In January 2015, the Canadian Supreme Court reversed a decision from 20 years ago which said that it was illegal to assist someone who was very ill from taking their life. The most recent ruling impacting the entire country now states that “death with dignity” is an inherent right of all Canadian citizens. In the USA seven states (Montana, Oregon, Washington, Vermont, New Mexico, California, and Colorado) now have either statutes of case law which mandates that patients who are ill and dying must have the right do death with dignity through assisted suicide, or specific statutes that prescribed the regulations that must be followed. There are strict guidelines that must be met to qualify for receiving the life ending medicines.
It may be of interest that Archbishop Desmond Tutu has written on this subject stating that death with dignity should be an inherent right and that Nelson Mandela was not accorded this at the end of his life. He was kept alive for about four months on machines… longer than his body would have naturally survived.
A celebrated case involves Brittany Maynard who was diagnosed with a brain tumor in February of 2014 and given nine months to live. She chose to move to Oregon and qualify through their Death with Dignity Law. She did secure the medicine to end her life and announced that she would end her life on November 1st (the announcement has been removed from the web since this was posted). Taking the medicine on her own is an important requirement of the law. Her symptoms and debilitation from her cancer were growing. Brittany was afraid to wait any longer for fear that she would not be able to take the medicine on her own because of the growing cancer in her brain. And indeed, she made the choice and died on November 1st.
Her mother has taken the courageous step of advocating that the California legislature pass a “Death with Dignity” bill. Her mother explains how Brittany was forced to establish residence in Oregon in order to qualify for this humanitarian program. It is a both heart breaking and inspiring presentation.
If you support this initiative, you can advocate for Death with Dignity in your state. Contact you senator and representative.
Dr Ira Byock, a well-known advocate for palliative care for the dying, has recently taken a strong position that it is time for citizens to begin to protest the failure to make death with dignity a central political theme for advocacy. I think his view reflects some of his frustration with the slow progress made by the medical profession thus far. He also voices a concern over the growing movement for assisted suicide an act he staunchly opposes.
It would be best if we didn’t need assisted suicide but the medical profession and medical schools have failed to focus on helping patients deal honestly and openly with impending death. Several recent books and articles have detailed horrific end of life experiences and advocated the need for change.
Buttressing this concern, a recent study found that the pain and suffering at end of life has actually gotten worse over the last ten years. If this is not a call to action, then what will it take?
Inadequate communication may be at the heart of the issue. Physicians vary in their ability to communicate about end of life and patients and their families are often no better as they are struggling with the emotion of losing a loved one. A recent PBS Frontline program entitled “Being Mortal” based on Atul Gawande’s recently published book of the same name addresses the difficulties doctors, patients, and families have in addressing this issue.
While it would be easy to blame physicians for not being a better communicators, medical schools often provide little to no training in communication. Instead, training focuses on scientific knowledge, research, technical methodological skill acquisition, and most importantly – preserving life. In watching Being Mortal, even the best efforts of doctors to communicate feelings lacked much depth and exploration.
An ideal would be a palliative care team that included social worker, family therapist, or psychologist – professionals better trained in communication skills – to assist doctors in interfacing with families when treatments fail and there appears to be little hope