Monday, February 15, 2016

Death with Dignity?

Tarris Rosell, PhD, DMin

What Kansans Need to Consider about House Bill No. 2150

(“The Kansas Death with Dignity Act”)

How would you answer the following question if a Gallup pollster asked?

When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?

As of mid-2015, nearly 7 out of 10 Americans polled answered that question, “Yes,” including 48% of those who attend church weekly. The vast majority of Americans, and 81% of young adults ages 18-34, currently favor physician-assisted suicide (PAS). Are they right? Could that large a majority possibly be mistaken?

Kansas legislators, like those in most states, have had opportunity to consider making PAS legal. It is already legal, with restrictions and regulations, in several other states, most notably Oregon, Montana, Vermont and Washington, and as of this year California. The addition of California now makes the question relevant to 1 in 10 of all Americans. The 1994 Oregon “Death with Dignity Act” served as the model in California, and also for Kansas House Bill No. 2150, introduced last year. No hearing was held.

Governor Jerry Brown, a Catholic Christian, recently signed that CA legislation after much thought. Kansas Governor Brownback, also a Catholic, seems unlikely to sign such a bill even if it were to get out of committee and garner enough support to get through both chambers of the Kansas legislature. Is this good public policy? Or are we wrong-headed in the Heartland?

One of the influences credited with raising Gallup percentages especially among young people was the physician-aided death of 29-year old Brittany Maynard.

Brittany was living in California when diagnosed with glioblastoma multiforme, an aggressive form of terminal brain cancer. After much research and discussion, Brittany decided to move with her husband and mother to Oregon so as to qualify for that state's "death with dignity" protocol. After establishing residency and meeting with physicians, Brittany received her lethal prescription of drugs, to be used or not at the recipient's will. If taken as a means to end life, Oregon law specifies that the drugs would need to be taken by Brittany's own hand. No one could do it for her.

Upon experiencing multiple seizures and cancer-related pain, Ms. Maynard decided to take a lethal dose of medications prescribed for this purpose, and thereby end her life on November 1, 2014. Close family and friends accompanied her at the time of departure. It was said to have been a peaceful death. Was it a "death with dignity?"

In a dialogue group I attend monthly, involving mostly physicians and chaplains, the Brittany Maynard case was discussed after viewing a six-minute YouTube video posted by Brittany prior to her death. I have facilitated discussion of this case with groups of seminarians and medical students, also. Each time, I poll the participants on their opinion of PAS. Regardless of the group, percentages mirror those of Gallup. So should the majority rule in Kansas on this matter?

A hospice physician friend suggested that Brittany Maynard might have utilized palliative care in hospice. He acknowledged that this could not guarantee a death without pain and suffering, but that hospice care places value on a dying patient’s dignity. Indeed, most surely do, and most hospice deaths seem relatively peaceful. This is what I, and most bioethicists I know, advocate rather than expanding access to PAS. It may well be that the American majority has been misled, and that the better way to achieve death with dignity is to promote palliative and hospice care—especially for those groups who don’t have access to comprehensive care. But really, for all of us.

Brittany and at least 859 other terminally ill patients in Oregon over the course of the last 15 years or so, have chosen a different route to their deaths. Even in Oregon this remains a remote event, affecting only about 3 deaths in 1,000. I don’t condemn them nor their assisting physicians. Condemnation gets us nowhere good. I urge thoughtful and respectful ethics dialogue instead.

I advocate for better advance care planning, earlier end-of-life conversations between patients and their physicians, and more robust discussions about goals of care in advance of health crises. Increased public funding seems necessary so as to train more palliative care and hospice physicians. More research, and research funding, is needed for rigorous evaluation of the care currently being provided to dying patients.

This seems to me the better path to death with dignity, not only in the Heartland but everywhere.

How does it seem to you?


Tarris Rosell, PhD, DMin, is the Rosemary Flanigan Chair at the Center for Practical Bioethics.

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Blogger Carla Davis said...

I've recently had someone in my family use Death with Dignity to end his life. This has made me think about how I feel about this law on a much deeper level. I work in the medical field and have taken care of many patients at the end of life. I feel like dignity in death is much the same as dignity in life. It is not what happens to you, it is in how you handle yourself during whatever happens to you. I was surprised by my strong reaction to my family member's death. I felt quite angry at him and I've been trying to figure out why that is.

I think that with hospice and palliative care, any death can be with dignity and without the horrible suffering that so many people are afraid of.
Thank you,

Carla, RN

Sunday, November 06, 2016  
Anonymous Dillon said...

I agree there should be better communication with doctors and patients related to end of life planning. I believe a persons autonomy is extremely important. To die a peaceful death on one's terms should be morally permissible if they are suffering from a terminal illness and the only relief is death. I don't think I should be able to prevent an individual from practicing their right of self-determination. Of course, I think there needs to be regulation to ensure the system is not abused and lives are not loss due abuse. Our current healthcare system is one of reaction rather than prevention and I think this is the primary problem. This is a difficult question to answer and I do not think there is clear cut path to take.


Friday, November 11, 2016  
Anonymous Dillon LeSieur said...

I don't think I should be able to prevent somebody from practicing their right to autonomy. If a person is suffering from a terminal illness and the only relief from the illness is death they should be able to end their life on their terms peacefully. Self-determination is powerful and I don't think it is something that should be prevented. There is always a fear of abuse so I think if death with dignity is something that is practiced in all states there should be regulation. I do agree there should be better communication between doctors and patients on end of life decisions. I work in a hospital and for some reason healthcare workers are afraid to talk end of life decisions with patients. We as a healthcare system should be more transparent in end of life care and it is something that should be discussed sooner than later. Death with dignity is a tuff topic but I am in support of it.


Friday, November 11, 2016  

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