She chose it all on the day she died (Euthanasia)

The Oregonian ^ | 9/30/07 | Dan Colburn

[wagglebee]

Lovelle Svart woke up Friday knowing it was the day she would die.

There was much to do. Her family and closest friends would be gathering at 11 a.m. in her mother's apartment in the Southwest Portland assisted-living center where they both lived.

She directed trips to the grocery store and even called AAA to jump-start the dead battery of her 2006 Scion. She double-checked delivery of food platters from Fred Meyer: turkey sandwiches, strawberries and grapes, pretzels, almonds and sparkling water. There would be pink roses on the dining table and a boombox in the corner to play music, including the polka tunes she loved.

Lovelle made one last trip to "the bridge," a wooden footbridge in a nearby park where she had found quiet sanctuary the past few weeks as painful cancerous tumors spread from her lungs through her chest and her throat.

The consummate planner, she had choreographed the day. She wanted to leave time -- five or so hours -- for storytelling, polka dancing and private goodbyes. And at 4 p.m., she intended to drink a fatal dose of medication, allowed by Oregon law, that would end her life.

A smoker since age 19, Lovelle found out five years ago that she had inoperable lung cancer. Radiation and chemotherapy slowed the cancer's spread but could not stop it.

In June, Lovelle's doctor warned her that she was likely to die within six months, making her eligible for Oregon's unique, 10-year-old Death With Dignity Act.

What some call doctor-assisted suicide and others call physician aid-in-dying or hastened death is one of the most passionately argued issues in U.S. medicine and politics. Proponents frame the question in terms of personal choice, death with dignity and freedom from pain. Opponents say assisted suicide violates the Hippocratic tradition of "First, do no harm" and undermines the doctor-patient relationship by turning physicians from healers into accomplices of death.

Far more people ask for a lethal prescription than actually use the drug. Either their symptoms overwhelm them before they make a final decision, or they find other ways to control those symptoms, including pain.

Lovelle was determined to keep control, if possible, of when and how she died.

On July 1, she filled out and signed a one-page form titled, "REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER." By signing, she agreed that she knew the expected result -- death -- and was aware of alternatives, such as hospice care.

By law, she also had to make two oral requests at least 15 days apart. Her doctor wrote the prescription for a lethal dose of barbiturate in late July, and she had it filled Aug. 7. She kept the orange bottle of clear liquid in a plastic grocery bag on a stack of towels in her bedroom closet -- "hidden in plain sight," as she put it.

She was still unsure whether she would take the drug, but said she took comfort in knowing it was there.

Once she knew she had less than six months to live, Lovelle also decided to try to start a more open public discussion of dying. During the past three months, mostly through a series of online video diaries for The Oregonian, she shared publicly the experience of facing death.

Lovelle, 62, has "touched a chord" by chronicling her "deeply intimate struggle with mortality," said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University.

"People are following closely," Tolle said Friday. "They want to know what happens to her.

"Lovelle has become their friend."

Friday morning, Lovelle stuck a yellow note on the door of her mother's apartment: "Please Do NOT Disturb. Unless Urgent. Thank you."

She wore a blue sweat suit over a "Cancer Fighter" T-shirt.

Lovelle delighted in Friday's blustery weather and a forecast that included possible thunder and lightning about the time she planned to die. "Oh, the woo-woo crowd will have a blast with that," she said.

After AAA jump-started her car, she left the engine running to recharge the battery, returned to her apartment and set the kitchen timer for 10 minutes to remind her.

When a friend later expressed shock that Lovelle had spent part of the last morning of her life dealing with a dead car battery, Lovelle explained:

"The car goes to my sister. I didn't want it to be dead."

In the living room, her family and friends sat and told stories and jokes, sometimes with political references. Sometimes they laughed a bit too loudly, out of nervousness at the occasion. Twice, Lovelle came out of the bedroom where she was having private meetings to say, "No politics!"

A bit later, Lovelle and George Eighmey, head of Compassion & Choices of Oregon, an advocacy group that works with most of the Oregonians who end their lives under the Death With Dignity Act, danced a brief but rousing polka.

By midafternoon, the studiously punctual Lovelle was falling behind her schedule. No one complained.

But a little before 4 p.m., she decided it was time to make her final preparations. First, she had to take the two pre-medication pills -- to calm her stomach and control vomiting. They were hard to swallow, given the tumors in her neck, but she got them down with water.

"It" would be in about an hour, she told her family. Time now to sit alone with her mom, Vi Svart, in her bedroom for the last time. The rest of the group sat in the living room, debating whether they wanted -- and whether Lovelle wanted them -- to be in the room with her at the end.

