Should We Have More Control Over When We Die?

Should We Have More Control Over When We Die?Modeled after Oregon’s Death with Dignity Act, the California End of Life Option Act, SB128 would allow a mentally competent, terminally ill adult in the final stages of his/her disease to request medication from a physician to bring about a peaceful death. This is a big step that should receive our careful thought and discussion.

Oregon has been closely following the impact of its Death with Dignity Act since it went into effect in 1997. So far the law seems to be working fairly well. People are not rushing to take their lives nor does there seem to be any excessive pressure to do so. Many safeguards are in place to insure this including two doctor consultations and two witnesses.

Out of approximately 30,000 Oregon deaths per year, only 71 were the result of ingesting prescribed medications for that purpose in 2013.

At first glance, it seems a good thing to provide people with a way out when the pain of illness is so severe that all quality of life is gone. And yet, I find myself troubled by the idea of making death too accessible.

A colleague of mine shared the story of her elderly father who attempted suicide three times in response to a terminal diagnosis. His family supported him in his decision and even researched options for him to try. The third failed attempt convinced him that this was not the way to go and he surrendered to the natural course of his illness. His wife was very grateful for this. It allowed her time to adjust to his dying and say goodbye. He may well have made the same decision under the provisions of the Death with Dignity Act in Oregon. But the reality that it was not so easy to take one’s life certainly impacted his decision.

My sociological imagination can easily conjure a society where early death becomes a seductive solution to the overwhelming medical needs and costs of a rapidly aging population. By limiting or eliminating coverage for quality end-of-life care, insurance companies may nudge the infirm and the elderly into this more permanent way out of their suffering.

Then there’s the reality that many of us are challenged by the idea of being a burden to our loved ones. A 2013 report by the Oregon Public Health Division on the Death with Dignity Act, identified loss of autonomy as the most frequent mentioned end-of life concern among those who participated (93%).

Death may be preferable to dependence in a culture that esteems productivity and calculates personal value by income earned.

The intrinsic benefits of submitting to the dependency of dying – the personal growth, healing and intimacy – may be hard to imagine for those used to a culture of rugged individualism. For a glimpse of what is possible along these lines, I recommend Marie de Hennezel’s book Intimate Death. Of course, I have no illusions that a loving and graceful death scenario is available to all. Many variables including poverty, community and family dynamics come into play.

There is another option available for those in severe pain at the end of life that has been around for a long time. It’s called palliative sedation. Physicians are allowed to prescribe whatever dose of medication is needed to control pain even when it may hastens death. This gives physicians considerable latitude in assistant their dying patients. I suspect that is how my maternal grandfather was able to depart this life so soon after expressing his wish to do so. Bed-ridden and in pain for weeks from end-stage prostate cancer, he was lucky to have a family physician who not only advised my mom to “keep him at home” rather than in the hospital but also may have provided that little extra help to get him over the line. The problem with palliative sedation, of course, is that it is at the doctor’s discretion not the patient’s. But it does skirt around the moral and psychological issues of ending one’s life which SB128 does not.

While some people, like my grandmother, seem to know the trick of dying and can leave when they decide it is in their best interest, others like my grandfather must  struggle long and hard for their release.

Dying is a lot like birth labor. Some have it easy, some don’t.

In the case of birth there is an out — Caesarian birth, which skips the birthing process by surgically removing  the baby from the mother’s uterus. It is an awesome life-saving procedure in times of crisis. However, for a number of years it was over-prescribed because it could be scheduled for the convenience of the doctor and certainly was more generous to the bottom line. I worry about comparable trends developing around dying once death becomes a medical procedure rather than a natural process.

Having said all this, I’m glad I’m not the one who must decide whether this bill should pass. I am reminded of an old Siskiyou folktale about the origin of death. In the story, Old Man proposes to Old Woman that, on the matter of death, people should be reborn and live-forever. Old Woman disagrees. She believes there should be a limited life-span so that people would use their time more wisely and there would be room provisions for new people being born. She got her way and it seemed a good decision — for a time — until it was HER child who was dying. When it is personal, theory, supposition and prediction become irrelevant. All we want is peace of mind.

Please share your own thoughts about this bill by posting a comment below.


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