one's death," although she admitted that she hates the phrase. Compassion in dying, she said, "means the opportunity for people to choose to some degree the manner of their death." She said one of the main concerns for her and others is being kept alive by "technological" means.
"My feeling is that's inhumane and cruel, especially when there is brain death. It's a terrible offense to an individual to keep the body going when the brain is gone," she said.
Mary Grove of Lakeland, a retired nurse, is the state representative of Compassion and Choices. In April, she arranged for a workshop by Helen Beum, a staff member with Compassion and Choices' national office in Denver, Colo. During the two-day workshop, Beum explained how terminally ill people of sound mind could choose how they might die nonviolently.
"I've been accused of killing old ladies. We don't do that," Grove said. "We try to prevent people from shooting themselves and upsetting their families. We never do anything hands-on. Our purpose is education. ... We tell them what their options are, and they make their own decisions. We give them a certain amount of instruction on how they can legally obtain medications (to end their lives)," Grove said.
She said that there is a screening process for those who contact her. She refers calls to Beum, who talks with the individuals to ensure they are not psychologically disturbed or depressed.
"The main problem is people who live alone, particularly older women, who need to know someone is there in case they need them," Grove said.
Polls and voter referendum results suggest less than half of Americans favor allowing doctors to administer lethal drugs, but the question of how far they should be permitted to go is the heart of the controversy. The American Academy of Hospice and Palliative Medicine's position statement on "physician-assisted death" includes guidelines for physicians in places where it may be legal. Among them:
The request must come voluntarily from a patient "with full decision-making capacity."
"All reasonable alternatives to physician-assisted death have been considered and implemented..."
The physician is willing to participate and not acting contrary to conscience.
Dr. Timothy Quill, professor of medicine, psychiatry and medical humanities at the University of Rochester Medical Center, was a plaintiff in a 1977 New York lawsuit challenging the state's law against physician-assisted suicide. He said by phone from his office that despite progress in resolving difficult cases with the legal use of heavy sedation, more needs to be done.
"There's still a role for the option of physician-assisted death for the toughest cases. People welcome having more choice," he said.
MORAL AND ETHICAL DILEMMA
But many doctors do not support physician-assisted suicide, which presents an ethical dilemma because they are trained to heal patients rather than abandon them to disease. As Leedy, of Good Shepherd Hospice, put it: "We as an organization and I as a physician do not support it."
The American Medical Association adopted a position on physician-assisted suicide in 1994, updated in 1996, that states in part: "(A)llowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible."
The president of the Polk County Medical Association, Dr. Jorge Gonzalez, said in an e-mailed statement, "All members of PCMA abide by this code of ethics from the AMA."
Dr. Tom McLaughlin, a urologist with Watson Clinic in Lakeland, also agreed. "Morally, I'm not for it," said McLaughlin, who was raised Catholic and now attends All Saints Episcopal Church.
McLaughlin said he has never faced a request for assistance in dying from a patient, but he said he understands the desire to avoid being sustained in a "permanent vegetative state" in which all brain activity ceases.
"If someone is terminal, physician-assisted suicide is one thing, but not doing aggressive therapy is another. ... I would not be for all these feeding tubes. I think feeding tubes are artificial," he said.
Public opinion is divided as well. An AP-Ipsos poll reported that 48 percent of Americans said physician-assisted suicide should be legal, and 44 percent said it should be illegal. However, 68 percent said there are circumstances when a patient should be allowed to die.
The Roman Catholic Church and many conservative Protestant groups are firmly opposed to physician-assisted suicide.
If there is disagreement about the role physicians should play in the end of life, everyone in the controversy agrees that people should let their family and friends know what their wishes are if they are unable to make their own decisions about their medical care. McLaughlin said "advance directives" - written instructions about one's wishes at the end of life - should be mandatory.
"I think in order to get a Medicare card, you should have to issue an advance directive. I've talked to some people in Congress about that," he said.
Mary Grove, of Compassion and Choices, said the Terri Schiavo case made people aware of the need for advance directives and a designated advocate. Schiavo, a young Florida woman who fell into a permanent vegetative state without leaving any written instructions, was the subject of a court dispute among family members before she died in March 2005.