Lovelle's three siblings and her mother, despite deep misgivings about her decision to end her life, supported Lovelle in her choice.

"I feel so at peace," she said. "I've had such a good time. . . . And today has been so wonderful.

"I'm really ready to go. I'm ready."

About 4:30, Lovelle announced she wanted "a hugging line" -- one last hug for everybody. "You'll be first and last," she said, turning to her mom.

Lovelle stood in the center of the living room and embraced them one by one -- long hugs with tears and laughter.

Then one last cigarette break on her favorite sitting stone next to the parking lot. Afterward, Lovelle took the elevator up to the third-floor apartment and hung up her coat and hat.

"OK," she said to no one in particular. "I'm going to get into bed now."

In many ways, Lovelle fits the pattern of Oregonians who choose to end their lives under the Death With Dignity Act.

Like most, she had cancer. She was in her 60s. Well educated and insured. Not formally religious. White. Enrolled in hospice care.

And fiercely independent.

"I could be very gregarious -- and very private," she said. "Very much the partygoer -- and very much want to stay home and read."

She was chosen Miss Cafeteria at Crater Lake Lodge in the summer of 1963, and she has the lemon-yellow rayon dress to prove it. She left it hanging in a plastic dry-cleaning bag on her bathroom door.

She loved surfboarding and polka-dancing and both her first and last names, "because they are different, and I like things that are different."

And she liked, as she was the first to admit, being in control.

Lovelle decided it was more important to die by taking the lethal drug while she had a degree of control over her body than to wait for nature to take its course. But how to decide when?

Her symptoms -- shortness of breath, stomach distress, weakness and pain -- were intensifying. If she waited too long, she would be unable to drink and swallow the lethal drug on her cupboard shelf.

Lovelle sought a shifty window between life-worth-living and incapacity, "this tiny bit of freedom" when, for her last act, she could swallow a fatal potion in the company of family and friends. "That's when I want to go."

Last Sunday, after a painful, restless night, Lovelle decided it was almost time.

Swallowing was more painful than ever, like choking on broken glass or razor blades, she said. She had barely eaten in two weeks. She started taking morphine to dull her pain.

She told family and friends to come Friday.

Lovelle sat on the foot of the bed, while 10 others gathered around. A photograph of Lovelle as a curly-haired 5-year-old stood on one bedside table; on the other were a glass tumbler containing the liquid medication, which looked like water, along with a container of morphine and Lovelle's ever-present mug of Gatorade. On the wall above the head of the bed were five more family photographs.

With some help, Lovelle yanked off her shoes and socks and slipped partway under the covers.

Eighmey stood by her bedside. He has attended more than three dozen deaths of this kind.

"Is this what you really want?"

"Actually, I'd like to go on partying," Lovelle replied, laughing before turning serious. "But yes."

"If you do take it, you will die."

"Yes."

Ever the detail person, she reminded him that she wanted her glasses and watch removed, "after I fall asleep."

Eighmey warned her that the clear liquid would taste bitter. She needn't gulp it. She would have about a minute and a half to get it down.

Lovelle dipped her right pinky into the glass and tasted.

"Yuck," she said. "That's why I need the Gatorade."

Holding the glass, Eighmey asked her again to affirm that this was her wish.

Yes, she replied.

Someone asked, "Can we have another hugging line?"

One by one, they came to head of the bed for hugs and teary whispers.

"Sweet dreams."

"It's all right."

"I know."

"Thank you for being my big sister."

"All the church is praying for you."

Lovelle was sitting up in bed, three pillows propping her up.

She held the glass tumbler in her right hand, raised it to her lips and drank. It was 8 minutes after 5.

"Most godawful stuff I ever tasted in my life," she said, making a face before taking a sip of Gatorade and plain water.

She laid back and scrunched down under the covers, glasses still on to see her loved ones.

She reached for her mother, who leaned closer, then laid down next to Lovelle, stroking her hand.

"Are you OK, honey?"

"I'm fine, Mom."

"You're not sick?"

"No. I'm peaceful. It stopped raining, the sun's out. And I've had a wonderful day.

Her eyes closed.

"It's starting to hit me now."

For a while, no one moved or spoke, as Lovelle drifted into a coma. Then Lovelle's mom asked for a prayer. Others spoke up with prayers and memories, which prompted other stories. Lovelle's brother Larry read part of William Wordsworth's "Intimations of Immortality."

