By KAY LONGHI
For The Beachcomber
When my first husband died of lung cancer, I was introduced to the concept of death with dignity. Years later, by the time my second husband died of esophageal cancer, it had become all too real. One husband had a “good” death, because he chose how and when to die. Hastened death wasn’t legal, but as a physician, John knew how to go about dying on his own terms.
Initiative 1000 would guarantee that all terminally ill Washingtonians have this same self-determination. Without it, you and your loved ones are left alone to find a means to control the circumstances of your final days of life.
The Death with Dignity Initiative allows mentally competent, terminally ill adults with six months or less to live to receive, under strict guidelines, a prescription for life-ending medication. It also mandates that terminally ill Washingtonians be informed of all other options, including palliative care, pain management and hospice care.
Opponents of I-1000 focus on the potential abuses. They say depressed, disabled, destitute and demented people would end their lives needlessly, or worse, a family member or HMO would do it for them. This is just not true. Look at the facts, not scare tactics, half-truths and moral judgments.
This initiative is closely patterned after the Oregon Death with Dignity Act, which has been in place for 10 years. Because of strict reporting requirements and continual oversight by the Oregon Department of Health, the law, facts demonstrate, is safe, compassionate and responsible.
Shortly after John’s biopsy confirmed non-treatable lung cancer, my husband made two decisions — to seek only hospice care and to arrange for a hastened death at a time and place of his choosing. Hospice and the comfort of knowing he was in control of his death helped make his last four months a close and strengthening time for our family.
The safeguards against abuse are precise and detailed. Independent studies prove that these safeguards protect patients. The Oregonian newspaper wrote in January, “Opponents, including us, warned that the law could steamroller vulnerable patients into suicide, target the disabled and become a destination for terminally ill people seeking to die
with doctor-prescribed drugs. In a dec-ade of experience with the law, though, no such abuses have shown up.”
In fact, look at what has happened for the common good in Oregon. It has one of the highest rates of hospice usage in the country. More Oregonians die at home than die in hospitals. Oregon’s use of pain medication for terminal patients is one of the highest in the nation.
Use of the law has been rare. Of the 30,000 Oregonians who die annually, only 40 on average use it. Required reports by prescribing Oregon physicians reveal the majority of patients who hastened their death were educated, had insurance, identified with a religious faith, had family members and died primarily of cancer and Lou Gerhig’s disease. Of the 541 prescriptions written for qualified patients, less than two-thirds actually used them. Dozens of prospective patients requesting the prescription were denied it because their doctors suspected mental health issues.
Federal confidentiality laws prevent a physician from notifying family members of any medical procedure or prescription without the patient’s permission. I-1000 is no different. In fact, it encourages family notification. In Oregon, 95 percent of patients who chose death with dignity did so with the full knowledge of their family.
Over his last four months, John renegotiated with himself about when to hasten his death. First it was when he was going to have to depend on a wheelchair; then it was when he was going to need oxygen full-time; then it was when he wouldn’t be able to easily leave the house. So when, over dinner one night, he told me he was ready to die, I knew he meant it. He wasn’t in pain or depressed. He wanted to live. But he was in the end stage of his disease. He knew what would happen to his body and mind over the next few days. So, like the majority of Oregon residents who hastened their death, he ended his life within days of when he would have died naturally. This was not suicide. His mental state was far different than those who can choose to live, but don’t.
I-1000 requires that the terminally ill patient, and only the terminally ill patient, decide to hasten his or her death, and then to self-administer the medication. This isn’t a decision made by those with a particular moral or religious ethic, or an insurance company, or a government representative. The choice is left in the hands of the patient — where it belongs.
— Islander Kay Longhi is a research coordinator at Harborview. She has served as president and is now a board member of Compassion and Choices of Washington, which supports I-1000.