"You should have a surrogate who can speak for you if you're unable to," she said. "I'm a surrogate for many people, because they can't find anyone in the family they can trust."
Everyone also agrees that people tend to avoid the subject. But Leedy said Kevorkian himself brought about a change by breaking a taboo.
"One thing Dr. Kevorkian has done is precipitate a discussion of end-of-life issues....If we can get people to talk about it, they'll be happier and healthier," Leedy said.
That seems to be the case for Marcelle Jones, who has considered her death from different angles and talked openly about it.
"I think it's going to be OK with me," she said. Then she added with a chuckle, "The only thing I'll regret is the desserts I haven't eaten."
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
15 minutes of fame can cause people to do really foolish things, like agree to be the object of a promotional video for the "Hemlock Society."
watched my Mom and her Twin die of cancer about a year apart... made up my mind right then and there. i'll never go out that way.
If I had to live in Lakeland, I’d commit suicide too.
They meant to say, "before she was killed in March 2005" right? Yeah...right!
I live only about 45 minutes from Lakeland, and avoid it whenever I can.
libertarian ping
Actually, I think Terri died February 25, 1990
In our family, we discuss this on a regular basis. We all agree: we need take no extraordinary steps to remain alive, but can take no active steps to cause a death.
And there are clear differences.
“I’d never do that. Suicide is against the laws of God. Only He who gives me life can take it away.”
Ditto!
That is the proper way to view this situation.
It’s too bad her “friends” don’t care about her either or they would comfort her and lift her up.
Libertarian ping! To be added or removed from my ping list freepmail me or post a message here.
I am speaking of those situations where the person knows their mind and states clearly what they want done--verifiably and in writing.
If I had a terminal disease and saw a future comprised only of a downhill course of pain and suffering, I *might* not want to live that way, and I might think about choosing the time of my death as well.
I can believe that some people do get to a point where they just cannot or do not want to go on the way they are. And while I might not agree with them, I might try to persuade them otherwise, and I might wish they would do otherwise, I could understand such a decision.
However, I really think that, wuss that I am, I would seek to simply float out on an opium haze as much as possible. IF that eventually caused respiratory failure, I would hope that God in his infinite wisdom would see that there are oftentimes no "right" choices in a twisted world, but only choices which say "I hope, in my pathetic sinfulness, which permeates everything, to try and glorify you in this choice." As weird as it may sound I believe that suicide (which is clearly breaking the command not to do murder) may be one of those choices when faced with exceptional pain. Again, I would hope that I could also "drink the cup," but no one knows the strength of soul he has till he stares down that barrel.
As far as others go, I hope that I can encourage my friends who are suffering to hang tough till the end. I do believe there is a difference in accepting the clear fact that God is calling me out of the world and accepting that vs. taking matters into my own hands. I would hope that I would be given fortitude, courage, and patience to die to the glory of God, and to help my friends seek to do likewise, rather than say "no" to the path (however ugly it looks).
For those not motivated by such reasoning, I can't see where it makes much difference one way or another, to tell the truth. As Sartre said, the only serious philosophical question left in a world without God is suicide. Nothing matters much, despite our emotional protestations to the contrary
As to doctors, I think it is significant that the Hippocratic oath contains the vow to "do no harm." I want a physician to be dedicated to healing ONLY. Executioners are, and should be, a completely separate class of people. I am against physician assisted suicide primarily because of what I believe it will do to the physicians. The "victims" are going to die anyway......, or so the reasoning goes.
The Schiavo case is a great example of how this thing comes in dressed as mercy, but walks out counting the money.
It’s a fine position, but not one that should be against the law for someone who has the faculties to decide the issue for themselves. And the decision does not belong in the hands of “friends” or family. I have had my own plan in mind for years and years. When I think it is time for me to check out I’ll be ready. It is only against the law of God for you........ and only you.
Lots of ice cream, television and morphine for me.
And every time the nurse came in to do something I waould ask if it was expensive. If they said yes, I would say give me two. :oP
And every time the nurse came in to do something I would ask if it was expensive. If they said yes, I would say give me two. :oP
Ping....
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