Lovelle lay motionless but for the gentle rise and fall of her chest. Her heart slowed but didn't stop.

About an hour into the vigil, Lovelle's mom lit three white candles in cut-glass candlesticks in the living room. "She's still with us," she said.

Hours passed. Given what Lovelle's body had been through -- not only lung cancer but also open-heart surgery in 2004, Eighmey was surprised how long she was lingering. But not her family.

"I hate to say this," one said with a smile, "but this is just like her."

"A little spitfire," agreed another.

"Above average -- that's Lovelle."

"One last reminder that she's the one in control."

Jane O'Dell, a volunteer for Compassion & Choices, sat at Lovelle's bedside all evening, holding her right hand, monitoring her breathing and regularly checking the pulse in her wrist and neck.

About 10:30 p.m., more than five hours after she had taken the drug, O'Dell signaled that Lovelle's breathing had become shallower and more labored. Her pulse dropped, her skin turned pallid and her fingernails bluish. It was more than a minute between breaths.

Family and friends resumed their bedside vigil, and silence again fell over the dark room. Lovelle's chest stopped moving.

Eighmey leaned over at 10:42 p.m. and put his ear to her chest to listen for a heartbeat. He stepped back, shaking his head and spoke in a quiet voice.

"She's gone."

[BuffaloJack]

The next step after “right to die” is “obligation to die”.

[MarineMom613]

Having read only the first page of this thread and it really hitting close to home, I’m just gonna jump in.
Last week my Mom was diagnosed with Pancreatic Cancer. Came out of no where and needless to say we are mostly still in shock. Her attitude right now is she is not afraid to die but is deathly afraid of the pain involved. I flew my sister up from Fla to help me with appointments etc at this initial stage. Right now she wants to keep on working (she’s 73), she’s a fighter and she hates being a burden.
I have a brother (who’s in denial) and a sister (step) whose other side of family has had several cancer deaths and she was a caregiver in most of those situations.
My mother lives with me and has given me control (legally) to make all medical decisions. She trusts me to follow her wishes regardless of emotions involved. Could I do what this woman chose for herself. NO. My mother is also my best friend and I would do everything to make her comfortable.
Since I am just at the beginning of this journey I am sure I will come up with all kinds of difficult decisions. Hopefully God will guide me down the hardest ones.
Sorry for rambling. Just wanted to put my 2 cents in.

[wagglebee]

Very true and unfortunately few people realize this.

[CDHart]

I am currently being treated for lung cancer - this article is horrifying.

Carolyn

[ninonitti]

For some reason I’m angry with her.

Why is that?

[BritExPatInFla]

“For some reason I’m angry with her.”

---

She probably doesn’t care. She’s at peace, no longer in pain and made HER decision on HER terms.

[Riverman94610]

“Living”like that poor woman was is no life at all.Why prolong the agony?.Take me to the next phase.
Your decision is one to be respected.Yet it would not be my choice.

[Ghost of Philip Marlowe]

I tend to be split on the issue, leaning toward it is wrong.

That those who are dying are starting to throw parties the day of their death pushes me well into the, “this is more effed up BS from a weak, lost people” side of the aisle.

If she was able to do so much on her last day, why couldn’t she have delayed it another week, or two, or four, and done something meaningful with that time, as opposed to calling caterers and getting her car jump-started. Unbelievable.

[palmer]

I am currently being treated for lung cancer

Hope you have a speedy and full recovery. The story of this woman was sickening. Life's purpose is to fully utilize one's humanity and reason to advance the human cause. She could have chosen to study, teach, create, help, or inspire in countless ways. Instead she chose to try to prove that life has no purpose. What a terrible example for the less fortunate.

[Pan_Yans Wife]

My mother was diagnosed with inoperable and terminal cancer last December. And it hasn’t been easy on the family.

There was never a time when we brought up old business to sort through, we haven’t gone back over each other’s failings. Without even saying it aloud, each of us determined from the very beginning that there wouldn’t be any “last fights”.

There is no regret, because each of us has had to accept the truth from the very first day.

When my mother told me she wouldn’t go through further chemo or radiation, part of her reasoning was because the radiation had permanently damaged her esophagus and to continue would only cause more damage. She worried that she wouldn’t be able to swallow saliva, let alone food.

She also knew that continued treatment would only prolong her suffering for three months. She is a frail and weak woman, and her body cannot withstand more treaments. Her doctors said they would do the treatments if she wanted, but they accepted her decision not to. They know that nothing can stop the cancer and she will die a cancer patient.

So, when my mother told me that she was ready to stop treatments, I said the only thing I knew to say. I told her that I hoped she knew how much I love her.

In the end stages of cancer, there is little to do or say. You can be there to care for the patient and you can talk of love and peace. But time is running out.

Ask me how quickly the past ten months have gone. Too fast. And I wish there was more time. But, there is nothing I can do to change it.

I will honor my mother’s wishes. And I will let her die on her own terms, surrounded by those who love her.

My life will never be the same when she’s gone. It doesn’t matter what happens today. The door is closing rapidly.

[CDHart]

May God give you peace and strength and comfort as you endure this trial.

Carolyn

[Mr. Silverback]

However, those who don’t value death would quickly impose this ethos on those who do not want to die.

There is no value in death and the "death with dignity" that Kevorkian's disciples preach is an illusion. My in-laws died in a small plane crash. I don't know all the gruesome details of how they were torn apart, but I know they were cremated primarily because of the condition of their bodies, and that my father-in-law was decapitated. They were probably screaming when they died, because they crashed after an entire wing came off while banking. Was that "dignified?" No, their lives were dignified--he was a Marine drill instructor and longterm power company lineman and she was a nurse, and they were one of the top three donors in their parish even though they had 8 kids.

Car crash victims don't die with dignity either. Dignity in death comes from how you face it, not from whether a guy pushes a needle in your arm.

Are you aware, BTW, that Osama bin Laden has said that he will defeat us is because his side values death and we value life?

Personally, I think the better solution for this woman would have been far better pain medication. If it hurts too much to live, then we should do more so it doesn’t hurt too much.

Since that option exists, why should we allow our medical system to be screwed with so some people can claim they're "dying with dignity?"

It is, after all, an easy way to empty expensive nursing homes and save money in socialized medicine.

Perhaps you can print out this poster, and display it to show the world your compassionate and fiscally conservative sentiments:

"This person suffering from hereditary defects costs the people 60,000 Reichmarks during his lifetime. People, that is your money. Read 'New People'., the monthly magazines of the race-political office of the NSDAP [Nazi Party]."

[FixedandDilated]

Looks like a really fun book. Wonder if Amazon has it? I can put it on my Wish List, and maybe I’ll get it for Christmas.

[Mr. Silverback]

But I am not going to smugly sit up here and judge this woman.And can you honestly look yourself in the mirror and say you would not make the same choice if that were you?.

Yes. And there is no "smug" about it.

[-YYZ-]

“The next step after “right to die” is “obligation to die”.”

That’s the one part of assisted suicide and voluntary euthanasia that really concerns me. I’ve leave it up to individuals and their personal beliefs to decide whether or not it is a moral thing for them to kill themselves, but creating an atmosphere where people feel pressured to do away with themselves to avoid becoming a “burden” on their family, friends, society, government, etc is something that I am not comfortable with.

[ga medic]

cancer Death can be horribly painful, and can take several weeks for a person to gradually die. My mother died from brain cancer and they never could get ahead of her pain. It took 6-8 weeks of horrible pain and suffering.

I have seen hundreds of people in the last moments of their lives. Cancer is the worst from my perspective.

[MarkBsnr]

The future of mankind?

[Mr. Silverback]

Not being one of you other-peoples-suffering-is-noble types, this sounds to me like a pretty fair way to go. Wait until the people who brought us asssited suicide are running the medical system. You ain't seen suffering yet.

[Mr. Silverback]

My mother died of uterine cancer and having spent the final days with her, there was no dignity in the way she died. She suffered greatly.

I am greatly sorry for your mother's suffering...my grnadmothers went through similar problems prior to their deaths. That said, there is no such thing as "death with dignity." Car and plane crash victims don't die with dignity. Dignity is in how you live your life before your number comes up.

[ga medic]

I do realize that as Christians we are to trust God. Especially, in those last moments of our lives. We also are supposed to avoid sin. We try, but sometimes trying isn’t enough. Facing several weeks of pain and suffering plus the burden on the caregivers is frightening. Some are strong and will face this head on, with grace and dignity. Some will show weakness, and try to control the process themselves. I don’t feel a need to point out weakness in others, when I am not certain of my own strength in such a situation. I am not advocating suicide or assisted suicide. Ideally, everyone would follow God’s will. I just have a lot of empathy for those who are facing such a difficult experience.

By the way, not all death is horrible. Traumatic death such as motor vehicle accidents or other sudden injury can be very peaceful and pain free. In most cases there is very little pain or suffering. Much different from weeks or months of pain and wasting away.